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Clinical Oral Investigations

, Volume 23, Issue 10, pp 3673–3689 | Cite as

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis

  • Andres Felipe Millan Cardenas
  • Bianca Medeiros Maran
  • Lucila Cristina Rodrigues Araújo
  • Fabiana Suelen Figuerêdo de Siqueira
  • Letícia Maíra Wambier
  • Carla Castiglia Gonzaga
  • Alessandro D. LoguercioEmail author
  • Alessandra Reis
Review

Abstract

Objectives

A systematic review and meta-analysis were performed to answer this research question: “Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?”

Material and methods

Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran’s Q test and I2 statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019).

Results

Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses.

Conclusion

Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes.

Clinical relevance

If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

Keywords

Tooth bleaching agents Tooth discolorations Dentin sensitivity Systematic review Meta-analysis 

Notes

Acknowledgments

This study was developed by Andres Felipe Millan Cardenas, Bianca Medeiros Maran, Lucila Cristina Rodrigues Araújo, Fabiana Suelen Figuerêdo de Siqueira, Letícia Maíra Wambier, and Carla Castiglia Gonzaga under the supervision of Profs. Alessandro Loguercio and Alessandra Reis. The authors would like to thank Prof. Ana Armas-Vega during the review process of meta-analysis.

Funding

This study was partially supported by National Council for Scientific and Technological Development from the Brazilian Government, under grants 303332/2017-4 and 305588/2014-1 and the Coordination of Improvement of Higher Level Personnel (CAPES) from the Brazilian Ministry of Education.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Andres Felipe Millan Cardenas
    • 1
  • Bianca Medeiros Maran
    • 2
    • 3
  • Lucila Cristina Rodrigues Araújo
    • 1
  • Fabiana Suelen Figuerêdo de Siqueira
    • 1
  • Letícia Maíra Wambier
    • 4
  • Carla Castiglia Gonzaga
    • 4
  • Alessandro D. Loguercio
    • 5
    • 6
    Email author
  • Alessandra Reis
    • 5
  1. 1.Postgraduate Program in DentistryCEUMA UniversitySão LuisBrazil
  2. 2.Department of Restorative DentistryState University of Western ParanáCascavelBrazil
  3. 3.Postgraduate Program in Dentistry, School of DentistryNorth Paraná UniversityLondrinaBrazil
  4. 4.Graduate Program in DentistryPositivo UniversityCuritibaBrazil
  5. 5.Department of Restorative DentistryState University of Ponta GrossaPonta GrossaBrazil
  6. 6.Escuela de la Salud Eugenio EspejoUniversidad UTEQuitoEcuador

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