Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

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 PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019).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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Sarrett DC (2002) Tooth whitening today. J Am Dent Assoc 133:1535–1538 quiz 1541

    Article  PubMed  Google Scholar 

  2. Joiner A (2006) The bleaching of teeth: a review of the literature. J Dent 34:412–419. https://doi.org/10.1016/j.jdent.2006.02.002

    Article  PubMed  Google Scholar 

  3. Auschill TM, Hellwig E, Schmidale S, Sculean A, Arweiler NB (2005) Efficacy, side-effects and patients’ acceptance of different bleaching techniques (OTC, in-office, at-home). Oper Dent 30(2):156–163. https://doi.org/10.2341/1559-2863-30-2-1

    Article  PubMed  Google Scholar 

  4. Meireles SS, Goettems ML, Dantas RV, Bona ÁD, Santos IS, Demarco FF (2014) Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial. J Dent 42(2):114–121. https://doi.org/10.1016/j.jdent.2013.11.022

    Article  PubMed  Google Scholar 

  5. Samorodnitzky-Naveh GR, Grossmann Y, Bachner YG, Levin L (2010) Patients’ self-perception of tooth shade in relation to professionally objective evaluation. Quintessence Int 41:E80–E83

    PubMed  Google Scholar 

  6. Haywood VB, Leonard RH, Nelson CF, Brunson WD (1994) Effectiveness, side effects and long-term status of nightguard vital bleaching. J Am Dent Assoc 125:1219–1226

    Article  PubMed  Google Scholar 

  7. Dahl JE, Pallesen U (2003) Tooth bleaching - a critical review of the biological aspects. Crit Rev Oral Biol Med 14:292–304

    Article  PubMed  Google Scholar 

  8. Gallagher A, Maggio B, Bowman J, Borden L, Mason S, Felix H (2002) Clinical study to compare two in-office (chairside) whitening systems. J Clin Dent 13:219–224

    PubMed  Google Scholar 

  9. Gurgan S, Cakir FY, Yazici E (2010) Different light-activated in-office bleaching systems: a clinical evaluation. Lasers Med Sci 25:817–822. https://doi.org/10.1007/s10103-009-0688-x

    Article  PubMed  Google Scholar 

  10. Wetter NU, Branco EP, Deana AM, Pelino JE (2009) Color differences of canines and incisors in a comparative long-term clinical trial of three bleaching systems. Lasers Med Sci 24:941–947

    Article  PubMed  Google Scholar 

  11. Rezende M, Siqueira SH, Kossatz S (2014) Clareamento dental - efeito da técnica sobre a sensibilidade dental e efetividade (Dental bleaching - technique effect on dental sensivity and effectiveness). Rev Assoc Paul Cir Dent 68:208–212

    Google Scholar 

  12. Mena-Serrano AP, Parreiras SO, do Nascimento EM, Borges CP, Berger SB, Loguercio AD, Reis A (2015) Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber. Oper Dent 40:E76–E82. https://doi.org/10.2341/13-352-L

    Article  PubMed  Google Scholar 

  13. Soares DG, Basso FG, Hebling J, de Souza Costa CA (2015) Immediate and late analysis of dental pulp stem cells viability after indirect exposition to alternative in-office bleaching strategies. Clin Oral Investig 19:1013–1020. https://doi.org/10.1007/s00784-014-1321-3

    Article  PubMed  Google Scholar 

  14. de Almeida LC, Soares DG, Gallinari MO, de Souza Costa CA, Dos Santos PH, Briso AL (2015) Color alteration, hydrogen peroxide diffusion, and cytotoxicity caused by in-office bleaching protocols. Clin Oral Investig 19:673–680. https://doi.org/10.1007/s00784-014-1285-3

    Article  PubMed  Google Scholar 

  15. Rezende M, Chemin K, Vaez SC, Peixoto AC, de Freitas RJ, Braga SSL, Faria-e-Silva AL, da Silva GR, Soares CJ, Loguercio AD (2018) Effect of topical application of dipyrone on dental sensitivity reduction after in-office dental bleaching: a randomized, triple-blind multicenter clinical trial. J Am Dent Assoc 149(5):363–371. https://doi.org/10.1016/j.adaj.2017.11.003

    Article  PubMed  Google Scholar 

  16. Dawson PF, Sharif MO, Smith AB, Brunton PA (2011) A clinical study comparing the efficacy and sensitivity of home vs combined whitening. Oper Dent 36(5):460–466. https://doi.org/10.2341/10-159-C

    Article  PubMed  Google Scholar 

  17. Deliperi S, Bardwell DN, Papathanasiou A (2004) Clinical evaluation of a combined in-office and take-home bleaching system. J Am Dent Assoc 135:628–634

    Article  PubMed  Google Scholar 

  18. Matis BA, Cochran MA, Wang G, Eckert GJ (2009) A clinical evaluation of two in-office bleaching regimens with and without tray bleaching. Oper Dent 34:142–149. https://doi.org/10.2341/08-64

    Article  PubMed  Google Scholar 

  19. Buchalla W, Attin T (2007) External bleaching therapy with activation by heat, light or laser--a systematic review. Dent Mater 23:586–596. https://doi.org/10.1016/j.dental.2006.03.018

    Article  PubMed  Google Scholar 

  20. Rezende M, Ferri L, Kossatz S, Loguercio AD, Reis A (2016) Combined bleaching technique using low and high hydrogen peroxide in-office bleaching gel. Oper Dent 41:388–396. https://doi.org/10.2341/15-266-c

    Article  PubMed  Google Scholar 

  21. Bernardon JK, Sartori N, Ballarin A, Perdigao J, Lopes G, Baratieri LN (2010) Clinical performance of vital bleaching techniques. Oper Dent 35:3–10. https://doi.org/10.2341/09-008cr

    Article  PubMed  Google Scholar 

  22. Kugel G, Perry RD, Hoang E, Scherer W (1997) Effective tooth bleaching in 5 days: using a combined in-office and at-home bleaching system. Compend Contin Educ Dent 18(378):380–373

    Google Scholar 

  23. Zhao K, Zong L, Zhang Q, Att W (2013) Clinical comparison between two bleaching techniques: a 180-day follow-up study. Quintessence Int 44(8):601–607. https://doi.org/10.3290/j.qi.a29702

    Article  PubMed  Google Scholar 

  24. Radz G (2014) Effectiveness of a combined in-office and take-home whitening system for teeth shades A3. 5 to A4. Compend Contin Educ Dent 35:696–700

    PubMed  Google Scholar 

  25. Paula E, Kossatz S, Fernandes D, Loguercio A, Reis A (2013) The effect of perioperative ibuprofen use on tooth sensitivity caused by in-office bleaching. Oper Dent 38:601–608. https://doi.org/10.2341/12-107-c

    Article  PubMed  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341. https://doi.org/10.1016/j.ijsu.2010.02.007

    Article  PubMed  Google Scholar 

  27. Coban A, Can E, Soyman M (2011) Clinical evaluation of in office at home and combined bleaching. Paper presented at the IADR/AADR/CADR 89th General Session, San Diego, California

  28. Machado LS, Anchieta RB, dos Santos PH, Briso AL, Tovar N, Janal MN, Coelho PG, Sundfeld RH (2016) Clinical comparison of at-home and in-office dental bleaching procedures: a randomized trial of a split-mouth design. Int J Periodontics Restorative Dent 36:251–260. https://doi.org/10.11607/prd.2383

    Article  PubMed  Google Scholar 

  29. Rodrigues JL, Rocha PS, Pardim SLS, Machado ACV, Faria-e-Silva AL, Seraidarian PI (2018) Association between in-office and at-home tooth bleaching: a single blind randomized clinical trial. Braz Dent J 29:133–139

    Article  PubMed  Google Scholar 

  30. Vochikovski L (2018) Sensibilidade dental e efetividade de um novo protocolo de aplicação da técnica de clareamento associado com aplicação de dessensibilizante. Dissertation, State University of Ponta Grossa, Ponta Grossa

  31. de Souza Costa CA, Riehl H, Kina JF, Sacono NT, Hebling J (2010) Human pulp responses to in-office tooth bleaching. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:e59–e64

    Article  Google Scholar 

  32. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  33. Franz-Montan M, Ramacciato JC, Rodrigues JA, Marchi GM, Rosalen PL, Groppo FC (2009) The effect of combined bleaching techniques on oral microbiota. Indian J Dent Res 20:304–307. https://doi.org/10.4103/0970-9290.57367

    Article  PubMed  Google Scholar 

  34. Dias KRHC, Lima JP, Silva TM, Monte Alto RV, Oliveira Jr OB (2012) Evaluation of efficacy of three tooth bleaching technique. Paper presented at the IADR/AADR/CADR 89th General Session, San Diego, California

  35. Lima JP (2012) Avaliação clínico visual de três técnicas de clareamento dental. Universidade do Estado do Rio de Janeiro

  36. Ma J, Liu W, Hunter A, Zhang W (2008) Performing meta-analysis with incomplete statistical information in clinical trials. BMC 8:56. https://doi.org/10.1186/1471-2288-8-56

    Article  Google Scholar 

  37. Higgins J, Green S (2010) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration. http://handbook.cochrane.org/. Accessed June 2019

  38. Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC (2014) How to write a systematic review. Am J Sports Med 42:2761–2768. https://doi.org/10.1177/0363546513497567

    Article  PubMed  Google Scholar 

  39. Loguercio AD, Maran BM, Hanzen TA, Paula AMd, Perdigão J, Reis A (2017) Randomized clinical trials of dental bleaching – compliance with the CONSORT Statement: a systematic review. Braz Oral Res 31. https://doi.org/10.1590/1807-3107bor-2017.vol31.0060

  40. Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412

    Article  PubMed  Google Scholar 

  41. da Costa JB, McPharlin R, Paravina RD, Ferracane JL (2010) Comparison of at-home and in-office tooth whitening using a novel shade guide. Oper Dent 35:381–388. https://doi.org/10.2341/09-344-C

    Article  PubMed  Google Scholar 

  42. Giachetti L, Bertini F, Bambi C, Nieri M, Scaminaci Russo D (2010) A randomized clinical trial comparing at-home and in-office tooth whitening techniques: a nine-month follow-up. J Am Dent Assoc 141:1357–1364

    Article  PubMed  Google Scholar 

  43. Moghadam FV, Majidinia S, Chasteen J, Ghavamnasiri M (2013) The degree of color change, rebound effect and sensitivity of bleached teeth associated with at-home and power bleaching techniques: a randomized clinical trial. Eur J Dent 7:405–411. https://doi.org/10.4103/1305-7456.120655

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pintado-Palomino K, Peitl Filho O, Zanotto ED, Tirapelli C (2015) A clinical, randomized, controlled study on the use of desensitizing agents during tooth bleaching. J Dent 43:1099–1105. https://doi.org/10.1016/j.jdent.2015.07.002

    Article  PubMed  Google Scholar 

  45. Kose C, Calixto AL, Bauer JR, Reis A, Loguercio AD (2016) Comparison of the effects of in-office bleaching times on whitening and tooth sensitivity: a single blind, randomized clinical trial. Oper Dent 41:138–145. https://doi.org/10.2341/15-085-C

    Article  PubMed  Google Scholar 

  46. Browning WD (2003) Use of shade guides for color measurement in tooth-bleaching studies. J Esthet Restor Dent 15:S13–S20

    Article  PubMed  Google Scholar 

  47. Kihn PW, Barnes DM, Romberg E, Peterson K (2000) A clinical evaluation of 10 percent vs. 15 percent carbamide peroxide tooth-whitening agents. J Am Dent Assoc 131:1478–1484

    Article  PubMed  Google Scholar 

  48. Chemin K, Rezende M, Loguercio AD, Reis A, Kossatz S (2018) Effectiveness of and dental sensitivity to at-home bleaching with 4% and 10% hydrogen peroxide: a randomized, triple-blind clinical trial. Oper Dent 43:232–240. https://doi.org/10.2341/16-260-C

    Article  PubMed  Google Scholar 

  49. Leonard RH Jr, Garland GE, Eagle JC, Caplan DJ (2002) Safety issues when using a 16% carbamide peroxide whitening solution. J Esthet Restor Dent 14:358–367

    Article  PubMed  Google Scholar 

  50. Matis BA, Mousa HN, Cochran MA, Eckert GJ (2000) Clinical evaluation of bleaching agents of different concentrations. Quintessence Int 31:303–310

    PubMed  Google Scholar 

  51. Luque-Martinez I, Reis A, Schroeder M, Munoz MA, Loguercio AD, Masterson D, Maia LC (2016) Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis. Clin Oral Investig 20:1419–1433. https://doi.org/10.1007/s00784-016-1863-7

    Article  PubMed  Google Scholar 

  52. Matis B (2000) Degradation of gel in tray whitening. Compend Contin Educ Dent Suppl S28:S31–S25 quiz S49

    Google Scholar 

  53. Al-Qunaian T, Matis B, Cochran M (2003) In vivo kinetics of bleaching gel with three-percent hydrogen peroxide within the first hour. Oper Dent 28:236–241. https://doi.org/10.2341/1559-2863-28-3-1

    Article  PubMed  Google Scholar 

  54. Matis B, Yousef M, Cochran M, Eckert G (2002) Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration. Oper Dent 27:12–18. https://doi.org/10.2341/1559-2863-27-1-1

    Article  PubMed  Google Scholar 

  55. Wang Y, Gao J, Jiang T, Liang S, Zhou Y, Matis BA (2015) Evaluation of the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment - a systematic review and meta-analysis. J Dent 43:913–923. https://doi.org/10.1016/j.jdent.2015.03.015

    Article  PubMed  Google Scholar 

  56. Cook S, McCleskey E (2002) Cell damage excites nociceptors through release of cytosolic ATP. Pain 95:41–47

    Article  PubMed  Google Scholar 

  57. Rezende M, Loguercio AD, Kossatz S, Reis A (2016) Predictive factors on the efficacy and risk/intensity of tooth sensitivity of dental bleaching: a multi regression and logistic analysis. J Dent 45:1–6. https://doi.org/10.1016/j.jdent.2015.11.003

    Article  PubMed  Google Scholar 

  58. Krause F, Jepsen S, Braun A (2008) Subjective intensities of pain and contentment with treatment outcomes during tray bleaching of vital teeth employing different carbamide peroxide concentrations. Quintessence Int 39:203–209

    PubMed  Google Scholar 

  59. Kose C, Reis A, Baratieri LN, Loguercio AD (2011) Clinical effects of at-home bleaching along with desensitizing agent application. Am J Dent 24(6):379–382

    PubMed  Google Scholar 

  60. Meireles SS, Heckmann SS, Santos IS, Della Bona A, Demarco FF (2008) A double blind randomized clinical trial of at-home tooth bleaching using two carbamide peroxide concentrations: 6-month follow-up. J Dent 36:878–884. https://doi.org/10.1016/j.jdent.2008.07.002

    Article  PubMed  Google Scholar 

  61. Charakorn P, Cabanilla L, Wagner W, Foong W, Shaheen J, Pregitzer R, Schneider D (2009) The effect of preoperative ibuprofen on tooth sensitivity caused by in-office bleaching. Oper Dent 34:131–135. https://doi.org/10.2341/08-33

    Article  PubMed  Google Scholar 

  62. Marson FC, Sensi LG, Vieira LCC, Araujo E (2008) Clinical evaluation of in-off ice dental bleaching treatments with and without the use of light-activation sources. Oper Dent 33:15–22. https://doi.org/10.2341/07-57

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Postgraduate Program in Dentistry, CEUMA University, Rua Josué Montello 1 – Renascença II, São Luis, MA, 650575-120, Brazil

    Andres Felipe Millan Cardenas, Lucila Cristina Rodrigues Araújo & Fabiana Suelen Figuerêdo de Siqueira

  2. Department of Restorative Dentistry, State University of Western Paraná, Rua Engenharia, 464 – Universitário, Cascavel, Paraná, 85819-190, Brazil

    Bianca Medeiros Maran

  3. Postgraduate Program in Dentistry, School of Dentistry, North Paraná University, Londrina, Paraná, Brazil

    Bianca Medeiros Maran

  4. Graduate Program in Dentistry, Positivo University, Rua Prof. Pedro Viriato Parigot de Souza 5300 –Prédio da Pós-Graduação, Curitiba, PR, 81280-330, Brazil

    Letícia Maíra Wambier & Carla Castiglia Gonzaga

  5. Department of Restorative Dentistry, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, BlocoM, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, 84030-900, Brazil

    Alessandro D. Loguercio & Alessandra Reis

  6. Escuela de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador

    Alessandro D. Loguercio

Authors
  1. Andres Felipe Millan Cardenas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bianca Medeiros Maran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucila Cristina Rodrigues Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabiana Suelen Figuerêdo de Siqueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Letícia Maíra Wambier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carla Castiglia Gonzaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandro D. Loguercio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alessandra Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro D. Loguercio.

Ethics declarations

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.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cardenas, A.F.M., Maran, B.M., Araújo, L.C.R. et al. Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis. Clin Oral Invest 23, 3673–3689 (2019). https://doi.org/10.1007/s00784-019-03042-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-019-03042-4

Keywords

Search

Navigation