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Objectives This randomized, parallel, single-blind clinical trial evaluated tooth sensitivity (TS), efficacy, gingival irritation (GI), aesthetic self-perception, and psychosocial impact of combined bleaching using in-office bleaching agents with different pHs. Materials and methods 160 participants were randomized into two groups ( n  = 80) with 35% hydrogen peroxide in-office bleaching gels: Whiteness HP Maxx (acidic, unstable pH) and Whiteness HP Automixx Plus (neutral, stable pH). In-office bleaching was performed in one session: HP Maxx (3 applications of 15 min) and HP Automixx Plus (1 application of 50 min). Both groups then received at-home bleaching with 10% carbamide peroxide for 4 h daily for two weeks. TS and GI were assessed using Visual Analogue Scales. Color change was measured with a spectrophotometer and color guides. Aesthetic self-perception and psychosocial impact were evaluated using three scales: Orofacial Aesthetics Scale, Oral Health Impact Profile, and Psychosocial Impact Questionnaire of Dental Aesthetics. Results The risk and intensity of TS significantly favored the neutral and stable pH gel for both in-office ( p  < 0.001) and combined treatments ( p  < 0.004). Both groups achieved significant whitening ( p  > 0.37). No difference in GI risk or intensity was found ( p  > 0.11). All aesthetic and psychosocial scales showed significant improvement post-treatment ( p  < 0.05). Conclusion Using a gel with neutral and stable pH during in-office bleaching reduces the risk and intensity of TS without compromising whitening efficacy. Clinical relevance Combining at-home and in-office bleaching with a neutral, stable gel reduces TS risk and intensity while ensuring optimal whitening results and patient comfort.

Objective This randomized clinical trial evaluated a copaiba oil-based gel in controlling dental sensitivity (DS) and color change after dental bleaching. Materials and methods Seventy-five volunteers were randomized into three groups ( n  = 25): GC (placebo gel – negative control); GKF2% (gel of 5% potassium nitrate and 2% sodium fluoride – positive control); and GCO (copaiba oil gel). Three bleaching sessions were performed using 35% hydrogen peroxide (HP 35%), with 7-day intervals. The desensitizing gels were applied for 10 min in each group. The DS was evaluated over 21 days using a visual analog scale (VAS). Color evaluation was done with a spectrophotometer before and after bleaching using the CIEDE2000. The DS was assessed between groups (Kruskal–Wallis test) and within groups (Friedman test). The color change was analyzed using one-way ANOVA and Tukey's test. Results GCO and GKF2% showed the lowest sensitivity values, with no significant difference ( p  < 0.05). In the intragroup analysis, GCO and GKF2% showed no differences across the three whitening sessions ( p  = 0.974, p  = 0.213, p  = 0.143, respectively). Conversely, GC exhibited an increase in DS after the last session ( p  = 0.035). All groups showed color change, without statistically significant differences between the groups ( p  = 0.725). Conclusion The copaiba gel reduced dental sensitivity after treatment with 35% hydrogen peroxide, without affecting the bleaching effectiveness. Clinical relevance The topical application of the experimental copaiba oil gel was effective in reducing dental sensitivity after bleaching with 35% hydrogen peroxide.

Objective To assess the bleaching efficacy, tooth sensitivity, enamel surface morphology, and oral health-related quality of life (OHRQoL) of two at-home bleaching products with matched effective hydrogen peroxide (HP) concentrations: Beyke iWhite (8% carbamide peroxide) and Invisalign (3% hydrogen peroxide). Materials and methods A randomized, triple-blind, split-mouth clinical trial was conducted with 22 participants undergoing a two-week bleaching treatment. The gel was used daily for 6–8 h. Tooth color and OHRQoL were assessed at baseline, post-bleaching, and 1-month follow-up. Tooth color was measured using a spectrophotometer (ΔE 00 ), while OHRQoL was evaluated using psychological questionnaires (OHIP and PIDAQ questionnaires). Daily tooth sensitivity reports were collected, and enamel morphology was analyzed using scanning electron microscopy. An in vitro experiment tracked the initial pH values of gels and their 8 h changes on bovine enamel. Statistical analysis included Wilcoxon Signed Rank tests for tooth sensitivity and questionnaires, paired t-tests for color change (ΔE 00 ), and ANOVA for pH changes. Results Both products presented effective color change (ΔE 00 = 5.39 ± 2.50 for 3% HP and ΔE 00 = 4.75 ± 2.25 for 8% CP) after two weeks, exceeding clinical acceptability thresholds (ΔE 00 >1.8). The 3% HP gel yielded a statistically greater color change than the 8% CP gel ( p < 0.05). The 8% CP gel induced statistically lower tooth sensitivity (NRS/VAS, p < 0.05), while both reported mild sensitivity (0 < NRS < 1.5, 0 < VAS < 3). OHRQoL improved significantly ( P < 0.05). Invisalign treatment led to more noticeable surface undulations than Beyke iWhite. The in vitro experiment indicated Beyke iWhite gel was initially alkaline, turning neutral, while Invisalign gel remained acidic. Conclusions Both products effectively whitened teeth while inducing mild tooth sensitivity, and both had a positive socio-psychological impact. The 3% HP gel provided a bleaching efficacy advantage, while the 8% CP gel demonstrated lower sensitivity and less enamel alteration. Clinical relevance Clinicians may consider at-home bleaching techniques with 3% HP and 8% CP to obtain effective bleaching results with slight side effects. Trial registration Chinese Clinical Trial Registry ChiCTR2400092807, 24/11/2024, Retrospectively registered.

Objective This clinical study evaluated an experimental pregabalin (PG) gel in reducing dental sensitivity (DS) and color change after dental bleaching. Materials and methods Seventy-five volunteers were selected and randomized into three groups: GPG (10% pregabalin gel), GKF (5% potassium nitrate and 2% sodium fluoride), and GP (placebo gel). Prior to the bleaching treatment, GPG and GKF received applications of the respective desensitizing gels for 10 min. The GP group received an application of placebo gel, similar to the other groups. The bleaching was performed with 35% hydrogen peroxide in 3 sessions, with a 7-day interval between sessions. Post-bleaching DS was assessed using the visual analog scale (VAS) over 21 days of follow-up. Color Assessment (ΔE00, ΔWID, and ΔEab) and luminosity (L) were measured at baseline (T0) and 7 days after the third session (T1). Friedman, Kruskal-Wallis, one-way ANOVA, and Tukey tests were used, with α = 5%. Results Intergroup analysis showed that on the 1st, 8th, and 15th days, DS was higher for GP ( p  < 0.006; p  = 0.004; p  < 0.001) and did not differ between GKF and GPG ( p  = 0.203; p  = 0.178; p  = 0.09). In the intragroup analysis, GP showed a significant increase in DS on the 15th day ( p  < 0.001). Conclusions The experimental 10% pregabalin gel reduced dental sensitivity and did not interfere with bleaching results. Clinical significance The topical application of 10% pregabalin gels and NKF was effective in reducing tooth sensitivity 24 hoursafter whitening with 35% hydrogen peroxide. Trial registration ClinicalTrials.gov trial registry with the identifier NCT06180707.

The purpose of this study is to evaluate the use of infrared photobiomodulation with low-level laser therapy (PBM) to reduce bleaching-induced tooth sensitivity (TS) after in-office bleaching. Eighty-three participants were randomized in blocks into two groups. In the experimental group, the patients received an application after each session of in-office bleaching (35% hydrogen peroxide, 1 × 50 min; 2 sessions with 1-week interval), while the laser application was simulated in the control group. The PBM system was operated in continuous mode, using 3 J of energy. A dose of 100 J/cm2 was applied for 30 s with 808 nm (100 mW of power) in the middle third of the crown. The risk and intensity of TS were recorded immediately after bleaching, 1 h, 24 h, and 48 h after each bleaching session, with a visual scale analog (0–10) and a five-point numerical scale (0–4). The color was recorded at the beginning, weekly, and 1 month after the end of the bleaching (VITA Classical, VITA Bleachedguide, and digital spectrophotometer). The risk of TS was 98% (95% CI 88 to 99%) for the laser group and 95% (95% CI 83 to 99%) for the control (RR = 1.03; 95% CI 0.94 to 1.12; p = 1.0). Similarly, no difference in the intensity of TS was detected for both pain scales (p > 0.65). Improvement in color change, regardless of the group, was observed (p > 0.15). The application of an PBM did not reduce the risk and intensity of TS when applied after the procedure using the parameters recommended by the manufacturer.Trial registration number and date of registration: RBR-4HCVSG—04/06/2019.

This study aimed to investigate the effect of low-level laser therapy (LLLT) on tooth sensitivity induced by in-office bleaching. Sixty-six patients enrolled in this randomized clinical trial. Following the in-office procedure with 40 % hydrogen peroxide, the participants were randomly divided into three groups. The patients in group 1 received irradiation from a low-level red laser (LLRL; 660 nm, 200 mW, 15 s, 12 J/cm 2 ), whereas participants in group 2 were subjected to a low-level infrared laser (LLIL; 810 nm) under similar conditions as in group 1. In group 3 (placebo), the laser treatment was the same as that in groups 1 and 2, but without energy output. The degree of tooth sensitivity was recorded at 1, 24, and 48 h after bleaching using a visual analog scale (VAS). The change in tooth shade was measured 30 days after tooth whitening. The intensity of tooth sensitivity was not significantly different between groups at 1 h after bleaching ( p  > 0.05). At 24 h after therapy, pain level was significantly lower in the LLIL group compared to the LLRL and placebo groups ( p  < 0.05). At 48 h after bleaching, VAS scores in the LLIL and LLRL groups were comparable to each other ( p  > 0.05) and both were significantly lower than that of the placebo group ( p  < 0.05). There was no significant difference in the efficacy of tooth whitening among groups ( p  > 0.05). LLLT with an infrared diode laser could be recommended as a suitable strategy to reduce the intensity of tooth sensitivity after in-office bleaching.

ObjectivesThis study aims to evaluate the color change and tooth sensitivity (TS) caused by at-home bleaching in patients with sound and with restored teeth.MethodsForty patients were selected according to the inclusion and exclusion criteria and divided into two groups: So (patients with six caries-free maxillary anterior teeth) and Re (patients with at least one restoration in the six maxillary anterior teeth). Both groups were bleached with 10% carbamide peroxide (CP) at-home bleaching. The color change (CIELab [ΔE*ab], CIEDE00 [ΔE00], and whiteness index [∆WID]) were assessed using a spectrophotometer at baseline, 2 weeks, and 1 and 3 months after bleaching. Patients recorded their TS using a numeric rating scale (0–4). Data of color change were submitted to Student’s T-test. The absolute risk and intensity of TS were compared using Fisher’s and the Mann–Whitney tests, respectively (α = 0.05).ResultsHigher ΔE*ab, ΔE00, and ∆WID values were observed for So in relation to Re after all recall rate (p < 0.0001). No significant differences were observed regarding of bleaching-induced TS (p > 0.9).ConclusionsAt-home dental bleaching with 10% CP generated the same pattern of TS in patients with or without restorations. However, in patients with restored teeth, it produced a lower color change after 2 weeks of bleaching.Clinical significanceAfter 2 weeks of at-home bleaching, a lower whitening effect was observed in patients with anterior restorations when compared with patients with sound teeth.Trial registrationClinicalTrials.gov identifier RBR-52j6gmg

Background Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort. Objective This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort. Methods Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05). Results Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall). Conclusions This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality. Clinical trial registration The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.

Objectives This study aimed to evaluate the efficacy of a 1% ibuprofen nanostructured topical gel in controlling in-office bleaching sensitivity (BS) and its impact on tooth color change. Methods A randomized, controlled, triple-blind, split-mouth clinical trial was conducted with 40 participants. The nanostructured ibuprofen gel (I) and placebo (P) were applied for 10 min before and after bleaching (35% hydrogen peroxide; 1 × 50 min; two sessions, one week apart) on each hemi-arch, randomly assigned. Bleaching sensitivity (BS) was assessed using the Visual Analog Scale (VAS), calculating absolute risk, relative risk, and BS intensity. The color change was measured subjectively with the Vitapan Classical ® shade guide (ΔSGU) and objectively with the EasyShade ® spectrophotometer (ΔE, ΔE00, ΔWID). Statistical analyses were performed using the paired t-test, Wilcoxon, and McNemar tests ( p  < 0.05). Results No statistically significant differences were found between I and P for absolute risk of BS (80% vs. 77%) or BS intensity at 1 h (0.6 vs. 0.8), 24 h (0.2 vs. 0.1), or 48 h (0.0 vs. 0.0). BS intensity was low to moderate. The color change was also statistically similar between groups: ΔE (12.81 ± 4.68 vs. 12.65 ± 5.32), ΔE00 (8.50 ± 3.71 vs. 8.52 ± 4.03), ΔWID (8.06 ± 7.55 vs. 8.34 ± 6.90), and ΔSGU (7.42 ± 2.94 for both). Conclusion The novel 1% ibuprofen nanostructured topical gel was ineffective in reducing BS and did not affect tooth color change. Clinical relevance The 1% ibuprofen nanostructured topical gel did not interfere with tooth color change but was ineffective in reducing the risk or intensity of in-office bleaching sensitivity. Although the formulation yielded positive results in a previous animal study, these outcomes were not replicated in humans, underscoring the need for clinical trials to confirm the efficacy of any approach for managing bleaching sensitivity, even if successful in animal models. Clinical trial registration number RBR-4ng46xj.

Key Points Considers the benefits of home bleaching as part of a patient's overall treatment plan. Describes the innovative use of a practice-based research project to answer a commonly asked question with respect to bleaching tray design. Discusses various bleaching tray designs and their indications. Aim This study aimed to compare the effect of extended margin and conventional bleaching trays on tooth bleaching and tooth sensitivity. Method and methods Twenty subjects (18–56 years) were investigated in a split arch design clinical study that was conducted in a general dental practice. Each subject received a custom made bleaching tray and 10% carbamide peroxide gel. The bleaching trays had the borders extended 5 mm beyond the gingival margins on the right side and finished just at the gingival margin on the left side. Shade change and tooth sensitivity were the primary outcomes studied and analysed in this study. The shade of the six upper and lower anterior teeth was assessed using a value-ordered shade guide before, one week and two weeks after treatment. Sensitivity was self-assessed using a visual analogue scale (VAS) at the end of the first and second weeks of the study. Results At the end of week two, the mean shade change was 5.01 (± 3.37) and 5.10 (± 3.36) for teeth covered by extended and non-extended tray design, respectively. The mean VAS sensitivity scores for teeth covered by extended and non-extended tray design were 0.96 (± 1.39) and 0.66 (± 0.96), respectively. There was no significant statistical difference between the two designs at any assessment point with regard to shade change and sensitivity (p >0.05). Conclusions It can be concluded that an extended tray design confers no superior effect in terms of the whitening outcome achieved or in reducing levels of sensitivity. Thus, both tray designs can be used depending on a dentist's personal preference.