At-home, in-office and combined dental bleaching techniques using hydrogen peroxide: Randomized clinical trial evaluation of effectiveness, clinical parameters and enamel mineral content.

Purpose: To conduct a clinical evaluation of dental bleaching techniques using hydrogen peroxide (HP), regarding tooth sensitivity, gingival irritation, subject's perception of color change, and calcium (Ca) and phosphorous (P) concentrations in enamel.

Methods: 75 volunteers were distributed according to the bleaching technique (n=25): (a) at-home: 10%HP (Opalescence GO) for 15 days of continuous use (1 hour per day); (b) in-office: 40%HP (Opalescence Boost) in three clinical sessions (40 minutes each session); (c) combined: one initial session with 40%HP, and the rest with 10%HP for 15 days of continuous use. Clinical evaluations and Ca and P concentration collections were obtained before, during bleaching treatment, and 15 days after conclusion of treatment. The generalized linear models were used to evaluate the data for VITA Classical scale, CIELAB, tooth sensitivity, degree of acceptability of the technique, Ca and P concentrations and to determine the ΔE variables and color change perception. Gingival irritation was analyzed by Fisher's Exact test. The total frequencies for each time interval (regardless of bleaching technique) were compared at 50% by the chi-square test.

Results: The in-office technique presented the lowest tooth sensitivity, but all techniques caused an increase in sensitivity over time (P< 0.0001). All techniques resulted in lower Ca and P concentrations in enamel at each time point, compared with the baseline concentrations. Calcium concentrations did not differ significantly among the treatments (P= 0.9360). Phosphorus concentration at the 8th day was higher for the in-office technique group (P< 0.05). All the bleaching techniques were effective in altering color, with ΔE values higher than 3.3, without any significant differences (P= 0.3255). Higher occurrence of gingival irritation was observed for at-home and combined techniques. The combined technique seemed to promote a color change faster than the other techniques.

Clinical Significance: All the dental bleaching techniques proved equally effective in promoting tooth color change. These techniques may reduce calcium and phosphorous content in enamel. The at-home and the combined techniques may cause greater dental sensitivity than the in-office technique, and led to a higher prevalence of gingival irritation.