In-office dental bleaching with light vs. without light: A systematic review and meta-analysis

Abstract

Objective

A systematic review and meta-analysis were performed to answer the following research question: Does light-activated in-office vital bleaching have a greater whitening efficacy and higher tooth sensitivity (TS) in comparison with in-office vital bleaching without light when used in adults?

Data and source

Only randomized clinical trials (RCTs) involving adults who had in-office bleaching with and without light activation were included. Controlled vocabulary and keywords were used in a comprehensive search for titles and abstracts in PubMed, and this search was adapted for Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without restrictions in May 2016 and was updated in August 2017. IADR abstracts (1990–2016), unpublished- and ongoing-trial registries, dissertations, and theses were also searched. The risk-of-bias tool of the Cochrane Collaboration was used for quality assessment. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development, and Evaluation approach. Through the use of the random effects model, a meta-analysis with a subgroup analysis (low and high hydrogen peroxide concentration) was conducted for color change (ΔE*, ΔSGU) as well as the risk and intensity of TS.

Study selection

We retrieved 6663 articles, but after removing duplicates and non-relevant articles, only 21 RCTs remained. No significant difference in ΔE*, ΔSGU, and risk and intensity of TS was observed (p > .05). For ΔE and risk of TS, the quality of the evidence was graded as moderate whereas the evidence for ΔSGU and intensity of TS was graded as very low and low, respectively.

Conclusion

Without considering variations in the protocols, the activation of in-office bleaching gel with light does not seem to improve color change or affect tooth sensitivity, regardless of the hydrogen peroxide concentration. (PROSPERO − CRD42016037630).

Clinical relevance

Although it is commercially claimed that in-office bleaching associated with light improves and accelerates color change, this study did not confirm this belief for in-office bleaching gels with either high or low levels of hydrogen peroxide.

Introduction

The heightened focus on aesthetics is evidenced by the patients’ increased demands to improve the appearance of their teeth. Within this context, changes in the smile play a significant role [ ]. One of the most popular cosmetic procedures is tooth whitening, a technically easier and lower-cost procedure compared to veneers. Also, it is a very conservative method for treating dental discoloration [ ]. Usually, dental vital bleaching is categorized as an in-office (professionally administered), an at-home (professionally dispensed) or an over-the-counter (self-administered) procedure that uses products based on hydrogen peroxide (HP) or carbamide peroxide [ ].

Of the three bleaching techniques, the in-office one entails direct professional supervision to avoid soft-tissue exposure and gel ingestion, reduce treatment time, and yield a rapid whitening result [ ]. There are many in-office bleaching products on the market whose manufacturers require catalytic decomposition by heat or light [ ]. Different types of light-activating sources—such as lasers, light-emitting diodes (LEDs), plasma arc lamps (PAC), and halogen lamps—can be used [ ]. The theoretical advantage of a light source is its ability to heat the HP, increasing the HP’s decomposition rate in free radicals for the oxidization of complex organic molecules [ ].

Despite the marketing claim of improved whitening from light-activated bleaching, this association has been questioned [ ], as many randomized clinical trials (RCTs) have been controversy on this issue [ ]. Additionally, some studies reported that the use of light may promote increased tooth sensitivity (TS) due to the release of more free radicals that reach the pulp [ ].

He et al.’s earlier systematic review of the literature [ ] showed that the association with light is not required for high-concentrate bleaching gels, but the same conclusion could not be reached for low-concentrate bleaching gels due to the small number of RCTs that compared light-activated systems with non-light systems. Since the publication of this previous systematic review, new RCTs comparing color change as well as the risk and intensity of TS in bleaching protocols with and without light activation have been published [ ].

Therefore, the purpose of this systematic review of the literature was to update the prior systematic review and establish whether there are evidence-based differences in the bleaching efficacy and TS of bleaching protocols performed with and without light using low and high HP concentrations. To this end, the following Population, Intervention, Comparison, and Outcome (PICO) question was answered: Does light-activated in-office vital bleaching have a greater whitening efficacy in comparison to in-office vital bleaching without light association when used in adults?

Materials and methods

Protocol and registration

This study’s protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO – CRD42016037630) and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reports [ ].

Information sources and search strategy

The controlled vocabulary (MeSH terms) and free keywords in the search strategy were defined based on the following PICO categories:

  • 1.

    Population (P): adult patients who underwent vital tooth bleaching;

  • 2.

    Intervention (I): in-office bleaching with light;

  • 3.

    Comparison (C): in-office bleaching without light;

  • 4.

    The outcome (O): color change in shade guide units (ΔSGU) and per a spectrophotometer (ΔE*) as well as the risk and intensity of TS taken after dental bleaching;

  • 5.

    Study design (S): RCTs.

Electronic databases (MEDLINE via PubMed, Cochrane Library, Brazilian Library in Dentistry, and Latin American and Caribbean Health Sciences Literature database [LILACS]) and citation databases (Scopus and Web of Science) were searched ( Table 1 ). The reference lists of all primary studies were manually searched for additional relevant publications. We also searched the related article links of each primary study in the PubMed database without restrictions on publication date or Latin-based languages.

Table 1
Electronic database and search strategy.
PUBMED (12/May/2016 updated in 09/Aug/2017)
#1 (((((((((((((((((((tooth discoloration[MeSH Terms]) OR dentition, permanent[MeSH Terms]) OR color[MeSH Terms]) OR color[Title/Abstract]) OR color[Title/Abstract]) OR “tooth discoloration”[Title/Abstract]) OR “tooth discolouration”[Title/Abstract]) OR “teeth discoloration”[Title/Abstract]) OR “teeth discolouration”[Title/Abstract]) OR “discoloured tooth”[Title/Abstract]) OR “discoloured teeth”[Title/Abstract]) OR “discoloured tooth”[Title/Abstract]) OR “discoloured teeth”[Title/Abstract]) OR “tooth staining”[Title/Abstract]) OR “teeth staining”[Title/Abstract]) OR “dental discoloration”[Title/Abstract]) OR “dental discolouration”[Title/Abstract]) OR “stained teeth”[Title/Abstract]) OR “stained tooth”[Title/Abstract]) OR “dental staining”[Title/Abstract] #2 (((((((((((((((((tooth bleaching[MeSH Terms]) OR peroxides[MeSH Terms]) OR tooth bleaching agents[MeSH Terms]) OR hydrogen peroxide[MeSH Terms]) OR carbamide peroxide[Supplementary Concept]) OR light[MeSH Terms]) OR lasers[MeSH Terms]) OR bleaching[Title/Abstract]) OR whitening[Title/Abstract]) OR “hydrogen peroxide”[Title/Abstract]) OR “carbamide peroxide”[Title/Abstract]) OR “in office”[Title/Abstract]) OR “light activation”[Title/Abstract]) OR heat[Title/Abstract]) OR ultraviolet[Title/Abstract]) OR lamp[Title/Abstract]) OR “light activated”[Title/Abstract]) OR LED[Title/Abstract] #3 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (“clinical trial”[tw]) OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR (placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR comparative study[pt] OR evaluation studies as topic[mh] OR follow-up studies[mh] OR prospective studies[mh] OR control*[tw] OR prospective*[tw] OR volunteer*[tw]) NOT (animals[mh] NOT humans[mh])
#1 AND #2 AND 3

Additionally, gray literature was investigated by searching the abstracts of the annual conference of the International Association for Dental Research and its regional divisions (1990–2016), the database System for Information on Grey Literature in Europe, and dissertations and theses using the ProQuest Dissertations and Theses full-text database as well as the Periódicos Capes Theses database.

To locate unpublished and ongoing trials related to the review question, clinical-trial registries were searched: Current Controlled Trials ( www.controlled-trials.com ), International Clinical Trials Registry Platform ( apps.who.int/trialsearch/ ), ClinicalTrials.gov ( www.clinicaltrials.gov ), Rebec ( www.rebec.gov.br ), and EU Clinical Trials Register ( www.clinicaltrialsregister.eu ).

Eligibility criteria

We included parallel and split-mouth RCTs that compared in-office dental bleaching with and without light in adult patients of any age group. RCTs were excluded if 1) the studies compared only different light-activated in-office bleaching treatments and 2) the studies compared in-office dental bleaching with combined bleaching (at-home bleaching with jump-start in-office bleaching).

Study selection and data collection process

Initially, the articles were selected by title and abstract in accordance with the previously described search strategy. Articles that appeared in more than one database were considered only once. Full-text articles were also obtained when the title and abstract presented insufficient information to make a clear decision. Subsequently, three reviewers classified those that met the inclusion criteria. Each eligible article received a study ID, combining the first author and year of publication.

Relevant information about the study design, participants, interventions, and outcomes was extracted independently through customized extraction forms by three authors; in cases of disagreement, a decision was reached by consensus. If there were multiple reports of the same study (i.e., reports with different follow-ups), data from all reports were extracted directly into a single data-collection form to avoid overlapping data. When data were not reported in the studies, authors were contacted by e-mail at least twice to request the missing information.

Concerning immediate color change, results from 1 week to 1 month post bleaching, depending on what the authors reported, were extracted. Regarding TS, the data from the most immediate period were collected.

Risk of bias in individual studies

Quality assessments of the selected trials were carried out by three independent reviewers using the Cochrane Collaboration tool for assessing the risk of bias in RCTs [ ]. The assessment criteria contained six items: sequence generation, allocation concealment, blinding of the outcome assessors, incomplete outcome data, selective outcome reporting, and other possible sources of bias. During data selection and quality assessment, any disagreements between the reviewers were solved through discussion, and if needed, consultation with a fourth reviewer (A.R.).

For each aspect of the quality assessment, the risk of bias was scored following the recommendations in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 ( ). Each domain level was judged as having a low, high, or unclear risk of bias. At the study level, the study had a low risk of bias if all key domains (see below) for each outcome had a low risk of bias. If one or more key domains were judged as having unclear risk, the study as a whole had an unclear risk; if at least one key domain was considered to have a high risk of bias, the study was considered to have a high risk of bias. When a study was judged as unclear in at least one key domain, its authors were contacted to obtain more information, which allowed for a definitive judgment (low or high risk of bias).

For the patient-centered outcomes, risk and intensity of TS, the key domains were adequate for sequence generation and allocation concealment (key domains). Patient blinding was not considered a key domain, as patients could easily identify the different bleaching protocols.

For color change in ΔSGU, three items of the Cochrane tool were considered key domains: adequate sequence generation, allocation concealment, and examiner blinding. However, for ΔE*, examiner blinding was not considered a key domain, as the previous knowledge of the treatment would not affect the results assessed by the spectrophotometer.

Summary measures and synthesis of results

Data were analyzed using Revman 5 (Review Manager Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). Data from eligible studies were either continuous (intensity of TS, ΔSGU, and ΔE*) or dichotomous (absolute risk of TS).

Only studies classified as having low risk or unclear risk of bias in the key domains were used in the meta-analysis of each outcome. The outcomes were summarized by calculating the risk ratio and the standardized mean difference for dichotomous data and continuous data, respectively along with the 95% confidence interval.

The random-effects models were used. Heterogeneity was assessed using the Cochran Q test and I 2 statistics. A subgroup analysis was performed for low- and high-concentrate bleaching gels. Studies with HP concentrations higher than 25% were classified as using high-concentrate products whereas studies with a concentration equal to or lower than 25% were considered to use low-concentrate products. Sensitivity analyses were also conducted to investigate the reasons for high heterogeneity whenever detected.

Publication bias

The funnel plot is a qualitative method for analyzing publication bias. For the continuous outcomes, the x-axis in the present analysis is the treatment effect (the overall standardized mean difference [SMD]) and the y-axis is the standard error of that treatment effect. For the dichotomous outcome, the x-axis is the risk ratio and the y-axis is the standard error of the log-risk ratio. We have not done this procedure separately for each subgroup due to the reduced number of studies in the subgroup with the low HP concentration.

Assessment of the quality of the evidence using GRADE

We graded the quality of the evidence for each outcome across the studies (body of evidence) by using the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) ( www.gradeworkinggroup.org/ ) to determine the overall strength of the evidence for each meta-analysis [ ]. The GRADEpro Guideline Development Tool (available online at www.gradepro.org) was used to create a summary-of-findings table, as suggested in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 ( ).

The GRADE approach for the RCTs addresses five reasons (risk of bias, imprecision, inconsistency, indirectness of evidence, and publication bias) to possibly downgrade the quality of the evidence (1 or 2 levels). Each of these topics was assessed as having “no limitations,” “serious limitations,” or “very serious limitations” to categorize the quality of the evidence for each outcome as high, moderate, low, or very low.

Materials and methods

Protocol and registration

This study’s protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO – CRD42016037630) and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reports [ ].

Information sources and search strategy

The controlled vocabulary (MeSH terms) and free keywords in the search strategy were defined based on the following PICO categories:

  • 1.

    Population (P): adult patients who underwent vital tooth bleaching;

  • 2.

    Intervention (I): in-office bleaching with light;

  • 3.

    Comparison (C): in-office bleaching without light;

  • 4.

    The outcome (O): color change in shade guide units (ΔSGU) and per a spectrophotometer (ΔE*) as well as the risk and intensity of TS taken after dental bleaching;

  • 5.

    Study design (S): RCTs.

Electronic databases (MEDLINE via PubMed, Cochrane Library, Brazilian Library in Dentistry, and Latin American and Caribbean Health Sciences Literature database [LILACS]) and citation databases (Scopus and Web of Science) were searched ( Table 1 ). The reference lists of all primary studies were manually searched for additional relevant publications. We also searched the related article links of each primary study in the PubMed database without restrictions on publication date or Latin-based languages.

Table 1
Electronic database and search strategy.
PUBMED (12/May/2016 updated in 09/Aug/2017)
#1 (((((((((((((((((((tooth discoloration[MeSH Terms]) OR dentition, permanent[MeSH Terms]) OR color[MeSH Terms]) OR color[Title/Abstract]) OR color[Title/Abstract]) OR “tooth discoloration”[Title/Abstract]) OR “tooth discolouration”[Title/Abstract]) OR “teeth discoloration”[Title/Abstract]) OR “teeth discolouration”[Title/Abstract]) OR “discoloured tooth”[Title/Abstract]) OR “discoloured teeth”[Title/Abstract]) OR “discoloured tooth”[Title/Abstract]) OR “discoloured teeth”[Title/Abstract]) OR “tooth staining”[Title/Abstract]) OR “teeth staining”[Title/Abstract]) OR “dental discoloration”[Title/Abstract]) OR “dental discolouration”[Title/Abstract]) OR “stained teeth”[Title/Abstract]) OR “stained tooth”[Title/Abstract]) OR “dental staining”[Title/Abstract] #2 (((((((((((((((((tooth bleaching[MeSH Terms]) OR peroxides[MeSH Terms]) OR tooth bleaching agents[MeSH Terms]) OR hydrogen peroxide[MeSH Terms]) OR carbamide peroxide[Supplementary Concept]) OR light[MeSH Terms]) OR lasers[MeSH Terms]) OR bleaching[Title/Abstract]) OR whitening[Title/Abstract]) OR “hydrogen peroxide”[Title/Abstract]) OR “carbamide peroxide”[Title/Abstract]) OR “in office”[Title/Abstract]) OR “light activation”[Title/Abstract]) OR heat[Title/Abstract]) OR ultraviolet[Title/Abstract]) OR lamp[Title/Abstract]) OR “light activated”[Title/Abstract]) OR LED[Title/Abstract] #3 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (“clinical trial”[tw]) OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR (placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR comparative study[pt] OR evaluation studies as topic[mh] OR follow-up studies[mh] OR prospective studies[mh] OR control*[tw] OR prospective*[tw] OR volunteer*[tw]) NOT (animals[mh] NOT humans[mh])
#1 AND #2 AND 3

Additionally, gray literature was investigated by searching the abstracts of the annual conference of the International Association for Dental Research and its regional divisions (1990–2016), the database System for Information on Grey Literature in Europe, and dissertations and theses using the ProQuest Dissertations and Theses full-text database as well as the Periódicos Capes Theses database.

To locate unpublished and ongoing trials related to the review question, clinical-trial registries were searched: Current Controlled Trials ( www.controlled-trials.com ), International Clinical Trials Registry Platform ( apps.who.int/trialsearch/ ), ClinicalTrials.gov ( www.clinicaltrials.gov ), Rebec ( www.rebec.gov.br ), and EU Clinical Trials Register ( www.clinicaltrialsregister.eu ).

Eligibility criteria

We included parallel and split-mouth RCTs that compared in-office dental bleaching with and without light in adult patients of any age group. RCTs were excluded if 1) the studies compared only different light-activated in-office bleaching treatments and 2) the studies compared in-office dental bleaching with combined bleaching (at-home bleaching with jump-start in-office bleaching).

Study selection and data collection process

Initially, the articles were selected by title and abstract in accordance with the previously described search strategy. Articles that appeared in more than one database were considered only once. Full-text articles were also obtained when the title and abstract presented insufficient information to make a clear decision. Subsequently, three reviewers classified those that met the inclusion criteria. Each eligible article received a study ID, combining the first author and year of publication.

Relevant information about the study design, participants, interventions, and outcomes was extracted independently through customized extraction forms by three authors; in cases of disagreement, a decision was reached by consensus. If there were multiple reports of the same study (i.e., reports with different follow-ups), data from all reports were extracted directly into a single data-collection form to avoid overlapping data. When data were not reported in the studies, authors were contacted by e-mail at least twice to request the missing information.

Concerning immediate color change, results from 1 week to 1 month post bleaching, depending on what the authors reported, were extracted. Regarding TS, the data from the most immediate period were collected.

Risk of bias in individual studies

Quality assessments of the selected trials were carried out by three independent reviewers using the Cochrane Collaboration tool for assessing the risk of bias in RCTs [ ]. The assessment criteria contained six items: sequence generation, allocation concealment, blinding of the outcome assessors, incomplete outcome data, selective outcome reporting, and other possible sources of bias. During data selection and quality assessment, any disagreements between the reviewers were solved through discussion, and if needed, consultation with a fourth reviewer (A.R.).

For each aspect of the quality assessment, the risk of bias was scored following the recommendations in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 ( ). Each domain level was judged as having a low, high, or unclear risk of bias. At the study level, the study had a low risk of bias if all key domains (see below) for each outcome had a low risk of bias. If one or more key domains were judged as having unclear risk, the study as a whole had an unclear risk; if at least one key domain was considered to have a high risk of bias, the study was considered to have a high risk of bias. When a study was judged as unclear in at least one key domain, its authors were contacted to obtain more information, which allowed for a definitive judgment (low or high risk of bias).

For the patient-centered outcomes, risk and intensity of TS, the key domains were adequate for sequence generation and allocation concealment (key domains). Patient blinding was not considered a key domain, as patients could easily identify the different bleaching protocols.

For color change in ΔSGU, three items of the Cochrane tool were considered key domains: adequate sequence generation, allocation concealment, and examiner blinding. However, for ΔE*, examiner blinding was not considered a key domain, as the previous knowledge of the treatment would not affect the results assessed by the spectrophotometer.

Summary measures and synthesis of results

Data were analyzed using Revman 5 (Review Manager Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). Data from eligible studies were either continuous (intensity of TS, ΔSGU, and ΔE*) or dichotomous (absolute risk of TS).

Only studies classified as having low risk or unclear risk of bias in the key domains were used in the meta-analysis of each outcome. The outcomes were summarized by calculating the risk ratio and the standardized mean difference for dichotomous data and continuous data, respectively along with the 95% confidence interval.

The random-effects models were used. Heterogeneity was assessed using the Cochran Q test and I 2 statistics. A subgroup analysis was performed for low- and high-concentrate bleaching gels. Studies with HP concentrations higher than 25% were classified as using high-concentrate products whereas studies with a concentration equal to or lower than 25% were considered to use low-concentrate products. Sensitivity analyses were also conducted to investigate the reasons for high heterogeneity whenever detected.

Publication bias

The funnel plot is a qualitative method for analyzing publication bias. For the continuous outcomes, the x-axis in the present analysis is the treatment effect (the overall standardized mean difference [SMD]) and the y-axis is the standard error of that treatment effect. For the dichotomous outcome, the x-axis is the risk ratio and the y-axis is the standard error of the log-risk ratio. We have not done this procedure separately for each subgroup due to the reduced number of studies in the subgroup with the low HP concentration.

Assessment of the quality of the evidence using GRADE

We graded the quality of the evidence for each outcome across the studies (body of evidence) by using the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) ( www.gradeworkinggroup.org/ ) to determine the overall strength of the evidence for each meta-analysis [ ]. The GRADEpro Guideline Development Tool (available online at www.gradepro.org) was used to create a summary-of-findings table, as suggested in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 ( ).

The GRADE approach for the RCTs addresses five reasons (risk of bias, imprecision, inconsistency, indirectness of evidence, and publication bias) to possibly downgrade the quality of the evidence (1 or 2 levels). Each of these topics was assessed as having “no limitations,” “serious limitations,” or “very serious limitations” to categorize the quality of the evidence for each outcome as high, moderate, low, or very low.

Results

Study selection

The search strategy was initially conducted May 12, 2016, and was updated August 09, 2017. After database screening and duplicate removal, 6663 studies were identified ( Fig. 1 ). After title screening, 305 studies remained, and this number was reduced to 21 after a careful examination of the abstracts.

Fig. 1
Flow diagram of study identification.

Characteristics of included articles

Study design and method of color evaluation

The characteristics of the 21 selected studies are listed in Table 2 . The parallel study design was predominantly used in these studies [ ], but some studies used the split-mouth design [ ].

Table 2
Summary of the primary studies included in theis systematic review.
Study ID Study design [setting] Number patients [drop-outs] Subjetcs age mean ± SD [range] (years) No. of males [%] Baseline color/evaluated tooth Groups/Materials Bleaching protocol Light source Color assessment [outcome] Tooth sensitivity: Scale [Outcome]
Gel protocol Applications × min [sessions] (interval) Light protocol Spectrum (nm)/(Intensity, mW/cm 2 ) [power output (W)]
Almeida, 2012 [ ] and Almeida 2012 [ ]* Parallel [n.r.] 40 [0] n.r. ± n.r. n.r. [n.r.] n.r./n.r. I: AH 10% CP a I: 4 h/daily (21 days) III: 20 s III: 450–500 (400) [0.2] Vita Classical o ; Photography VAS 0–10
[18–28] II: IO 35% HP b II-IV: 3 × 10 min [3] (7 days) IV: 3 × 3 min IV: 470–808 (120) [0.2] [ΔSGU] [Risk and intensity of TS]
III: IO 35% HP b + light A
IV: IO 35% HP b + light B
Alomari, 2010 [ ] Parallel [n.r.] 40 [n.r.] 27.8 ± n.r. [18–40] 12 [30] A3/Anterior teeth I: IO 35% HP c I-IV: 3 × 20 min [1] II-IV: 3 × 20 min n.r./(n.r.)/[n.r.] Vita Classical o NRS 0–3
II: IO 35% HP c + light B [ΔSGU] [Intensity of TS]
III: IO 35% HP c + light C
IV: IO 35% HP c + light D
Bernardon, 2010 [ ] Split-mouth 90 [1] n.r. ± n.r. [n.r.–n.r.] n.r. [n.r.] A2/Anterior teeth I: AH 10% CP a vs. IO 35% HP b + light B AH: 8 h/daily (14 days) 4 min n.r. (n.r.) [n.r.] Vita Classical o ; Spectrophotometer p Photography VAS 0–10
[n.r.] II: IO 35% HP b vs . IO 35% HP b + light B IO: 3 × 15 min [2] (15 days) [ΔSGU and ΔE] [Intensity of TS]
III: AH 10% CP a vs . IO 35% HP b + light B [1 session] and AH 10% CP a
Bortolatto, 2013 [ ] Parallel [n.r.] 40 [8] n.r. ± n.r. n.r. [n.r.] n.r./n.r. I: IO 35% HP d I: 3 × 15 min [3] (7 days) 3 × 4 min 425–480/810 (300) [1.8/0.6] Spectrophotometer p VAS 0–100
[18–25] II: IO 35% HP d + light B II: 3 × 8 min [3] (7 days) [ΔE] [Risk and intensity of TS]
Calatayud, 2010 [ ] Split-mouth 21 [0] n.r. ± n.r. n.r. [n.r.] A2/Anterior teeth I: IO 35% HP e + light E I and II: 2 × 10 min [1] 2 × 10 min 380–530 (n.r.) [n.r.] Vita Classical o n.r. [n.r.]
[n.r.] [18–38] II: IO 35% HP e [ΔSGU]
Freitas, 2016 [ ] Split mouth 22 [0] 20.5 ± n.r. [18–25] 10 [45] A2/Anterior teeth I: IO 35% HP d I: 3 × 15 min [1] 3 × 1 min (interspersing 1 min) 470/810 (35–400) Vita Classical o VAS 0–10
[University] II: IO 35% HP d + light B II: 3 × 8 min [1] [0.2] [ΔSGU] [Risk of TS]
Gurgan, 2010 [ ] Parallel [n.r.] 40 [0] 27.3 ± n.r. [18–30] 11 [27.5] A3/Anterior teeth I: IO 38% HP c I: 2 × 15 min [1] II: 2 × 105 s II: 815 (n.r.) [10] Vita Classical o VAS 0–10
II: IO 37% HP f + light E II: 3 × 8 min [1] III: 2 × 10 min (interspersing 30 s) III: 400–490 (2800) [n.r] Spectrophotometer p Photography [Intensity of TS]
III: IO 35% HP g + light F III: 3 × 20 min [1] IV: 2 × 20 min IV: 400–500 (n.r.) [n.r.] [ΔSGU and ΔE]
IV: IO 38% HP h + light C IV: 2 × 20 min [1]
Henry, 2013 [ ] Split-mouth 49 [0] 38.4 ± 13.6 24 [49] A3/Anterior teeth I: IO 25% HP i + light D I and II: 3 × 15 min [1] 3 × 15 min n.r. (n.r.) [n.r.] Spectrophotometer p VAS 0–10
[n.r.] [n.r.–n.r.] II: IO 25% HP i [ΔE] [Intensity of TS]
Kossatz, 2011 [ ] Parallel [University] 30 [0] n.r. ± n.r. n.r. [n.r.] C2/Upper Incisor I: IO 35% HP b + light B I and II: 3 × 15 min [2] (7 days) 3 × 5 min (interspersing 2 min) 470/830 (200) [n.r.] Vita Classical o VAS 0–10
[n.r–n.r.] II: IO 35% HP b [ΔSGU] [Risk]
Kugel, 2006 [ ] Split-mouth 10 [0] n.r. ± n.r. n.r. [n.r.] A3/Anterior teeth I: IO 15% HP j + light F I and II: 3 × 20 min [1] 3 × 20 min n.r. (n.r.) [n.r.] Vita Classical o Questionary
[n.r.] [n.r–n.r.] II: IO 38% HP c Photography [Risk of TS]
[ΔSGU and ΔE]
Kugel, 2009 [ ] Parallel [University] 33 [3] 30.9 ± n.r. [22–48] n.r. [n.r.] A2/Anterior teeth I: IO 25% HP k + light D I-III: 3 × 20 min [1] 20 min n.r. (n.r.) [n.r.] Photography NRS 0–3
II: IO 25% HP k [ΔE] [Risk of TS]
III: only light D
Marson, 2008 [ ] Parallel [n.r.] 40 [0] n.r. ± n.r. n.r. [n.r.] n.r./Anterior teeth I: IO 35% HP b I-IV: 3 × 15 min [2] (7 days) 3 × 15 min I: 400–500 (n.r.) [n.r.] Vita Classical o Spectrophotometer p NRS 0–4
[18–28] II: IO 35% HP b + light A II: 450–500 (n.r.) [n.r.] [ΔSGU and ΔE] [Risk of TS]
III: IO 35% HP b + light C III: 470 (n.r.) [n.r.]
IV: IO 35% HP b + light B
Mena Serrano, 2016 [ ] Parallel [University] 77 [0] 22.5 ± 3.8 [18–27] 27 [35] A3/Upper Canine I: IO 20% HP b I-IV: 3 × 15 min [2] (7 days) 5 × 1 min (interspersing 2 min) 470/830 (200) [n.r.] Vita Classical o VAS 0–100 and
II: IO 20% HP b + light B Spectrophotometer p NRS 0–4
III: IO 35% HP b [ΔSGU and ΔE] [Risk and intensity of TS]
IV: IO 35% HP b + light B
Moncada, 2013 [ ] Parallel [University] 87 [26] 23.2 ± 3.7 [18–37] 23 [26.4] n.r./n.r. I: IO 15% HP + light B I: 3 × 15 min [1] I: 5 × 1 min and 30 s I: 470/830 (450) [n.r.] n.r. VAS 0–100
II: IO 35% HP + light E II: 3 × 10 min [1] II: 3 × 6 min II: n.r. (n.r.) [n.r.] [n.r.] [Intensity of TS]
III: IO 35% HP l III: 1 × 45 min [1]
Mondelli, 2012 [ ] Split-mouth 48 [19] n.r. ± n.r. n.r. [n.r.] A3/Anterior teeth I: IO 35% HP d + light B I and III: 3 × 11 min [1] 3 × 3 min (interspersing 1 min) 470/810 (350/200) [n.r.] Spectrophotometer p Photography VAS 0–10
[n.r.] [n.r–n.r.] II: IO 35% HP d II and IV: 3 × 15 min [1] [ΔE] [Intensity of TS]
III: IO 38% HP c + light B V: 2 h/daily (10 days)
IV: IO 38% HP c
V: AH 15% CP m
Ontiveros, 2009 [ ] Split-mouth 20 [0] n.r. ± n.r. n.r. [n.r.] A2/Anterior teeth I: IO 25% HP i + light D I and II: 3 × 15 min [1] 3 × 15 min 350–600 (n.r.) [n.r.] Vita Classical o VAS 0–10
[n.r.] [18–30] II: IO 25% HP i Spectrophotometer p [Intensity of TS]
Vita Bleachedguide 3D-Master q
[ΔSGU and ΔE]
Papathanasiou, 2002 [ ] Split-mouth [University] 20 [0] n.r. ± n.r. [n.r.–n.r.] n.r. [n.r.] A3/Anterior teeth I: IO 35% HP c + light A I and II: 1 × 20 min [1] 20 min n.r. (n.r.) [n.r.] Vita Classical o Photography Questionary
II: IO 35% HP c [ΔSGU] [Risk of TS]
Polydorou, 2013 [ ] Parallel [n.r.] 60 [0] 27.6 ± 5.0 n.r. [n.r.] C1/Upper Canine I: IO 38% HP c I-III: 4 × 15 min [1] II: 4 × 8 min II: 480–520 (n.r.) [150] Vita Classical o n.r. [n.r.]
[18–70] II: IO 38% HP c + light A III: 4 × 30 s III: 980 (n.r.) [6] Spectrophotometer p
III: IO 38% HP c + light E [ΔSGU and ΔE]
Strobl, 2010 [ ] Split-mouth 20 [0] n.r. ± n.r. 7 [35] A1/n.r. I: IO 35% HP n + light G I and II: 2 × 1 min and 45 s and [2] (7 days) 3 × 10 s 1064 μm (n.r.) [4] Vita Classical o VAS 0–10
[n.r.] [n.r.–n.r.] II: IO 35% HP n Chromatometer ShadeEye NCC r [Risk of TS]
[ΔSGU and ΔE]
Tavares, 2003 [ ] Parallel 87 [0] 44.0 ± n.r. 38 [44] D4/Upper Incisor I: IO 15% HP + light F I-III: 3 × 20 min [1] 60 min 400–505 (130–160) [n.r.] Vita Classical o NRS 0–3
[n.r.] [20–67] II: IO 15% HP CR-321 Chromameter s [Risk of TS]
III: IO placebo gel + light F [ΔSGU and ΔE]
Ziemba, 2005 [ ] Parallel [n.r.] 50 [1] n.r. ± n.r. [n.r.] A3/Anterior teeth I: IO 25% HP i + light D I and II: 3 × 15 min [1] 3 × 15 min 365–500 (n.r.) [n.r.] Vita Classical o VAS 0–10
[18–70] II: IO 25% HP i [ΔSGU] [Intensity of TS]
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Jun 17, 2018 | Posted by in General Dentistry | Comments Off on In-office dental bleaching with light vs. without light: A systematic review and meta-analysis
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