The Association of CPP-ACPF Associated With LASER in the Treatment of Tooth Sensitivity After at Home Bleaching

Tooth whitening is a procedure that has been increasingly requested by patients aroundthe world, whether at home or in office bleaching. Tooth sensitivity is the main sideeffect of bleaching. It have a great power to interfere negatively in the quality of lifeof those affected. According to the literature, about 51% of people who had at‐homebleaching developed postoperative sensitivity.The objective of this clinical, randomized, double‐blind study is to evaluate theeffectiveness of the association of casein phosphopeptides‐fluoridated amorphous calciumphosphate with photobiomodulation in the treatment of tooth sensitivity after homebleaching, with 22% carbamide peroxide and also evaluate the effectiveness of at homebleaching through color analysis.Fifty patients will be selected, who will be divided into four treatment groups: PLACEBOgroup (will receive a LASER simulation and a manipulated paste without active ingredientto simulate the CPP‐ACPF paste); CPP‐ACPF group (will receive the CPP‐ACPF folder and aLASER simulation); LASER group (will receive the LASER and a manipulated paste withoutactive ingredient to simulate the CPP‐ACPF paste); LASER+CPP‐ACPF group (will receive theLASER and the CPP‐ACPF folder). As it is a split‐mouth study, each patient will receivetwo different types of treatment, one on each side of the arches, thus, the sample sizeof each group will be 25 patients (n=25).The treatment with the CPP‐ACPF paste (MI paste plus) will be carried out in the CPP‐ACPFand LASER+CPP‐ACPF groups, at the following times: before the bleaching treatment (T0),after one week of bleaching (T1), after two weeks of bleaching (T2), after three weeks ofbleaching (T3). The application will be made on the buccal surfaces of the teeth, up tothe second premolars, with the aid of a microbrush applicator (Microbrush, 3M Espe), forfive minutes. Afterwards, patients will be instructed to spit out the excess and avoidingesting anything for 30 minutes. In the PLACEBO group, this clinical protocol will beperformed exactly, but using the paste without active ingredient.The LASER and CPP‐ACPF+FBM groups will receive the application of LASER (Therapy EC, DMC,São Carlos, SP, Brazil), using the infrared light spectrum with a wavelength of 808 nmwith its active medium of Arsento Gallium and Aluminum (AsGaAl), at three points, one inthe center of the crown of the tooth, another in the center of the cervical region andthe last one in the incisal region, with the light beam directed apically, from all teethto the second premolar of each hemi ‐upper and lower arch. The energy used was 1 Jouleper point for 10 seconds.While the PLACEBO and CPP‐ACPF groups received a LASER simulation. The sounds emitted bythe laser during its use will be simulated by a mobile application.All study participants will receive a tube of bleaching agent (Whiteness Simple 22%, FGM,Joinville, Brazil) and will be instructed to apply a drop of the product on thevestibular surface of each tooth on the whitening tray (up to the second premolars) anduse for two uninterrupted hours for 21 days.Sensitivity will be assessed using a visual analogue scale (VAS), where patients shoulddaily mark their pain level (from 0 to 10) on each side of the arcade. After the 21 daysof treatment, they will receive a new VAS, to evaluate if was any sensitivity will occurduring 30 days after the bleaching treatment.In parallel with bleaching treatment and sensitivity treatment, the color analysis ofteeth 13, 11, 21 and 23 will be performed, with the Vita Easyshade Advance 4.0spectrophotometer, to monitor the bleaching performance, in each week. The first one willoccur before starting the bleaching treatment (baseline) and a new measurement will beperformed every week, together with the application of treatments for sensitivity.The collected data will be tabulated in an Excel Microsoft Windows 2010) spreadsheet andanalyzed in the Jamovi 1.6.23 (The Jamovi Project, 2020) software. For inter‐ andintra‐group analysis of sensitivity values, the Repeated Measures statistical test willprobably be used. For all statistical analyses, a significance level of 5% will beadopted.