Clinical comparison of at-home and in-office dental bleaching procedures: A randomized trial of a split-mouth design

The objective of this clinical study was to evaluate the association between two dental bleaching techniques — hydrogen peroxide bleaching (in-office bleaching) and carbamide peroxide (home bleaching) – and color change, dental sensitivity, morphology, and superficial roughness of dental enamel. Were performed two applications according to the manufacturer's specifications, one per week, of the in-office bleachingwith38% hydrogen peroxide. We applied the home bleaching technique for two weeks with 10% carbamide peroxide in a custom-made tray. The factor studied was the "bleaching technique" on 2 levels: Technique 1 (in-office bleaching associated with home bleaching) and Technique 2 (home bleaching only).The response variables were color change, dental sensitivity, morphology, and superficial roughness. According to a random draw, the volunteers had their maxillary right and left hemi arches submitted to in-office placebo treatment and to in-office bleaching, respectively (Phase 1), and at home bleaching (Phase 2) treatment for both hemi-arches, characterizing a split-mouth type of design. The color change was performed in the incisor and canine teeth by visual and digital evaluation before and after phase 1 and after the conclusion of each session of attendance. The dental sensitivity was assessed using the visual analogical method whereas the enamel surface changes and roughness were analyzed by electron microscopy (SEM) and by optical interferometry (IFM), through replicas clinically obtained based on central incisors before and after bleaching procedures. No differences were observed between the bleaching techniques for both the visual and digital analysis. There was a significant difference in the dental sensitivity between dental bleaching techniques, with the associated bleaching technique producing the highest levels of dental sensitivity after the baseline; it was higher during the sessions of in-office bleaching. Microscopic analysis of the morphology and roughness of enamel surface showed no significant changes between the bleaching techniques. We conclude that both techniques leads to similar results in color change; the combination technique leads to the highest levels of sensitivity. Neither technique promotes changes in morphology and surface roughness of tooth enamel.