Efficacy, side-effects and patients' acceptance of different bleaching techniques (OTC, in-office, at-home)

This clinical study compared the efficacy of three different bleaching techniques with respect to the bleaching times required in order to achieve six grades of whitening in human teeth. Any side effects that were noted and the patients' acceptance of the method were recorded by a visual analog scale ranging from 0 to 10. Moreover, epoxy casts from the study teeth were analyzed by scanning electron microscopy in order to detect any potential changes in the enamel surface due to treatments. Thirty-nine volunteers participated in the study and were allocated randomly to one of three different bleaching treatments: Group A (n=13) used Whitestrips (over-the-counter technique; one cycle=30 minutes), Group B (n=13) used Opalescence PF 10% (at-home bleaching technique; one cycle=8 hours) and Group C (n=13) used Opalescence Xtra Boost (in-office bleaching technique; one cycle=15 minutes) until a defined whitening of six tabs compared to the baseline were reached (assessed by the VITA shade guide). All three methods achieved six grades of whitening. The mean treatment time required to reach the defined level of whitening was 31.85 +/- 6.63 cycles in Group A, 7.15 +/- 1.86 cycles in Group B and 3.15 +/- 0.55 cycles in Group C. All products differed significantly from each other in terms of treatment cycles and required treatment time (p<0.001 by ANOVA and Mann-Whitney-U-test). Using the VA scale, side effects noted within the three groups were minimal. Tooth hypersensitivity ranged from 2.62 (Whitestrips) to 3.38 (Opalescence PF), and gingival irritation ranged between 0.23 (Opalescence Xtra Boost) and 0.85 (Whitestrips). The most accepted method was the at-home bleaching technique. None of the teeth studied showed detectable enamel surface changes in the subsequent SEM analysis using 200x and 2000x magnification.