Blanqueamiento dental en consulta vs. en casa: una revisión narrativa de eficacia y seguridad

To compare in-office (chairside) and at-home (dentist-supervised) vital tooth bleaching techniques in terms of efficacy, longevity, safety, sensitivity, and patient-reported outcomes. A narrative review of the literature was conducted using PubMed, Scopus, and Cochrane Library, including randomized trials, systematic reviews, and meta-analyses published between 2000 and 2025. Studies directly comparing in-office and at-home bleaching with peroxide-based agents were selected. Outcomes of interest included immediate color change, relapse over time, incidence and intensity of tooth sensitivity, and adverse effects on enamel or pulp. Emphasis was placed on high-quality evidence from the last five years. Both techniques achieved significant, perceptible whitening. Numerous meta-analyses showed no clinically meaningful difference in bleaching efficacy when treatment protocols were followed. At-home bleaching (10-16% carbamide peroxide) and in-office bleaching (25-40% hydrogen peroxide) produced comparable ΔE and shade guide improvements. Some studies suggested slightly greater long-term color stability with at-home bleaching, likely due to longer contact time and ease of touch-ups. Sensitivity occurred frequently with both methods (incidence 37-90% at-home, 17-100% in-office), but was typically more intense in-office and milder but more recurrent with at-home use. No irreversible pulp or enamel damage was reported. Light activation did not enhance whitening outcomes or reduce sensitivity. Both methods were well accepted by patients. In-office and at-home bleaching are equally effective and safe. In-office offers faster results but a higher risk of acute sensitivity; at-home provides gradual whitening with lower intensity side effects and better long-term maintainability. Choice of technique should be individualized based on sensitivity profile, desired speed, compliance potential, and lifestyle.