The efficacy of tooth bleaching.
Burrows S.
Current tooth lightening systems use hydrogen peroxide or carbamide peroxide which releases
hydrogen peroxide as the bleaching agent. In vitro and in vivo studies, mostly comparing
different bleaching systems, have demonstrated the efficacy of vital and non-vital tooth
bleaching. Bleaching treatments are affected by a number of factors including the actual
cause of tooth discoloration. All in-surgery bleaching agents are chemically activated and,
whilst better results are possible with lights, these are not essential. Shade change can be
evaluated subjectively and may be observed after only a few nights with Night Guard Vital
Bleaching (NGVB). Objective methods of shade evaluation are used in most randomized
controlled trials. There are a number of methods used to bleach teeth but NGVB using 10%
carbamide peroxide in trays produces the optimal result with the least side-effects.
The’inside/outside’ bleaching technique using 10% carbamide peroxide is the most effective
and safest method of bleaching non-vital teeth. Although more than 90% success has been
reported, regression of the colour change is a common problem in vital and non-vital tooth
bleaching and retreatment is necessary in many cases, usually after 1-3 years. The
overwhelming evidence indicates that tooth bleaching is effective if supervised by a dentist.
CLINICAL RELEVANCE: The clinician should be able to inform patients that both vital and
non-vital tray bleaching using 10% carbamide peroxide can produce excellent results when
supervised. However, shade regression is likely in 1-3 years.
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