Universidade Ceuma, Rua Josue Montello s/n, São Luís, Maranhão 65075-120, Brazil.
Universidade Estadual Ponta Grossa, Avenida General Carlos Cavalcanti, 4748, Uvaranas, Ponta Grossa, Paraná 84030-900, Brazil.
J Dent. 2018 Jan;68:91-97. doi: 10.1016/j.jdent.2017.11.008. Epub 2017 Nov 21.
This randomized double-blind clinical trial compared tooth sensitivity (TS), bleaching efficacy, and cytokine levels after applying in-office bleaching treatments containing 15% and 35% hydrogen peroxide (HP15% and HP35%, respectively).
Twenty-five volunteers were randomly assigned to receive HP15% or HP35% treatment. The bleaching agent was applied in three 15-min applications per session. Two bleaching sessions were separated by a 1-week interval. The participants scored TS using a visual analog scale and numerical rating scale. Bleaching efficacy was determined by subjective and objective methods. Gingival crevicular fluid was collected from three jaws sites per patient for the analysis of fluid volume. Flow cytometry was used to analyze gingival crevicular fluid levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor, and interferon-gamma. All measurements were obtained before and after bleaching. All data were statistically analyzed (α=0.05).
The absolute risk and intensity of TS was higher for HP35% than for HP15% (p>0.002). One month post-bleaching, HP35% produced more bleaching than HP15% (p=0.02). However patient perception (p=0.06) and patient satisfaction (p=0.53) with regard to bleaching were not significantly different. No significant differences existed in the gingival fluid volume (p>0.38) or in any cytokine level (p>0.05) for either HP concentration.
Treatment: with HP35% is more effective than HP15%, but generates a greater risk and intensity of TS. No inflammatory changes occurred despite the difference in the HP concentrations.
Hydrogen peroxide at a lower concentration (e.g., 15%) should be considered a good treatment alternative for in-office bleaching because the higher concentration for in-office bleaching generates a greater risk and intensity of TS for patients.
本随机双盲临床试验比较了 15%和 35%浓度过氧化氢（HP15%和 HP35%）诊室漂白治疗后牙齿敏感（TS）、漂白效果和细胞因子水平。
25 名志愿者随机分为接受 HP15%或 HP35%治疗组。漂白剂每 15 分钟应用一次，共三次。两次漂白间隔一周。参与者使用视觉模拟评分和数字评分法评估 TS。通过主观和客观方法评估漂白效果。从每位患者的三个牙槽嵴位点采集龈沟液，用于分析液体量。采用流式细胞术分析龈沟液中白细胞介素（IL）-1β、IL-2、IL-4、IL-6、IL-10、肿瘤坏死因子和干扰素-γ的水平。所有测量均在漂白前后进行。所有数据均进行统计学分析（α=0.05）。
HP35%的 TS 绝对风险和强度均高于 HP15%（p＞0.002）。漂白后 1 个月，HP35%的漂白效果优于 HP15%（p=0.02）。然而，患者对漂白的感知（p=0.06）和满意度（p=0.53）无显著差异。两种 HP 浓度下龈沟液量（p＞0.38）或任何细胞因子水平（p＞0.05）均无显著差异。
与 HP15%相比，HP35%治疗更有效，但会增加 TS 的风险和强度。尽管 HP 浓度不同，但未发生炎症变化。
对于诊室漂白，应考虑使用浓度较低的过氧化氢（如 15%），因为较高浓度的过氧化氢会增加患者 TS 的风险和强度。
