使用10%与更高浓度过氧化脲凝胶进行家庭漂白：系统评价与Meta分析

At-home Bleaching With 10% vs More Concentrated Carbamide Peroxide Gels: A Systematic Review and Meta-analysis.

作者信息

de Geus J L, Wambier L M, Boing T F, Loguercio A D, Reis A

出版信息

Oper Dent. 2018 Jul/Aug;43(4):E210-E222. doi: 10.2341/17-222-L.

DOI:10.2341/17-222-L

PMID:29949477

Abstract

OBJECTIVE

To perform a systematic review to answer the following research question: Is at-home bleaching in adults with more concentrated carbamide peroxide (CP) gels as effective and safe as bleaching performed with 10% carbamide peroxide gels?

METHODS AND MATERIALS

A comprehensive search was carried out in the MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (1990 to 2016) and unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periodicos Capes Theses Databases) were also searched. The risk of bias of the included studies was analyzed using the Cochrane Risk of Bias tool from the Cochrane Collaboration. We meta-analyzed the data using the random effects model to compare 10% CP and more concentrated CP gels in terms of color change (ΔSGU or ΔE) and risk and intensity of tooth sensitivity (TS). The quality of the evidence was rated using the GRADE approach.

RESULTS

After the database screening, 182 articles remained, and this number was reduced to 17 after examination of the abstracts and/or full texts. Four articles were follow-ups of earlier studies, and thus we collected 13 studies. Ten studies were at unclear risk of bias, while three were at low risk of bias. Lower risk and intensity of TS was observed for 10% CP. The odds ratio for the risk of TS was 0.41 (95% CI 0.20 to 0.84, p=0.01), and the difference in means for TS intensity was 0.44 (95% CI 0.67 to -0.20, p=0.0003). No significant difference was observed in terms of color change in ΔSGU (difference in means 0.29; 95% CI 0.25 to 0.83, p=0.29) and for ΔE (difference in means -0.16; 95% CI 0.38 to 0.06, p=0.16). Except from the ΔSGU, for which the evidence was graded as low quality, the other outcomes were considered at moderate quality.

CONCLUSIONS

At-home bleaching with 10% CP showed similar bleaching efficacy with lower risk and intensity of TS in comparison with more concentrated carbamide peroxide gels.

摘要

目的

进行一项系统评价，以回答以下研究问题：对于成人而言，使用浓度更高的过氧化脲（CP）凝胶进行家庭漂白与使用10%过氧化脲凝胶进行漂白相比，在效果和安全性上是否相同？

方法与材料

通过PubMed、Scopus、Web of Science、LILACS、BBO、Cochrane图书馆和SIGLE对MEDLINE进行了全面检索，无任何限制。还检索了国际牙科研究协会（IADR）摘要（1990年至2016年）以及未发表和正在进行的试验注册信息、学位论文（ProQuest学位论文数据库和巴西高等教育人员素质提升协调办公室论文数据库）。使用Cochrane协作网的Cochrane偏倚风险工具分析纳入研究的偏倚风险。我们使用随机效应模型对数据进行荟萃分析，以比较10% CP凝胶和浓度更高的CP凝胶在颜色变化（ΔSGU或ΔE）以及牙齿敏感（TS）的风险和强度方面的差异。使用GRADE方法对证据质量进行评级。

结果

数据库筛选后，剩余182篇文章，在查看摘要和/或全文后，这一数量减少至17篇。4篇文章是早期研究的随访，因此我们收集了13项研究。10项研究的偏倚风险不明确，3项研究的偏倚风险较低。观察到10% CP凝胶的TS风险和强度较低。TS风险的比值比为0.41（95%置信区间0.20至0.84，p = 0.01），TS强度的均值差异为0.44（95%置信区间0.67至 -0.20，p = 0.0003）。在ΔSGU的颜色变化方面（均值差异0.29；95%置信区间0.25至0.83，p = 0.29）以及ΔE方面（均值差异 -0.16；95%置信区间0.38至0.06，p = 0.16）未观察到显著差异。除了ΔSGU的证据质量被评为低质量外，其他结果的证据质量被认为是中等质量。