Postgraduate Program in Dentistry, CEUMA University, Rua Josué Montello 1 - Renascença II, São Luis, MA, 650575-120, Brazil.
Department of Restorative Dentistry, State University of Western Paraná, Rua Engenharia, 464 - Universitário, Cascavel, Paraná, 85819-190, Brazil.
Clin Oral Investig. 2019 Oct;23(10):3673-3689. doi: 10.1007/s00784-019-03042-4. Epub 2019 Aug 29.
A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?"
Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019).
Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses.
Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes.
If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.
进行了系统评价和荟萃分析，以回答这个研究问题：“在成年人中，联合诊室（IO）和家庭（AH）漂白是否比单独 AH 或 IO 漂白更能改善颜色变化和降低牙齿敏感性（TS）？”
纳入了比较联合应用与单独应用漂白的成人随机对照试验。使用 Cochrane 协作工具评估偏倚风险（RoB）。使用随机效应模型对比色标尺单位（∆SGU）和分光光度计（∆E*）的颜色变化、TS 的风险和强度进行荟萃分析。使用 Cochran's Q 检验和 I 统计量评估异质性。GRADE 评估证据质量。于 2017 年 8 月 28 日检索 PubMed、Scopus、Web of Science、LILACS、BBO、Cochrane Library、SIGLE、IADR 摘要、未发表的、正在进行的试验注册、论文和学位论文，并于 2019 年 1 月 29 日更新。
保留了 12 项研究。其中 2 项被认为具有低 RoB。对于联合 vs IO 漂白，未观察到 ∆E*、∆SGU 和 TS 风险的显著差异；没有数据可分析 TS 的强度。对于联合 vs AH 漂白，未观察到 ∆E*、∆SGU 的显著差异，但 AH 漂白的 TS 风险（RR 1.40，95%CI 1.10 至 1.80）和强度（MD 1.40，95%CI 0.18 至 2.63）较低。所有荟萃分析的证据质量均被评为低或极低。
单独 AH 组的 TS 风险和强度较低，而不会影响颜色变化。然而，由于大多数结果的证据质量较低，仍鼓励开展更多研究。
如果临床医生要在联合或单独 AH 漂白之间进行选择，单独 AH 可能更可取；联合漂白可能会增加 TS 的风险，而不会改善颜色变化。对于联合或单独 IO 漂白，未观察到颜色变化和 TS 风险的重要临床差异；然而，由于缺乏数据，无法比较 TS 的强度。由于证据质量低/极低，应进行进一步研究。
