Terra Renata Maria Oleniki, Favoreto Michael Willian, Morris Tom, Loguercio Alessandro D, Reis Alessandra
Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Uvaranas, Ponta Grossa, PR, Brazil.
Department of Restorative Dentistry, School of Dentistry, Tuiuti University of Paraná, Santo Inácio, Curitiba, PR, Brazil.
J Dent. 2025 Sep;160:105857. doi: 10.1016/j.jdent.2025.105857. Epub 2025 Jun 1.
INTRODUCTION/OBJECTIVES: This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of at-home bleaching agents and concentrations in patients with permanent dentition (PROSPERO 2021 CRD42021265220).
Randomized clinical trials (RCTs) comparing any two at-home bleaching systems were considered eligible. A Bayesian NMA was conducted for color change (ΔE, ΔSGU) to compare different carbamide peroxide (CP) or hydrogen peroxide (HP) concentrations. The risk of bias (RoB) was assessed using the Cochrane tool 2.0 and the quality of evidence (QoE) with the GRADE approach.
A comprehensive search was conducted in PubMed, Cochrane Central, LILACS/BBO, SCOPUS, Web of Science, EMBASE, and grey literature.
STUDY SELECTION/RESULTS: 81 studies were eligible and 53 included in the NMA. A high RoB was observed in most studies included. No statistically significant differences were found in most of the comparisons, except for the extreme concentrations. For ΔE: CP 5 % vs. CP 15-17 % (mean difference, [95 % CrI]: -3.36 [-6.53 to -0.22]); HP 2-4 % vs. CP 15-17 % (-1.85 [-3.63 to -0.08]); CP 5 % vs. CP 35-37 % (-4.23 [-8.21 to -0.22]). For ΔSGU: HP 14-16 % vs. CP 5 % (4.66 [0.27 to 9.01]); HP 14-16 % vs. HP 2-4 % (4.06 [0.74 to 7.46]). The QoE was low.
Most at-home agents showed similar bleaching efficacy (ΔE, ΔSGU), except when the highest and lowest concentrations were compared one another with a low QoE. Further well-designed, low-bias RCTs is essential to achieve higher QoE.
Low-certainty evidence points to similar efficacy of most at-home bleaching agents across concentrations, suggesting their clinical versatility in dental practice.
引言/目的：本系统评价和网状Meta分析（NMA）旨在比较恒牙列患者使用家庭漂白剂及其浓度的疗效（国际前瞻性系统评价注册库编号：2021年CRD42021265220）。
比较任意两种家庭漂白系统的随机临床试验（RCT）被视为合格。进行了贝叶斯网状Meta分析以比较不同浓度的过氧化脲（CP）或过氧化氢（HP）的颜色变化（ΔE、ΔSGU）。使用Cochrane工具2.0评估偏倚风险（RoB），并采用GRADE方法评估证据质量（QoE）。
在PubMed、Cochrane Central、LILACS/BBO、SCOPUS、Web of Science、EMBASE和灰色文献中进行了全面检索。
研究选择/结果：81项研究符合条件，53项纳入网状Meta分析。在纳入的大多数研究中观察到较高的偏倚风险。除了极端浓度外，大多数比较中未发现统计学上的显著差异。对于ΔE：5% CP对比15 - 17% CP（平均差，[95% CrI]：-3.36 [-6.53至-0.22]）；2 - 4% HP对比15 - 17% CP（-1.85 [-3.63至-0.08]）；5% CP对比35 - 37% CP（-4.23 [-8.21至-0.22]）。对于ΔSGU：14 - 16% HP对比5% CP（4.66 [0.27至9.01]）；14 - 16% HP对比2 - 4% HP（4.06 [0.74至7.46]）。证据质量较低。
除了将最高和最低浓度相互比较时证据质量较低外，大多数家庭漂白剂显示出相似的漂白效果（ΔE、ΔSGU）。进一步设计良好、低偏倚的随机对照试验对于获得更高的证据质量至关重要。
低确定性证据表明大多数家庭漂白剂在不同浓度下疗效相似，这表明它们在牙科实践中具有临床通用性。
