Minimally invasive approach for improving aesthetic in a patient with tetracycline-stained teeth by bleaching:A clinical evaluation

Objective:To compare 16% carbamide peroxide(CP)with a higher concentration of hydrogen peroxide(HP)for bleaching teeth in office or at-home to erase tetracycline stains on teeth.Materials and methods:In a randomized,self-controlled clinical trial,we assigned eligible subjects to group A with 40% HP compared with 16% CP or group B with 45% CP compared with 16% CP on the split maxillary arch and followed the manufacturers’instructions.Tooth color changes were measured with vita 3D-bleached guide and colorimeter at baseline and three-time assessment.Tooth sensitive intensity was evaluated using numeric rating scales,and oral soft and hard tissue examination was recorded.Patient satisfaction survey was conducted at the last tooth color evaluation.Results:There were 20 subjects enrolled.The color changes by the end of the study were A1(40% HP)=8.22,A2(16% CP)=8.20,B1(45% CP)=11.27,B2(16% CP)=8.26 respectively.All groups experienced significant shade reductions by bleaching,the 45% CP group had significantly greatest color changes compared with the other groups(p=0.03).For tooth sensitivity evaluation,significant differences were observed in 40% HP group(p=0.01),but with mild level.None patients suffered oral soft or hard tissue abnormalities before and after treatment.Patients were more in favor of using 45% CP according to the questionnaire results.Conclusion:The 3 whitening agents were effective and safe for the whitening of tetracycline-stained teeth,the 45% CP agent had quicker whitening efficacy with low tooth sensitivity and positive feedback.Clinical significance:45% of high-concentration CP whitener by at-home using,brought faster and superior efficacy to bleaching tetracycline-stained teeth while had the equal intensity of tooth sensitivity.