Avaliação da influência da composição de géis clareadores com e sem cálcio na sensibilidade e variação de cor dos dentes sob influência da dieta: comparação entre a técnica assistida e supervisionada

Abstract

Dental bleaching is a minimally invasive dental procedure aimed at removing stains and pigmentation from teeth, promoting whitening and, consequently, aesthetic improvement. The pursuit of an ideal smile has led to an increased demand for aesthetic procedures, among which dental bleaching is one of the most soughtafter treatments in dental clinics. This study aimed to evaluate the influence of the composition of carbamide peroxide (CP) and hydrogen peroxide (HP) gels, with and without calcium, on tooth color variation under dietary influence, sensitivity, and treatment longevity, comparing the supervised technique (ST) and the assisted technique (AT). The study involved 43 participants, divided into five groups: the first three groups underwent ST using CP at concentrations of 10%, 16%, and 22%, while the last two groups received AT using 35% HP, with one of these groups utilizing a gel containing calcium. In AT, color variation and sensitivity were assessed before and immediately after each weekly session, whereas in ST, these variables were analyzed weekly. Color variation was measured using the Vitapan Classical® scale (Vita Zahnfabrik, H. Rauter GmbH & Co, Bad Säckingen, Germany), and sensitivity was evaluated using the visual analog scale (VAS). For both techniques, the consumption of pigmented foods was recorded through a questionnaire. The collected data were statistically analyzed using SPSS software, version 20.0 (SPSS Inc., Chicago, IL, USA). The statistical tests applied included Shapiro-Wilk, White, Mann-Whitney, Kruskal-Wallis, Fisher’s Exact Test, Multinomial Logistic Regression, Mixed ANOVA, and Spearman’s Correlation, with a confidence level of 95%. The results indicated that AT was more effective in achieving lighter tooth shades. By the third week of the protocol (p=0.05), 45% of the individuals undergoing AT reached the B1 shade (the lightest), whereas only 13% of those treated with ST attained this shade. Regarding dental sensitivity, no cases of severe pain were reported, only mild to moderate discomfort. Sensitivity levels were significant in the second (p=0.007) and third (p=0.003) weeks of the bleaching protocol. A modification in the bleaching protocol, requiring a mandatory desensitization step, may be as effective as the incorporation of calcium into the formulation for managing dentin sensitivity. However, the comparison between color variation and the intensity of food consumption did not show significant differences (p>0.05) for any of the foods analyzed. Therefore, this study concludes that all evaluated gel compositions, whether with or without calcium, are equally effective in producing color variation in dental bleaching without causing severe sensitivity. A TCA, both with and without added calcium in its HP composition, exhibited higher levels of color alteration compared to at-home bleaching, while presenting a lower incidence of sensitivity. However, individual variability must be taken into account.