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142 rev port estomatol med dent cir maxilofac. 2021;62(3):141-149

Eficácia do branqueamento em consultório com diferentes barreiras
de tecidos moles – ensaio clínico aleatorizado

r e s u m o

Palavras-chave: Objetivos: Avaliar a eficácia do branqueamento dentário de técnica in-office paint-on com
Cor peróxido de hidrogénio a 6% com dois tipos diferentes de materiais de isolamento relativo.
Peróxido de hidrogénio Métodos: Vinte pacientes foram selecionados de acordo com os critérios de inclusão e ex-
Verniz clusão, submetidos a profilaxia dentária profissional e alocados aleatoriamente num de dois
Vaselina grupos. Foi realizado o protocolo de técnica de branqueamento in-office (VivaStyle Paint On
®
Espectrofotometria PIus, lvoclarVivadent , Liechtenstein) com dois materiais de isolamento relativo: Grupo 1
Dente – Vaselina; Grupo 2 – resina block-out. A eficácia de branqueamento foi avaliada com ΔE e
00
ΔWI , calculados a partir dos valores CIE L*a*b* obtidos por análise espectrofotométrica
D
(SpectroShade). Testes estatísticos apropriados foram realizados para analisar diferenças
intragrupo nos valores CIE L*a*b* e WI e diferenças intergrupo em ΔE e ΔWI com α=0,05.
D 00 D
Resultados: Ambos os grupos apresentaram diferenças estatisticamente significativas
(P<0,01) no CIE L*a*b* e WI . Tanto ΔE quanto ΔWI ultrapassaram o limite de aceitabilida-
D 00 D
de (ΔE 00 >1,8; ΔWI > 2,60). O Grupo 2 apresentou valores médios estatisticamente signifi-
D
cantes superiores (P<0,01) com ΔE = 3,5 ± 1,5 e ΔWI = 8,6 ± 4,2.
00 D
Conclusões: A técnica de branqueamento dentário in-office do tipo paint-on a 6% peróxido de
hidrogénio apresentou eficácia clínica, porém dependente do material de isolamento, com
melhores resultados na aplicação de resina block-out, sugerindo a sua recomendação clínica.
(Rev Port Estomatol Med Dent Cir Maxilofac. 2021;62(3):141-149)
© 2021 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

physical barrier is essential for soft-tissue protection since
Introduction 10
contact with the agents can lead to organic tissue damage.
Whiter teeth have been associated with a perception of beau- In the previously described 6% HP paint-on varnish technique,
ty, health, and fitness. Thus, tooth color is considered one of a Vaseline barrier is indicated as a soft-tissue protection ma-
the most important components in smile evaluation and fa- terial due to its known occlusion effect and use in dentistry as
cial esthetics, and tooth bleaching techniques have gained a a gingival barrier. 3,6,8,11-13 Despite Vaseline’s isolating proper-
major clinical relevance. 1,2 ties, its semi-solid consistency increases solubility in the pres-
Nowadays, tooth bleaching products usually have perox- ence of fluids, which hinders isolation in the oral environment.
ide-releasing agents, such as hydrogen peroxide (HP) or carba- An alternative soft-tissue protection material is the light-cur-
3,4
mide peroxide. In fact, initially, HP percentages were com- ing resin, which grants insolubility in water and superior ad-
monly high. However, peroxide-releasing agents have known hesion to various surfaces, including the gingival tissue; how-
adverse effects on biological tissues that can increase with ever, it entails a higher economic cost. 14-18
3,5
higher concentrations. For this reason, manufacturers and Although the properties of different soft-tissue protection
clinicians searched for effective techniques with low HP con- materials are well known, their influence on the bleaching
centrations, which resulted in the nightguard vital bleaching effectiveness is yet to be assessed. Therefore, this clinical study
3
technique gaining popularity over the years. Although in-of- aimed to evaluate the effectiveness of a 6% HP paint-on whit-
fice bleaching techniques are associated with higher HP con- ening varnish used with two different types of soft-tissue pro-
centrations, a new protocol was described in 2006 consisting tection materials. The following null hypothesis was estab-
of two sixty-minute sessions (six ten-minute applications each lished: there are no differences in the bleaching effectiveness
session), with a week interval, of a paint-on whitening varnish of an in-office 6% HP paint-on varnish technique when used
6
with a lower HP percentage (6% HP). Nowadays, using lower with two different soft-tissue protection materials.
HP techniques has even more relevance since the European
Council Directive 2011/84/EU decreed tooth bleaching products
as cosmetics and prohibited the use of concentrations higher Material and methods
than 6% HP. 7
In-office bleaching effectiveness depends on appropriate A randomized clinical trial was performed at the Faculty of
field isolation since peroxide-releasing agents can be inacti- Dentistry of Universidade de Lisboa after the local ethics
vated when in contact with saliva due to cellular enzymes and committee’s approval. This trial is part of an undergoing
8,9
diffusion in water environments. Additionally, the use of a tooth-bleaching research registered at the U.S. National Li-