In Vitro Comparison of Three Chairside Bleaching Protocols: Effects on Enamel Microhardness, Colour, and Qualitative Cytotoxicity Risk

TL;DR

This study compares three teeth whitening methods to see how they affect enamel hardness and color, finding that one method whitens effectively with less enamel damage.

Contribution

The study introduces a comparative analysis of three high-concentration bleaching protocols under controlled conditions, linking whitening efficacy with enamel safety.

Findings

All three protocols produced significant whitening (mean ΔE 5.7–6.3).

Hydrogen-peroxide gels caused greater enamel hardness loss and carbonate depletion compared to carbamide-peroxide gel.

A moderate association was found between color change and hardness loss, but it was not predictive for individuals.

Abstract

Background and Objectives: The rapid increase of whitening products use raises questions about enamel safety. We compared three high-concentration protocols—Opalescence Quick (45% carbamide peroxide ≈ 15% H2O2), Opalescence Boost (40% H2O2), and BlancOne Ultra (35% H2O2 + LED)—under controlled conditions to balance color change (ΔE) with enamel integrity (microhardness, FTIR). We also constructed a qualitative cytotoxicity risk profile from published data; no biological assays were performed in this study. Methods: Seventy-two matched half-crowns were randomized to Control or one of the three protocols. Outcomes were a change in Vickers microhardness, spectrophotometric color difference, and FTIR carbonate-to-phosphate ratio after 24 h in artificial saliva. We also compiled a qualitative cytotoxicity risk profile from published evidence; no biological assays were performed. One-way ANOVA with Tukey HSD on Δ-scores, Shapiro–Wilk and Levene’s tests for assumptions, Welch’s t-tests for tooth-class comparisons, and Pearson correlation between ΔE and ΔMH. Results: All active protocols produced clearly visible whitening (mean ΔE 5.7–6.3). Hydrogen-peroxide gels showed greater hardness loss and carbonate depletion than the carbamide-peroxide gel under similar contact time. The association between greater shade change and hardness loss was moderate and not predictive for individuals. Conclusions: Under harmonized conditions, all systems whitened effectively. Pursuing changes beyond ~6 units offered little extra benefit while increasing enamel impact. Carbamide-based Opalescence Quick achieved comparable aesthetics with lower acute enamel effects. Clinicians should individualize exposure time and pair in-office whitening with short-term remineralising care. Cytotoxicity comments are qualitative and literature-based only.

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