This study aimed to answer the question through a systematic review: Can carbamide peroxide be as effective as hydrogen peroxide and cause less in-office bleaching sensitivity? A literature survey was performed in PubMed/MEDLINE, Embase, Scopus, ISI Web of Science, and gray literature. Primary clinical trials that compared the efficacy or the in-office bleaching sensitivity between carbamide and hydrogen peroxides were included. The risk of bias was evaluated using the RoB2. The certainty of the evidence was assessed using the GRADE approach. DPI training significantly improved the mean scores of the dental undergraduates from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. The limited evidence suggests that the 37% carbamide peroxide may be similarly effective to the 35% hydrogen peroxide for bleaching teeth in-office and causes less bleaching sensitivity. However, more well-designed split-mouth clinical trials are necessary to strengthen the evidence.

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To evaluate the effect of vital tooth bleaching agent and alcohol pretreatment on dentin bonding, flat dentin windows were produced on the buccal side of the crowns of fifty-five extracted, human premolars. A bleaching gel, Opalescence® with 10% of carbamide peroxide (Ultradent Product, USA) was daily applied on the teeth of three experimental groups for six hours for 10 consecutive days, while teeth of a control group were not bleached. After 6 hours of bleaching gel application, the specimens were washed and stored in saline until the next day application. After application of One-step® dentin bonding agent (Bisco, USA), Z-250® resin (3M-ESPE, USA) was bonded to dentin with a mount jig. Shear bond strength was measured with an Instron machine (Type 4202, Instron Corp., USA) after 24 hours. The results were analyzed using one-way ANOVA and Duncan's multiple range test at p < 0.05.

Immediate bonding group showed significantly lower bond strength than un-bleached control group (p < 0.05).

Ethanol-treated group showed significantly higher bond strength compared to immediate bonding group (p < 0.05). However, the bond strength of the ethanol treatment group was lower than that of the un-bleached control group (p < 0.05).

There were no significant difference in shear bond strength between the 2-week delayed bonding group and the ethanol-treated group (p > 0.05) and between delayed bonding group and un-bleached control group (p > 0.05).

In the condition of the present study, it seems that alcohol pretreatment after bleaching procedure can reduce the adverse effect of vital bleaching agent on dentin bonding.

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• Effect of the bleaching light on whitening efficacy
  Jong-Hyun Park, Hye-Jin Shin, Deok-Young Park, Se-Hee Park, Jin-Woo Kim, Kyung-Mo Cho
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The bleaching of discolored nonvital teeth is conservative treatment that satisfy the cosmetic desire. The most common method for this treatment, walking bleaching, is using 30% hydrogen peroxide and sodium perborate.

Many alternatives are suggested for preventing the external cervical root resorption that is the common complication of the nonvital teeth bleaching with 30% hydrogen peroxide.

The same extent of oxidation reactions as that resulted by the bleaching with the application of 30% hydrogen peroxide and sodium perborate can also be acquired more safely by materials that contain 10% carbamide peroxide, used primarily for the bleaching of vital teeth. Therefore, this study was performed to evaluate the efficacy of 10% and 15% carbamide peroxide bleaching gel in nonvatal teeth bleaching.

The internal bleaching of intentionally discolored teeth was performed in vitro with 10% carbamide peroxide (Group 1), 15% carbamide peroxide (Group 2), mixture of distilled water and sodium perborate (Group 3), and mixture of 30% hydrogen peroxide and sodium perborate (Group 4). The bleaching materials were refreshed following 3, 6, 9 and 12 days. To evaluate the bleaching effect, the color change of the crowns was measured at 1, 2, 3, 4, 7 and 15 days of bleaching using the colorimeter.

The results were as follows :

1. L* and ΔE* values were increased with time in all bleaching agents(p<0.01).

2. There was no significant difference in L* and ΔE* value among bleaching agents.

3. ΔE* value higher than 3 was shown after 3 days of bleaching with 10% carbamide peroxide gel, 1 day with 15% carbamide peroxide gel, 4 days with mixture sodium perborate and distilled water and 4 days with mixture sodium perborate and 30% hydrogen peroxide, respectively.

These results revealed that the use of 10% and 15% carbamide peroxide bleaching gel in non-vital teeth bleaching is as effective as mixture of distilled water and sodium perborate and mixture of 30% hydrogen peroxide and sodium perborate. Accordingly, carbamide peroxide could be used clinically to bleach discolored non-vital teeth.