title: Nightguard vital bleaching: a long-term study on efficacy, shade retention. side effects, and patients' perceptions.
abstract: BACKGROUND
  The scientific literature is lacking in long-term clinical data on the duration of efficacy and post-treatment side effects of nightguard vital bleaching.
  
  
  OBJECTIVE
  This longitudinal clinical study was undertaken (1) to determine the clinical efficacy and duration of efficacy at 3, 6, and 47 months post treatment of a peroxide-containing whitening solution; (2) to evaluate safety issues with respect to using a peroxide whitening solution; and (3) to determine patients' perceptions of the whitening technique.
  
  
  METHODS
  This project was part of a nightguard vital bleaching study involving human participants. The study teeth for efficacy and duration of efficacy when using a 10% carbamide peroxide solution were the four maxillary central and lateral incisors, with the tooth shade being taken from the middle third of the tooth. Safety issues evaluated were the changes in gingival index (GI), plaque index (PI), nonmarginal gingival index (NMGI), nongingival oral mucosal index (NGOMI), and tooth vitality (TV). Radiographic changes of the study teeth and the patients' perceptions of tooth sensitivity (TS) or gingival irritation (Girr) during treatment and post treatment were also evaluated.
  
  
  RESULTS
  The active 10% carbamide peroxide whitening solution used in this study was effective in lightening teeth (98%), and this effect was sustained at a mean of 47 months post treatment in 82% of the participants. When evaluating safety issues, 66% of the participants using the active solution reported TS or Girr. No one reported TS or Girr or any other adverse effects at the end of the study.
  
  
  CONCLUSIONS
  The results of this study concur with those of previously reported studies that nightguard vital bleaching using a 10% carbamide peroxide whitening solution according to the manufacturer's instructions is efficacious and safe, with minimal side effects. In addition, long-term shade retention was reported by 82% of the participants at the end of the study, with no adverse side effects.
  
  
  CONCLUSIONS
  Results of this study should reassure dentists that nightguard vital bleaching is a safe, effective, and predictable method to lighten teeth. The whitening effect lasted up to 47 months in 82% of the patients, with no adverse side effects reported at the end of the study.
authors.affiliation: Department of Diagnostic Sciences and General Dentistry, University of North Carolina School of Dentistry, Chapel Hill 27599-7450, USA. Ralph_Leonard@dentistry.unc.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Leonard
authors.forename: C
authors.initials: C
authors.lastname: Bentley
authors.forename: J C
authors.initials: JC
authors.lastname: Eagle
authors.forename: G E
authors.initials: GE
authors.lastname: Garland
authors.forename: M C
authors.initials: MC
authors.lastname: Knight
authors.forename: C
authors.initials: C
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000077463:Carbamide Peroxide; D003116:Color; D018592:Cross-Over Studies; D003774:Dental Plaque Index; D003791:Dental Pulp Test; D003807:Dentin Sensitivity / Q000209:etiology; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007180:Incisor; D008137:Longitudinal Studies; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects; D017060:Patient Satisfaction; D010512:Periodontal Index; D010545:Peroxides / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014073:Tooth Bleaching / Q000009:adverse effects; D014508:Urea / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D004338:Drug Combinations; D010545:Peroxides; D000077463:Carbamide Peroxide; D014508:Urea