Avaliação da sensibilidade e eficácia do clareamento dental em pacientes adolescentes e adultos: estudo clínico randomizado e revisão sistemática
Carregando...
Arquivos
Data
2020-02-10
Autores
Veloso, Sheyla Mamede
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Esse trabalho objetivou através de um ensaio clínico de acompanhamento de 7 dias comparar o clareamento por 2 técnicas em jovens e adultos, avaliando a sensibilidade dental, eficácia e impactos na qualidade de vida, e por meio de uma revisão sistemática avaliar a segurança e eficácia do clareamento caseiro em comparação as demais técnicas em adolescentes. No estudo clínico 80 participantes constituíram 2 grupos: Jovens – JOV (14 a 20 anos) e adultos – ADU (40 a 60 anos) onde foram divididos aleatoriamente de acordo com a técnica clareadora: caseiro (CAS) e de consultório (CONS). A sensibilidade foi acompanhada com auxílio da Escala Visual Análoga (EVA) e Escala de Classificação Numérica (ECN), as alterações de cores através das escalas VITA Bleachedguide (VB), VITA Clássica (VC) e por fotografias e o impacto na qualidade de vida foi mensurado pelo questionário OHIP-14. Para análise estatística dos dados foram utilizados os testes ANOVA 2 fatores e de medidas repetidas, comparações múltiplas de Tukey, Kruskal-Wallis e Friedman. Os resultados mostraram que pela EVA os grupos CAS apresentaram menor sensibilidade que os CONS e que todos grupos apresentaram sensibilidade após 7 dias igual a inicial, pela ECN os grupos CONS apresentaram a sensibilidade após 2ª sessão e 7 dias superior à inicial e após 1ª sessão. As escalas VB e VC mostraram alterações de cores após 2ª sessão/semana e 7dias superior que após 1ª sessão/semana e apenas a escala VB detectou um clareamento após 7 dias dos JOV superior aos ADU. Pela análise de fotografias os JOV apresentaram um maior clareamento que os ADU. Não houve entre os grupos diferenças estatísticas para impactos na qualidade de vida. Pode-se concluir que a sensibilidade final para todos os grupos foi igual à sensibilidade inicial, que os JOV apresentaram um maior clareamento e que não houve diferenças no impacto na qualidade de vida. Na revisão sistemática, com base na pergunta de pesquisa e estratégia PICO (P): Pacientes adolescentes com dentes escurecidos (I) Intervenção: Clareamento dental caseiro (C) Comparação: demais técnicas de clareamento dental; (O) Desfecho: Sensibilidade dental, injúrias aos tecidos moles e eficácia clareadora, foi realizada uma busca com estratégia definida nas principais bases de dados eletrônicas. Foram incluídos ensaios clínicos que responderam a pergunta de pesquisa, e a extração de dados e análise de risco de viés foram realizada. Três artigos foram selecionados e estes comparavam clareamento caseiro com moldeiras x fitas. Para a alteração de cor, não foram encontradas diferenças entre os tratamentos, porém foi observada uma alta heterogeneidade. Adicionalmente uma meta-regressão que mostrou que a concentração do peróxido de hidrogênio (fitas) afeta significativamente a alteração de cor, explicando 100% da heterogeneidade para este desfecho. A incidência de sensibilidade e injúrias aos tecidos moles não foi influenciada pela técnica clareadora e os estudos apresentaram uma baixa heterogeneidade. Esta revisão pode concluir que os resultados obtidos sugerem que não existem diferenças entre as técnicas clareadoras (moldeiras x fitas) para à eficácia clareadora e segurança em jovens.
This study aimed, comparing 2 whitening techniques in young and adults people, assessing dental sensitivity, efficacy and impacts on quality of life by a 7-day follow-up clinical trial, and through a systematic review to evaluate the safety and efficacy of the home bleaching compared to other techniques in adolescents. In the clinical trial 80 participants constituted 2 groups: Young - YOUN (14 to 20 years old) and adults - ADU (40 to 60 years old) where they were randomly divided according to the whitening technique: at home (HOM) and in office (OFFI). Sensitivity was monitored with the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS), the color changes through the VITA Bleachedguide (VB), VITA Classical (VC) shade guides, and by photographs and the impact on quality of life was measured by the OHIP-14 questionnaire. Statistical analyses were performed using the 2-way ANOVA and repeated measures ANOVA. For multiple comparisons, Tukey, Kruskal-Wallis and Friedman tests were used. The results showed that by VAS the HOM groups showed less sensitivity than the OFFI and that all groups showed sensitivity after 7 days equal to the initial, by NRS the OFFI groups showed the sensitivity after the second session and 7 days higher than the initial and after the first session. The VB and VC scales showed color changes after the second session/week and 7 days higher than after the first session/week, and only the VB scale detected a whitening after 7 days of the YOUN superior to the ADU. Through the analysis of photographs, the YOUN showed greater leaching than the ADU. There were no statistical differences between groups for impacts on quality of life. It can be concluded that the final sensitivity for all groups was equal to the initial sensitivity, that the YOUN showed greater whitening and that there were no differences in the impact on quality of life. In the systematic review, based on the research question and strategy PICO (P): Adolescent patients with darkened teeth (I) Intervention: Home tooth whitening (C) Comparison: other teeth whitening techniques; (O) Outcome: Dental sensitivity, injuries to soft tissues and whitening efficacy, a search was carried out with a defined strategy in the main electronic databases. Clinical trials that answered the research question were included, and data extraction and risk of bias analysis were performed. Three studies were selected and they compared home whitening with trays x strips. For the color change, no differences were found between treatments, but a high heterogeneity was observed. Additionally, a meta-regression that showed that the concentration of hydrogen peroxide (strips) significantly affects the color change, explaining 100% of the heterogeneity for this outcome. The incidence of sensitivity and injuries to soft tissues was not influenced by the bleaching technique and the studies showed low heterogeneity. This review concluded that the results obtained suggest that there are no differences between the whitening techniques (trays x strips) for whitening efficacy and safety in young people.
This study aimed, comparing 2 whitening techniques in young and adults people, assessing dental sensitivity, efficacy and impacts on quality of life by a 7-day follow-up clinical trial, and through a systematic review to evaluate the safety and efficacy of the home bleaching compared to other techniques in adolescents. In the clinical trial 80 participants constituted 2 groups: Young - YOUN (14 to 20 years old) and adults - ADU (40 to 60 years old) where they were randomly divided according to the whitening technique: at home (HOM) and in office (OFFI). Sensitivity was monitored with the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS), the color changes through the VITA Bleachedguide (VB), VITA Classical (VC) shade guides, and by photographs and the impact on quality of life was measured by the OHIP-14 questionnaire. Statistical analyses were performed using the 2-way ANOVA and repeated measures ANOVA. For multiple comparisons, Tukey, Kruskal-Wallis and Friedman tests were used. The results showed that by VAS the HOM groups showed less sensitivity than the OFFI and that all groups showed sensitivity after 7 days equal to the initial, by NRS the OFFI groups showed the sensitivity after the second session and 7 days higher than the initial and after the first session. The VB and VC scales showed color changes after the second session/week and 7 days higher than after the first session/week, and only the VB scale detected a whitening after 7 days of the YOUN superior to the ADU. Through the analysis of photographs, the YOUN showed greater leaching than the ADU. There were no statistical differences between groups for impacts on quality of life. It can be concluded that the final sensitivity for all groups was equal to the initial sensitivity, that the YOUN showed greater whitening and that there were no differences in the impact on quality of life. In the systematic review, based on the research question and strategy PICO (P): Adolescent patients with darkened teeth (I) Intervention: Home tooth whitening (C) Comparison: other teeth whitening techniques; (O) Outcome: Dental sensitivity, injuries to soft tissues and whitening efficacy, a search was carried out with a defined strategy in the main electronic databases. Clinical trials that answered the research question were included, and data extraction and risk of bias analysis were performed. Three studies were selected and they compared home whitening with trays x strips. For the color change, no differences were found between treatments, but a high heterogeneity was observed. Additionally, a meta-regression that showed that the concentration of hydrogen peroxide (strips) significantly affects the color change, explaining 100% of the heterogeneity for this outcome. The incidence of sensitivity and injuries to soft tissues was not influenced by the bleaching technique and the studies showed low heterogeneity. This review concluded that the results obtained suggest that there are no differences between the whitening techniques (trays x strips) for whitening efficacy and safety in young people.
Descrição
Palavras-chave
Clareamento dental, Clareadores dentários, Adolescente, Revisão sistemática, Ensaio clínico controlado aleatório, Tooth bleaching agents, Tooth bleaching, Clinical trials