Impact of the in-office bleaching gels pH on tooth sensitivity in combined bleaching techniques: a randomized clinical trial.

OBJECTIVES: This randomized, parallel, single-blind clinical trial evaluated tooth sensitivity (TS), efficacy, gingival irritation (GI), aesthetic self-perception, and psychosocial impact of combined bleaching using in-office bleaching agents with different pHs. MATERIALS AND METHODS: 160 participants were randomized into two groups (n = 80) with 35% hydrogen peroxide in-office bleaching gels: Whiteness HP Maxx (acidic, unstable pH) and Whiteness HP Automixx Plus (neutral, stable pH). In-office bleaching was performed in one session: HP Maxx (3 applications of 15 min) and HP Automixx Plus (1 application of 50 min). Both groups then received at-home bleaching with 10% carbamide peroxide for 4 h daily for two weeks. TS and GI were assessed using Visual Analogue Scales. Color change was measured with a spectrophotometer and color guides. Aesthetic self-perception and psychosocial impact were evaluated using three scales: Orofacial Aesthetics Scale, Oral Health Impact Profile, and Psychosocial Impact Questionnaire of Dental Aesthetics. RESULTS: The risk and intensity of TS significantly favored the neutral and stable pH gel for both in-office (p < 0.001) and combined treatments (p < 0.004). Both groups achieved significant whitening (p > 0.37). No difference in GI risk or intensity was found (p > 0.11). All aesthetic and psychosocial scales showed significant improvement post-treatment (p < 0.05). CONCLUSION: Using a gel with neutral and stable pH during in-office bleaching reduces the risk and intensity of TS without compromising whitening efficacy. CLINICAL RELEVANCE: Combining at-home and in-office bleaching with a neutral, stable gel reduces TS risk and intensity while ensuring optimal whitening results and patient comfort.