Does the Use of Reservoirs Have Any Impact on the Efficacy of At-Home Bleaching? A Systematic Review

Martini, Eveline Claudia; Parreiras, Sibelli Olivieri; Acuña, Eric Dario; Loguercio, Alessandro Dourado; Reis, Alessandra

doi:10.1590/0103-6440201902422

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Article • Braz. Dent. J. 30 (3) • May-Jun 2019 • https://doi.org/10.1590/0103-6440201902422 copy

Does the Use of Reservoirs Have Any Impact on the Efficacy of At-Home Bleaching? A Systematic Review

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Abstract

To answer the following focused question through a systematic review: “Are the risk and intensity of tooth sensitivity (TS) and bleaching efficacy different between adult patients who undergo at-home bleaching using trays with reservoirs and those who use trays without reservoirs?”. A comprehensive search was performed in the MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and grey literature without restrictions. Abstracts from conferences; unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periódicos Capes Theses databases) were searched. Only randomized clinical trials (RCTs) were included. We used the Risk of Bias tool (RoB) from the Cochrane Collaboration for quality assessment. After the removal of duplicates, title and abstract screening and full-text examination, nine RCTs remained for qualitative analyses. The great majority of the studies did not report the method of randomization, allocation concealment, and examiner blinding during color assessment. From the nine studies, eight were at unclear risk of bias. In regard to color change, four studies reported no change and two reported improved color change with reservoirs. Only four studies recorded tooth sensitivity and they reported no significant differences. Only one study reported greater gingival irritation with reservoirs. Lack of data reporting prevented us from running a meta-analysis. Further well-designed RCT should be conducted to answer this research question. So far there is not evidence to support that reservoirs in bleaching trays improve color change. PROSPERO - CRD42016037628

Key Words:
systematic review; reservoirs; at-home bleaching; dental sensitivity

Study ID	Study design [setting]	Method of color Assessment	Subject’s age in mean ± SD [range] (yrs)	No. of subjects (male [%])	No. patients [drop-outs]	Groups/ materials	Bleaching protocol	Outcomes evaluated
Study ID	Study design [setting]	Method of color Assessment	Subject’s age in mean ± SD [range] (yrs)	No. of subjects (male [%])	No. patients [drop-outs]	Groups/ materials	Bleaching protocol	Color change	Tooth sensitivity	Gingival Inflammation
Bosma 2000 ¹⁷17 Bosma M BJ, Dorfman W, Soo K. Evaluation of a tray fabrication design and effects on vital tooth bleaching. Hilltop Research, Inc Project No 98100673 August 7 2000.	Split mouth [n.r.]	Vita shade guide and narrative description based on photographies	n.r. ± n.r. [n.r.]	n.r.[n.r.]	34 [0]	n.r. 16% CP^c	4 h daily (2 weeks)	ΔSGU, but SD was not reported	Not evaluated	n.r.
Delgado 2000 ⁽¹⁸18 Delgado RJM ML. Nightguard vital bleaching without the addition of spacers to the cast. A simpler and faster, low cost and effective technique. Rev Cienc Odontol 2000;3:41-46.	Split mouth [University]	Narrative description based on photographies	n.r. ± n.r. [19-23]	n.r.	12 [0]	15% CP^d	8 h daily (15 days)	n.r. Only subjective description	Absolute risk, but data was partially reported	Not evaluated.
Ishikawa 2011 ¹⁶16 Ishikawa A TY. Clinical efficiency of home whitening with/without reservoirs. J Dent Res 2011;85((Spec Iss B): #174.).	Parallel [n.r.]	Colorimeter^a	n.r. ±n.r. [20-40]	n.r.[n.r.]	5 [0]	n.r. 10% CP^e	2 h daily (14 days)	ΔL, Δa, Δb, but SD was not reported.	Not evaluated	Not evaluated
Javaheri 2000 ¹⁹19 Javaheri DS, Janis JN. The efficacy of reservoirs in bleaching trays. Oper Dent 2000;25:149-151.	Split mouth [n.r.]	Shade guide unit^b	n.r. ± n.r. [19-64]	8 [26]	30 [0]	10% CP^f	2 hours/twice a day (10 days)	ΔSGU but data was not reported.	Absolute risk	Absolute risk
Kirsten 2009 ²²22 Kirsten GA, Freire A, de Lima AA, Ignacio SA, Souza EM. Effect of reservoirs on gingival inflammation after home dental bleaching. Quintessence Int 2009;40:195-202.	Split mouth [University]	n.r.	n.r. ± n.r. [18-25]	19 [100]	19 [0]	16% CP^g	2 h daily (21 days)	Not evaluated.	Not evaluated.	Not evaluated. Only histological evaluation of the gingival tissue.
Matis 2002 ¹⁵15 Matis BA, Hamdan YS, Cochran MA, Eckert GJ. A clinical evaluation of a bleaching agent used with and without reservoirs. Oper Dent 2002;27:5-11.	Split mouth [n.r.]	Photos, Shade Guide and Colorimeter readings	48.3 ± n.r. [23-68]	12 [44]	27 [0]	15% CP^h	2 h daily (14 days)	ΔE and ΔSGU but SD was not reported in both measures	Absolute risk but SD was not reported	Intensity of pain, but SD was not reported
Miller 2000 ²⁰20 Miller MB, Castellanos IR, Rieger MS. Efficacy of home bleaching systems with and without tray reservoirs. Pract Periodontics Aesthet Dent 2000;12:611-614.	Split mouth [n.r.]	Narrative description based on photographs	n.r. ± n.r. [20-50]	4 [19]	21 [0]	HP (5.5ⁱ and 7.5%ⁱ); Nonperoxide^j; CP (10^l, 10^f, 10^m; 16^c, 16^l, 16ⁿ, 16^m; 15^b, 20^o)	Not mentioned (followed manufacturer’s directions).	n.r.Only subjective description.	Not evaluated	Not evaluated
Morais e Moura 2007 ²⁵25 Morais e Moura R DN, BADINI SRG. Evaluation of the need of internal spacers in a mounthguard for home bleaching technique. Study in vivo. Rev Odonto 2007;15.	Split mouth [n.r.]	Narrative description based on photographs	n.r. ± n.r.[15-40]	8 [22]	36 [0]	10% CP^p	4 h daily (14-30 days)	n.r.Only subjective description	Absolute risk, data was partially reported	Not evaluated
Martini 2018 ²⁴24 Martini EC PS, Loguercio AD, Reis A. Evaluation of the presence and absence of reservoirs in a home bleaching tray: randomized, multicenter and blind clinical trial. Brazilian Registry of Clinical Trials (ReBrac); 2018.	Split mouth [University]	Shade Guide and Colorimeter readings	n.r.[18-50]	n.r.	n.r.	10% CP^q	3 h daily (21 days)	ΔE and ΔSGU	Risk and intensity (VAS and NRS scales)	Absolute risk

Study ID	Description of the results
Study ID	Color change	Tooth sensitivity	Gingival Inflammation
Bosma 2000 ¹⁷17 Bosma M BJ, Dorfman W, Soo K. Evaluation of a tray fabrication design and effects on vital tooth bleaching. Hilltop Research, Inc Project No 98100673 August 7 2000.	Subjective description through photos with a reduction of 5.6 color units in the 2 groups, without significant differences (p> 0.05).	Not evaluated	Not observed in any group.
Delgado 2000 ⁽¹⁸18 Delgado RJM ML. Nightguard vital bleaching without the addition of spacers to the cast. A simpler and faster, low cost and effective technique. Rev Cienc Odontol 2000;3:41-46.	Subjective description through photos. The authors concluded that the groups were not different.	Only one patient reported tooth sensitivity and was treated with 1.1% NaF. No measurement in pain scale was reported by the authors.	Not evaluated
Ishikawa 2011¹⁶16 Ishikawa A TY. Clinical efficiency of home whitening with/without reservoirs. J Dent Res 2011;85((Spec Iss B): #174.).	5 patients were evaluated through objective color measurement. 8 units of color on the side with reservoirs and 6.8 on the side without reservoirs (p < 0.05).	Not evaluated	Not evaluated
Javaheri 2000 ¹⁹19 Javaheri DS, Janis JN. The efficacy of reservoirs in bleaching trays. Oper Dent 2000;25:149-151.	30 patients evaluated with subjective color measurement, no difference between sides was noted and no statistical analysis was performed.	None of the patients reported tooth sensitivity.	None of the patients reported irritation in the mucosa..
Kirsten 2009 ²²22 Kirsten GA, Freire A, de Lima AA, Ignacio SA, Souza EM. Effect of reservoirs on gingival inflammation after home dental bleaching. Quintessence Int 2009;40:195-202.	Not evaluated.	Not evaluated.	19 patients evaluated, sides with reservoir increase of inflammation only immediately after bleaching (p = .0075). Differences were found in the inflammation intensity between groups immediately after and 45 days after bleaching (p < 0.01). Mild inflammation in the group without reservoir and moderate inflammation with a reservoir.
Matis 2002 ¹⁵15 Matis BA, Hamdan YS, Cochran MA, Eckert GJ. A clinical evaluation of a bleaching agent used with and without reservoirs. Oper Dent 2002;27:5-11.	Group with reservoirs had significantly higher ΔE than group without reservoirs in all time assessments (p<0.01), except week 6 (p = 0.11).	No significant difference (p = 0.90).	No significant difference (p = 0.46).
Miller 2000 ²⁰20 Miller MB, Castellanos IR, Rieger MS. Efficacy of home bleaching systems with and without tray reservoirs. Pract Periodontics Aesthet Dent 2000;12:611-614.	Subjective description through photos and without differences between groups.	No significant difference.	Not evaluated.
Morais e Moura 2007 ²⁵25 Morais e Moura R DN, BADINI SRG. Evaluation of the need of internal spacers in a mounthguard for home bleaching technique. Study in vivo. Rev Odonto 2007;15.	Not evaluated.	18^th day only - same tooth sensitivity in both groups.	Not evaluated.
Martini 2018 ²⁴24 Martini EC PS, Loguercio AD, Reis A. Evaluation of the presence and absence of reservoirs in a home bleaching tray: randomized, multicenter and blind clinical trial. Brazilian Registry of Clinical Trials (ReBrac); 2018.	Results not collected yet (study found in a clinical trial registry)	Results not collected yet	Results not collected yet

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[1] Correspondence: Profa. Dra. Alessandra Reis, Rua Carlos Cavalcanti, 4748 Bloco M, Sala 64-A, 84030-900, Ponta Grossa, PR, Brazil; Tel: +55-42-9 9903-0101. e-mail: reis_ale@hotmail.com