Effect of the type of application tip for 35% hydrogen peroxide on bleaching efficacy and tooth sensitivity: A randomized clinical trial

J Esthet Restor Dent. 2024 Jul;36(7):1029-1037. doi: 10.1111/jerd.13219. Epub 2024 Mar 12.


Objectives: Evaluate the bleaching efficacy (BE) and tooth sensitivity (TS) of in-office bleaching using different application tips.

Methods: Forty-eight participants were selected (split-mouth), one to receive bleaching with an attached brush tip and one with a conventional tip. The procedure was performed with Whiteness Automixx Plus 35%. The BE was evaluated at the beginning, weekly, one and 12 months post-bleaching with a Vita Easyshade spectrophotometer (ΔE*ab, ΔE00, and WID) and with Vita classical A1-D4 and Vita Bleachedguide shade guides units (ΔSGU). Absolute risk and intensity of TS were recorded using the Visual Analogue Scale. The equivalence of BE was analyzed using the two one-sided t-tests for paired samples. The absolute risk of TS was evaluated using the McNemar test, and the TS intensity was measured with the paired t test (α = 0.05).

Results: The equivalence of BE was observed for both groups in all color evaluations (p > 0.05). A lower absolute risk and intensity of TS were observed for the attached brush tip when compared with the conventional tip (p < 0.003 and p < 0.0001).

Conclusion: Using an attached brush tip showed the same BE as a conventional tip. However, for the attached brush tip, there was a reduction in TS.

Clinical significance: The applicator-attached brush tip is recommended for in-office dental bleaching, because of the possible reduction in risk and intensity of TS.

Keywords: bleaching gels; dentin sensitivity; hydrogen peroxide; randomized clinical trial; tooth bleaching.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Dentin Sensitivity* / prevention & control
  • Female
  • Humans
  • Hydrogen Peroxide*
  • Male
  • Tooth Bleaching Agents
  • Tooth Bleaching* / methods
  • Young Adult


  • Hydrogen Peroxide
  • Tooth Bleaching Agents