Evaluation of tooth sensitivity and whitening effects of tooth whitening agents containing calcium, hydroxyapatite and fluoride.

Abstract

This randomized clinical trial evaluated the effects of hydrogen peroxide (HP)-based whitening agents containing calcium, hydroxyapatite, and fluoride on color change (ΔE₀₀), whiteness change (ΔWID), and post-whitening tooth sensitivity (TS). Sixty participants were randomly allocated to three groups (n = 20) and treated with different in-office whitening systems: Opalescence Boost (40% HP and fluoride), Whiteness HP Blue (35% HP and calcium), and Biowhiten ProOffice PowerHP (18% HP and hydroxyapatite). Color change was measured spectrophotometrically before treatment, immediately after treatment, and at 1, 2, 4, 8, and 16 weeks, as well as at 6 months and 1 year. Tooth sensitivity was assessed using the Numerical Rating Scale (NRS). Patient satisfaction was also evaluated using a questionnaire. ΔE₀₀ values showed significant differences among the groups at all evaluation periods except immediately after treatment and at 1 year (p < 0.05). ΔWID values demonstrated significant differences at all time points except at 2 weeks, 4 weeks, and 1 year (p < 0.05). Immediately after treatment, NRS scores were significantly lower in the HP18 group than in the HP40 group (p < 0.05), while the HP35 group did not differ significantly from either group. No significant differences among the groups were observed at the subsequent time points (p > 0.05). No significant difference was found in patient satisfaction scores (p = 0.728). Despite differences in hydrogen peroxide concentration and formulation characteristics, all whitening systems provided comparable whitening efficacy, tooth sensitivity outcomes, and patient satisfaction after 1 year. The study was conducted prospectively and registered retrospectively at ClinicalTrials.gov (NCT06855940) on February 25, 2025.