Non-Cochrane · intervention · PM42782920
Effect of Applicator Brush Use on Color Change, Hydrogen Peroxide Penetration, and Gel Consumption in In-Office Bleaching: A Systematic Review and Meta-Analysis.
Miranda Samille Biasi, Rodrigues Rosalia Maux de Carvalho, Leal Caroline de Farias Charamba, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14090533
Findings
10 findings
| Population | ||||
|---|---|---|---|---|
| Extracted human premolars | 35% hydrogen peroxide in-office bleaching gel applied with applicator brush | 35% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔWID Laboratory | MD 0.03 [-1.65, 1.71] Very low Downgraded: risk of bias, imprecision, indirectness 3 studies |
| Extracted human premolars | 35% hydrogen peroxide in-office bleaching gel applied with applicator brush | 35% hydrogen peroxide in-office bleaching gel applied without applicator brush | Hydrogen peroxide concentration in pulp chamber (µg/mL) Laboratory | MD -0.51 [-1.07, 0.06] Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness 3 studies |
| Extracted human premolars | 35% hydrogen peroxide in-office bleaching gel applied with applicator brush | 35% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔE00 Laboratory | MD -0.37 [-0.95, 0.21] Very low Downgraded: risk of bias, imprecision, indirectness 3 studies |
| Extracted human premolars | 35% hydrogen peroxide in-office bleaching gel applied with applicator brush | 35% hydrogen peroxide in-office bleaching gel applied without applicator brush | Bleaching gel consumption (g) Laboratory | MD -0.07 [-0.15, 0.00] Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness 3 studies |
| Extracted human premolars | 35% hydrogen peroxide in-office bleaching gel applied with applicator brush | 35% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔEab Laboratory | MD -0.36 [-1.47, 0.74] Very low Downgraded: risk of bias, imprecision, indirectness 3 studies |
| Adolescents aged 12–16 years with vital permanent teeth | 6% hydrogen peroxide in-office bleaching gel applied with applicator brush | 6% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔEab Clinical | no estimate extracted GRADE not reported 1 study · 60 participants |
| Adolescents aged 12–16 years with vital permanent teeth | 6% hydrogen peroxide in-office bleaching gel applied with applicator brush | 6% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔE00 Clinical | no estimate extracted GRADE not reported 1 study · 60 participants |
| Adolescents aged 12–16 years with vital permanent teeth | 6% hydrogen peroxide in-office bleaching gel applied with applicator brush | 6% hydrogen peroxide in-office bleaching gel applied without applicator brush | Subjective color change ΔSGU Clinical | no estimate extracted GRADE not reported 1 study · 60 participants |
| Adolescents aged 12–16 years with vital permanent teeth | 6% hydrogen peroxide in-office bleaching gel applied with applicator brush | 6% hydrogen peroxide in-office bleaching gel applied without applicator brush | Color change ΔWID Clinical | no estimate extracted GRADE not reported 1 study · 60 participants |
| Adolescents aged 12–16 years with vital permanent teeth | 6% hydrogen peroxide in-office bleaching gel applied with applicator brush | 6% hydrogen peroxide in-office bleaching gel applied without applicator brush | Tooth sensitivity risk and intensity Clinical | no estimate extracted GRADE not reported 1 study · 60 participants |
Included primary studies 4
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bernardi 2022 Use of an applicator brush with high concentration bleaching gels. PMID:35776203 | 2022 | this review only | not stated | not extracted yet |
| Carneiro 2023a In-office dental bleaching in adolescents using 6% hydrogen peroxide with different application tips: randomized clinical trial. PMID:37909527 | 2023 | this review only | not stated | not extracted yet |
| Carneiro 2023b Application Tip and Concentration of a Self-mixing Bleach: Hydrogen Peroxide Inside the Pulp Chamber, Color Change, and Amount of… PMID:36786759 | 2023 | this review only | not stated | not extracted yet |
| Centenaro 2024 Effect of a brush tip on in-office bleaching gels in an attachable syringe: Hydrogen peroxide penetration, bleaching efficacy and amount… PMID:39019248 | 2024 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with vital permanent teeth; human or bovine teeth | Extracted upper human premolars (n=3 in vitro studies; 184 specimens); adolescents aged 12-16 years (n=1 RCT; 60 participants) |
| Intervention | In-office whitening gel applied with an applicator brush | Applicator brush tip with in-office hydrogen peroxide gels 6% to 40% (n=4); 35% HP pooled (n=3) |
| Comparison | In-office whitening gel applied without an applicator brush | Application tip without brush (n=4) |
| Outcomes | Hydrogen peroxide concentration in the pulp chamber; amount of whitening gel used; color change (abstract also lists tooth sensitivity) | HP concentration in pulp chamber (n=3); bleaching gel consumption (n=3); color change ΔEab, ΔE00, ΔWID (n=4; pooled n=3); tooth sensitivity risk and intensity (n=1, not pooled) |
| Study designs | In vitro, in situ, randomized and non-randomized clinical trials | In vitro studies (n=3); RCT (n=1) |
| Timing | Not specified | RCT color follow-up 1 week, 2 weeks, 3 weeks and 1 month; in vitro timing not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | Partial Yes | no |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: Yes | RCT: N/A · Yes · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |