Objective: The purpose of this study was to compare the efficacy of a combined peroxide and light in-office tooth whitening system (BriteSmile) with 3 other whitening products. These included an overnight tray system, an in-office hand held light and peroxide system, and a whitening toothpaste. Methods: 100 subjects with an initial tooth shade of D4 (Vita) or darker participated in a parallel four-cell randomized single blind clinical trial. The outcome measure was the assessment of tooth color change of the 6 anterior maxillary teeth, 4 incisors and 2 canines. Tooth color was evaluated subjectively using a Vita shade guide and objectively using a chromameter to measure 9 sites across each tooth surface (3 incisal, 3 mid-tooth and 3 gingival). Safety and patient acceptance were evaluated by examination and subject questionnaires. Tooth color was assessed before and after treatment, and at 3 and 6 months. Results: There were no significant differences in the initial average shade guide values between the 4 groups. Post treatment, the group assigned to the BriteSmile treatment demonstrated a significantly larger change in tooth color than the other groups, with a mean change of 7.95 (+1.38) shade guide values. The hand held light and peroxide group had a mean change of 5.31 (+1.35), the tray group had a mean change of 5.97 (+1.62), and the toothpaste group had a mean change of 1.63 (+1.60). Conclusions: The BriteSmile system produced the greatest change in tooth color; this difference was highly significant (p<0.0001). The tray system and hand held system whitened teeth to a lesser extent. Their results differed significantly from toothpaste, but not from each other, indicating that the 2 procedures produced a similar whitening outcome. Toothpaste had a minimal effect on tooth whitening.

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