Objective: This research was conducted to systematically evaluate the clinical effectiveness of the 4 most popular direct-to-consumer whitening “intensive” systems. Methods: A meta-analysis was conducted using an inclusive dataset from 10 randomized clinical trials having common entrance criteria and methods. Each study compared 2 or more of the most popular direct-to-consumer, peroxide-based tooth whitening system under labeled 2-week usage conditions. Treatments were Crest® Whitestrips® (WS), Crest® Night Effects™ (NE), Colgate® Simply White™ (SW), or Colgate® Simply White® Night (SWN). Effectiveness was measured objectively as L*a*b* color change using digital image analysis. Comparative efficacy was evaluated using a mixed model that adjusted for study, age and baseline color. Results: The pooled sample included 420 subjects (18-75 years of age) who used the strip or brush-applied products. After 14 days, adjusted mean (SE) Db* (yellowness) was –2.4 (0.08), –1.0 (0.08), –0.3 (0.07), and –0.3 (0.09) for WS, NE, SW and SWN, respectively. Results were similar for DL* (lightness). Except for SW compared to SWN, groups differed significantly (p < 0.0001) in Db* and DL*. Less effective treatments had significantly (p < 0.0001) fewer two-parameter color improvements (–Db* and +DL*), with 100% of subjects in WS having two-parameter color improvements, compared to 81% in NE, 53% in SW, and 40% in SWN. For some subjects, use of peroxide for tooth whitening without a barrier resulted in color degradation. These outcomes were expected given the use of objective color measurement blinded as to treatment assignment and time. Conclusion: This meta-analysis demonstrated that whitening strips and percarbonate film provided significant color improvement (yellowness and lightness) compared to two popular paint-on gels.

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