Efeitos Comparativos De Diferentes Mecanismos De Ação Dessensibilizantes Na Redução Da Sensibilidade Dentária Induzida Pelo Clareamento Dentário De Consultório: Uma Revisão Sistemática Com Metanálise Em Rede

Abstract

Objective: This study aimed to assess, through a systematic review with network meta-analysis (NMA), the comparative effects of different desensitizing mechanisms of action on bleaching induced tooth sensitivity (TS) associated with in-office bleaching in patients with permanent dentition. (PROSPERO CRD42024544723) Data: Randomized controlled trials (RCTs) comparing desensitizing agents for the management of TS associated with in-office bleaching were included. A Bayesian NMA was conducted to evaluate both the intensity and the risk of TS across different categories of desensitizing agents, with individual interventions grouped at the network level according to their mechanisms of action (Tubule-occluder, Nerve-desensitization, Mixed, Association technique, and Desensitizer-free). TS intensity was assessed using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2.0 (RoB 2.0), and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Sources: The literature search was systematically conducted in PubMed, Cochrane Library, Brazilian Library of Dentistry (BBO), Latin American and Caribbean Health Sciences Literature (LILACS), Embase, Scopus, Web of Science and grey literature sources. Study Selection: After duplicate removal and title and abstract screening, 242 studies were selected for full-text assessment. Of these, 46 studies met the eligibility criteria and were included in the systematic review. Conclusion: The findings indicate that the use of desensitizing agents is consistently associated with a greater reduction in bleaching-induced TS compared with Desensitizer-free in-office bleaching strategies. However, differences among active desensitizing mechanisms were limited, imprecise, and did not demonstrate clinically robust superiority of any specific approach. Clinical Relevance: These findings support the routine use of desensitizing agents to reduce TS associated with in-office bleaching. Given the absence of consistent clinically meaningful differences among desensitizing mechanisms, the choice of desensitization strategy may be guided by clinical practicality, availability, and patient-related factors rather than presumed mechanistic superiority.