Introduction/objectives: This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of at-home bleaching agents and concentrations in patients with permanent dentition (PROSPERO 2021 CRD42021265220).

Data: Randomized clinical trials (RCTs) comparing any two at-home bleaching systems were considered eligible. A Bayesian NMA was conducted for color change (ΔE, ΔSGU) to compare different carbamide peroxide (CP) or hydrogen peroxide (HP) concentrations. The risk of bias (RoB) was assessed using the Cochrane tool 2.0 and the quality of evidence (QoE) with the GRADE approach.

Sources: A comprehensive search was conducted in PubMed, Cochrane Central, LILACS/BBO, SCOPUS, Web of Science, EMBASE, and grey literature.

Study selection/results: 81 studies were eligible and 53 included in the NMA. A high RoB was observed in most studies included. No statistically significant differences were found in most of the comparisons, except for the extreme concentrations. For ΔE: CP 5% vs. CP 15-17% (mean difference, [95% CrI]: -3.36 [-6.53 to -0.22]); HP 2-4% vs. CP 15-17% (-1.85 [-3.63 to -0.08]); CP 5% vs. CP 35-37% (-4.23 [-8.21 to -0.22]). For ΔSGU: HP 14-16% vs. CP 5% (4.66 [0.27 to 9.01]); HP 14-16% vs. HP 2-4% (4.06 [0.74 to 7.46]). The QoE was low.

Conclusions: Most at-home agents showed similar bleaching efficacy (ΔE, ΔSGU), except when the highest and lowest concentrations were compared one another with a low QoE. Further well-designed, low-bias RCTs is essential to achieve higher QoE.

Clinical significance: Low-certainty evidence points to similar efficacy of most at-home bleaching agents across concentrations, suggesting their clinical versatility in dental practice.

Keywords: Network meta-analysis; Systematic review; Tooth Bleaching Agents; Tooth bleaching; Tooth discoloration.

Copyright © 2025. Published by Elsevier Ltd.

简介/目标：这项系统综述和网络 meta 分析（NMA）旨在比较永久性牙齿患者中在家使用的漂白剂及其浓度的疗效（PROSPERO 2021 CRD42021265220）。

数据：纳入了任何两种家庭用漂白系统之间的随机对照试验（RCTs）。使用贝叶斯 NMA 对颜色变化（ΔE，ΔSGU）进行了比较，以对比不同浓度的过碳酰胺尿素（CP）或过氧化氢（HP）。风险偏倚（RoB）评估采用 Cochrane 工具 2.0 进行，证据质量（QoE）则通过 GRADE 方法进行评价。

资料来源：在 PubMed、Cochrane Central、LILACS/BBO、SCOPUS、Web of Science、EMBASE 和灰色文献中进行了全面检索。

研究选择/结果：81 项研究符合纳入标准，其中 53 项被纳入 NMA。大多数研究观察到高 RoB。除了极端浓度外，多数比较未发现统计学上的显著差异。对于 ΔE：CP 5% 对 CP 15-17%（平均差值 [95% CrI]：-3.36 [-6.53 到 -0.22]）；HP 2-4% 对 CP 15-17% （-1.85 [-3.63 到 -0.08]）；CP 5% 对 CP 35-37% （-4.23 [-8.21 到 -0.22]）。对于 ΔSGU：HP 14-16% 对 CP 5%（4.66 [0.27 到 9.01]）；HP 14-16% 对 HP 2-4%（4.06 [0.74 到 7.46]）。证据质量低。

结论：大多数家庭用漂白剂在 ΔE 和 ΔSGU 的漂白效果上表现出相似性，除了最高和最低浓度的比较外（低 QoE），还需要进一步设计良好的、偏倚较低的 RCTs 来提高证据质量。

临床意义：低确定性的证据表明，在不同浓度下大多数家庭用漂白剂具有相似的效果，这提示它们在牙科实践中的临床灵活性。

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