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Published on: July 4, 2017
Bleaching effectiveness of hydrogen peroxide containing titanium dioxide: A systematic review and meta-analysis
Yi-Ling Cheng1, Chen Su1, Bing-Jie Zhong1
1Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China; Department of Prosthodontics & Research Center of Dental Esthetics and Biomechanics, Fujian Medical University, Fuzhou, China.
Objectives:
This systematic review and meta-analysis aimed to evaluate the efficacy of incorporating titanium dioxide (TiO2) into a hydrogen peroxide (HP) gel to increase bleaching effectiveness.
Data Sources:
A comprehensive search was conducted in the PubMed, Web of Science, and Scopus databases through February 12, 2024.
Study Selection:
The eligibility criteria included studies comparing the bleaching effectiveness of HP alone to HP with incorporated TiO2. The risk of bias for in vitro studies was assessed using the RoBDEMAT tool, while in vivo studies were evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color difference (ΔE00) and whiteness index for dentistry (WID). The mean difference (MD) and 95% confidence interval (CI) for the ΔE00 and ΔWID values were calculated using a random-effects model (α=0.05).
Results:
A total of 17 studies were included in this systematic review, and 5 were included in the meta-analysis. Among the 17 eligible studies, 11 were in vitro studies, and 6 were in vivo studies. The commonly used HP concentrations were 6% and 35%, and the concentrations of incorporated TiO2 ranged from 0.2% to 10%. The meta-analysis demonstrated that incorporating TiO2 into HP gels resulted in significantly greater ΔE00 values (P=0.04; MD=0.50; 95% CI: 0.01 to 0.98) and ΔWID values (P=0.003; MD=2.28; 95% CI: 0.75 to 3.80) than did using HP gels alone, with the ΔWID exceeding the perceptible threshold.
Conclusions:
HP gels with TiO2 showed increased color and whitening index changes. However, standardized bleaching protocols, consistent color evaluation, and post-bleaching monitoring are needed for validation and study comparability. TiO2 properties (particle size, shape, crystal phase) significantly affect gel performance, requiring further research to determine optimal parameters.
Clinical Relevance:
Using a low-concentration HP gel with TiO2 may be a promising alternative to high-concentration HP bleaching, potentially minimizing the side effects.
