Effect of tooth bleaching in patients with fixed orthodontic appliances: A systematic review

Patients seeking a harmonious smile that combines satisfactory aesthetics and stable occlusion raise questions about the concomitant association of treatments. This systematic review aimed to answer the following question: "Does the application of hydrogen peroxide on teeth with fixed metallic orthodontic brackets interfere with the dental bleaching effect?". The PICOS (Population, Intervention, Comparison, Outcome, and Study design) strategy and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adhered to during the review process. A comprehensive search strategy was implemented, encompassing the PubMed®, Web of Science, Scopus, Embase, and LILACS databases. The risk of bias was assessed using the Cochrane risk of bias (RoB) 2.0 tool. The initial search yielded 51 articles, which were then filtered to remove duplicates. The titles and abstracts of 26 studies were subsequently reviewed. Eleven articles were selected for full-text reading, and after applying the eligibility criteria, 3 studies were included for qualitative analysis. Two studies were classified as having a low risk of bias, while 1 study was classified as having some concerns. The bleaching was satisfactory with 8% and 10% hydrogen peroxide (HP) applied for 45 min daily over 10 days, even with fixed orthodontic brackets. However, a single study that employed the in-office technique (38% HP) demonstrated that fixed orthodontic appliances influenced external tooth bleaching. Tooth bleaching using the home bleaching technique yielded effective results when performed alongside orthodontic treatment.