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Implications of European Union Sodium Perborate Restrictions for Intracoronal Bleaching Procedures: A Narrative
Marco M Herz1, Christian Meller1, Christian Klein1,2
1Department for Conservative Dentistry, University of Tübingen, Tübingen, Germany.
Objectives:
To critically evaluate current and emerging intracoronal bleaching agents and to provide an evidence-informed framework for clinical decision-making in the postsodium perborate era.
Overview:
The declining availability of sodium perborate, particularly within the European Union, has substantially altered contemporary intracoronal bleaching practice. A narrative review was conducted using a structured PubMed/MEDLINE literature search and manual reference screening. Evidence regarding bleaching efficacy, biological safety, peroxide diffusion, cervical root resorption, dentin-related effects, restorative implications, regulatory developments, and emerging bleaching materials was critically synthesized. Hydrogen peroxide, carbamide peroxide, and sodium percarbonate all achieve clinically relevant whitening but differ in biological characteristics and the strength of supporting evidence. Hydrogen peroxide remains effective but raises greater concerns regarding peroxide diffusion and concentration-dependent biological effects. Carbamide peroxide is supported by extensive contemporary clinical evidence and long-term outcome data, whereas sodium percarbonate represents a promising borate-free alternative currently supported primarily by laboratory and ex vivo studies.
Conclusions:
Among currently available intracoronal bleaching agents, carbamide peroxide is supported by one of the largest bodies of contemporary clinical literature and represents one of the most extensively documented contemporary alternatives to sodium perborate. Sodium percarbonate shows considerable potential but requires prospective clinical validation before more definitive clinical recommendations can be made.
Clinical Significance:
This review provides an evidence-informed framework for selecting contemporary intracoronal bleaching agents to achieve predictable esthetic outcomes in the postsodium perborate era while identifying priorities for future clinical research.