Efficiency of Teeth Bleaching after Regenerative Endodontic Treatment: A Systematic Review

Abstract

The aim of this review is to evaluate of effectiveness of bleaching procedures used to treat discolored teeth subsequent to regenerative endodontic procedures (REPs) based on the review of in vitro and in vivo studies. This literature review was carried out according to the PRISMA guidelines. Four databases (PubMed, Scopus, the Cochrane Library, and Web of Science databases) were searched electronically, until 30 January 2020 without a year limit. The quality of studies was assessed using a modified methodological index for non-randomized studies. After analyzing 1405 studies, 6 in vitro and 9 in vivo studies were eligible for this review. In in vitro studies, effectiveness of bleaching was assessed in teeth discolored by antibiotic pastes, blood, and barrier materials in various combinations. In all analyzed studies, bleaching was effective in teeth discolored by antibiotic pastes as well as by blood and barrier materials. Of 26 treated teeth in the in vivo studies, 17 teeth were bleached successfully. In six cases, there was improvement of the shade. In three cases, bleaching was not sufficient. Bleaching material, techniques, and times differed between studies. Whitening of discolored teeth after REPs is achievable. However, to establish precise guidelines, further long-term clinical studies should be performed.

Keywords: bleaching; carbamide peroxide; hydrogen peroxide; regenerative endodontic treatment; revascularization; sodium perborate.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram of the search strategy.

Figure 2

Delta E values defining the color changes of the tooth induced by bleaching materials reported in in vitro studies. Abbreviations: BD, Biodentine; CA, closed apices; CG, control group; d, day; DAP, double antibiotic paste; GIC, glass ionomer cement; HP, hydrogen peroxide; MTA, mineral trioxide aggregate; OA, open apices; PMTA, Pro Root MTA; SP, sodium perborate; TAPA, triple antibiotic paste with amoxicillin; TAPC, triple antibiotic paste with cefaclor; TAPD, triple antibiotic paste with doxycycline; TAPM, triple antibiotic paste with minocycline; TPB, thermo/photo bleaching; w, week; WB, walking bleaching; WMTA, white MTA.