Influence of dental bleaching on the pulp tissue: A systematic review of in vivo studies

IF 5.4 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE International endodontic journal Pub Date : 2024-03-12 DOI:10.1111/iej.14061

Mariana Viana Donato, Alexandre Henrique dos Reis-Prado, Lucas Guimarães Abreu, Lara Cancella de Arantes, Juliana Goto, Hebertt Gonzaga dos Santos Chaves, Luciano Tavares Angelo Cintra, André Luiz Fraga Briso, Isabella Faria da Cunha Peixoto, Francine Benetti

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Abstract

Background

Although several studies indicate the harmful effects of bleaching on pulp tissue, the demand for this procedure using high concentrations of hydrogen peroxide (HP) is high.

Objectives

To investigate the influence of bleaching on the pulp tissue.

Methods

Electronic searches were conducted (PubMed/MEDLINE, Scopus, Cochrane Library and grey literature) until February 2021. Only in vivo studies that evaluated the effects of HP and/or carbamide peroxide (CP) bleaching gels on the inflammatory response in the pulp tissue compared with a non-bleached group were included. Risk of bias was performed according to a modified Methodological Index for Non-Randomized Studies scale for human studies and the Systematic Review Centre for Laboratory Animal Experimentation's RoB tool for animal studies. Meta-analysis was unfeasible.

Results

Of the 1311 studies, 30 were eligible. Of these, 18 studies evaluated the inflammatory response in animal models. All these studies reported a moderate-to-strong inflammatory response in the superficial regions of pulp, characterized by cell disorganization and necrotic areas, particularly during the initial periods following exposure to 35%–38% HP, for 30–40 min. In the evaluation of human teeth across 11 studies, seven investigated inflammatory responses, with five observing significant inflammation in the pulp of bleached teeth. In terms of tertiary dentine deposition, 11 out of 12 studies noted its occurrence after bleaching with 35%–38% HP in long-term assessments. Additionally, three studies reported significant levels of osteocalcin/osteopontin at 2 or 10 days post-treatment. Other studies indicated an increase in pro-inflammatory cytokines ranging from immediately up to 10 days after bleaching. Studies using humans' teeth had a low risk of bias, whereas animal studies had a high risk of bias.

Discussion

Despite the heterogeneity in bleaching protocols among studies, High-concentrations of HP shows the potential to induce significant pulp damage.

Conclusions

High-concentrations of bleaching gel increases inflammatory response and necrosis in the pulp tissue at short periods after bleaching, mainly in rat molars and in human incisors, in addition to greater hard tissue deposition over time. However, further well-described histological studies with long-term follow-up are encouraged due to the methodological limitations of these studies.

Registration

PROSPERO (CRD42021230937).

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牙齿漂白对牙髓组织的影响：体内研究的系统回顾。

背景：尽管一些研究表明漂白对牙髓组织有害，但使用高浓度过氧化氢（HP）进行漂白的需求量很大：研究漂白对牙髓组织的影响：方法：进行电子检索（PubMed/MEDLINE、Scopus、Cochrane Library 和灰色文献），直至 2021 年 2 月。仅纳入了评估HP和/或过氧化卡巴酰胺（CP）漂白凝胶与未漂白组相比对牙髓组织炎症反应影响的体内研究。对于人类研究，根据修改后的非随机研究方法指数表进行偏倚风险分析；对于动物研究，根据实验动物实验系统性审查中心的 RoB 工具进行偏倚风险分析。元分析不可行：在 1311 项研究中，有 30 项符合条件。其中 18 项研究评估了动物模型的炎症反应。所有这些研究都报告了牙髓表层区域的中度至强烈炎症反应，其特点是细胞紊乱和坏死区域，尤其是在暴露于 35%-38% HP 30-40 分钟后的初期。在对人类牙齿进行的 11 项评估研究中，有 7 项研究调查了炎症反应，其中 5 项研究观察到漂白牙齿的牙髓有明显炎症。在牙本质三级沉积方面，12 项研究中有 11 项指出，在使用 35%-38% HP 漂白后的长期评估中出现了牙本质三级沉积。此外，有三项研究报告称，在治疗后 2 天或 10 天，骨钙素/osteopontin 的水平显著升高。其他研究表明，漂白后的促炎细胞因子会在短短10天内增加。使用人类牙齿进行的研究偏倚风险较低，而动物研究的偏倚风险较高：讨论：尽管各研究的漂白方案不尽相同，但高浓度漂白剂有可能诱发严重的牙髓损伤：结论：高浓度漂白凝胶会在漂白后短时间内增加牙髓组织的炎症反应和坏死，主要是在大鼠磨牙和人类门牙中，此外，随着时间的推移，硬组织沉积也会增加。然而，由于这些研究在方法上的局限性，我们鼓励进一步开展长期跟踪的组织学研究：PROCROPERO（CRD42021230937）。

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来源期刊

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.