Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Int Endod J. 2024 Jun;57(6):630-654. doi: 10.1111/iej.14061. Epub 2024 Mar 12.
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.
To investigate the influence of bleaching on the pulp tissue.
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.
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.
Despite the heterogeneity in bleaching protocols among studies, High-concentrations of HP shows the potential to induce significant pulp damage.
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.
PROSPERO (CRD42021230937).
尽管有几项研究表明漂白对牙髓组织有有害影响，但使用高浓度过氧化氢（HP）进行该程序的需求很高。
研究漂白对牙髓组织的影响。
电子检索（PubMed/MEDLINE、Scopus、Cochrane 图书馆和灰色文献）至 2021 年 2 月。仅纳入了评估 HP 和/或过氧化脲（CP）漂白凝胶对与未漂白组相比牙髓组织炎症反应的影响的体内研究。根据改良的针对非随机研究的方法学指数对人类研究进行偏倚风险评估，并对动物研究采用系统性综述中心实验室动物实验的 RoB 工具进行评估。无法进行荟萃分析。
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中的炎症反应。所有这些研究都报告了牙髓浅层区域存在中度至重度炎症反应，特征为细胞排列紊乱和坏死区域，尤其是在暴露于 35%-38% HP 后最初的 30-40 分钟内。在 11 项研究中评估了人类牙齿，其中 7 项研究评估了炎症反应，其中 5 项研究观察到漂白牙齿的牙髓有明显炎症。关于第三牙本质沉积，在使用 35%-38% HP 进行长期评估的 12 项研究中有 11 项注意到其发生。此外，有 3 项研究报告在治疗后 2 或 10 天骨钙素/骨桥蛋白水平显著升高。其他研究表明，漂白后即刻至 10 天内促炎细胞因子水平升高。使用人类牙齿的研究具有低偏倚风险，而动物研究具有高偏倚风险。
尽管研究中的漂白方案存在异质性，但高浓度的 HP 显示出在漂白后短时间内对牙髓组织造成显著损伤的潜力。
高浓度的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，主要发生在大鼠磨牙和人类切牙中，此外随着时间的推移会有更多的硬组织沉积。然而，由于这些研究存在方法学限制，因此鼓励进行进一步的描述性良好的长期随访的组织学研究。
PROSPERO（CRD42021230937）。
