Boruga Madalina, Tapalaga Gianina, Luca Magda Mihaela, Bumbu Bogdan Andrei
Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Dent J (Basel). 2025 Jul 28;13(8):346. doi: 10.3390/dj13080346.
The rising demand for aesthetic dental treatments has spurred interest in peroxide-free color correctors as alternatives to traditional hydrogen peroxide formulations, which are associated with tooth sensitivity and potential enamel demineralization. This systematic review evaluates the whitening efficacy and safety profile of hydrogen peroxide-free color corrector (HPFCC) products, focusing on color change metrics, enamel and dentin integrity, and adverse effects. Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science throughout January 2025 for randomized controlled trials, observational studies, and in vitro experiments comparing HPFCC to placebo or peroxide-based agents. The data extraction covered study design, sample characteristics, intervention details, shade improvement (ΔE00 or CIE Lab), enamel/dentin mechanical properties (microhardness, roughness, elastic modulus), and incidence of sensitivity or tissue irritation. Risk of bias was assessed using the Cochrane tool for clinical studies and the QUIN tool for in vitro research. Six studies ( = 20-80 samples or subjects) met the inclusion criteria. In vitro, HPFCC achieved mean ΔE00 values of 3.5 (bovine incisors; = 80) and 2.8 (human molars; = 20), versus up to 8.9 for carbamide peroxide ( < 0.01). Across studies, HPFCC achieved a mean ΔE00 of 2.8-3.5 surpassing the perceptibility threshold of 2.7 and approaching the clinical acceptability benchmark of 3.3. Surface microhardness increased by 12.9 ± 11.7 VHN with HPFCC ( < 0.001), and ultramicrohardness rose by 110 VHN over 56 days in prolonged use studies. No significant enamel erosion or dentin roughness changes were observed, and the sensitivity incidence remained below 3%. These findings derive from one clinical trial ( = 60) and five in vitro studies ( = 20-80), encompassing violet-pigment serums and gels with differing concentrations. Due to heterogeneity in designs, formulations, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. Although HPFCC ΔE00 values were lower than those of carbamide peroxide, they consistently exceeded perceptibility thresholds while maintaining enamel integrity and causing sensitivity in fewer than 3% of subjects, supporting HPFCCs as moderate but safe alternatives for young patients.
对美容牙科治疗需求的不断增加，激发了人们对无过氧化物牙齿颜色校正剂的兴趣，将其作为传统过氧化氢配方的替代品，传统配方与牙齿敏感和潜在的牙釉质脱矿有关。本系统评价评估了无过氧化氢牙齿颜色校正剂（HPFCC）产品的美白效果和安全性，重点关注颜色变化指标、牙釉质和牙本质完整性以及不良反应。按照PRISMA指南，我们在2025年1月期间检索了PubMed、Scopus和Web of Science，以查找比较HPFCC与安慰剂或基于过氧化物的制剂的随机对照试验、观察性研究和体外实验。数据提取涵盖研究设计、样本特征、干预细节、色泽改善（ΔE00或CIE Lab）、牙釉质/牙本质机械性能（显微硬度、粗糙度、弹性模量）以及敏感性或组织刺激的发生率。使用Cochrane工具评估临床研究的偏倚风险，使用QUIN工具评估体外研究的偏倚风险。六项研究（n = 20 - 80个样本或受试者）符合纳入标准。在体外，HPFCC在牛切牙（n = 80）中的平均ΔE00值为3.5，在人类磨牙（n = 20）中为2.8，而过氧化脲的该值高达8.9（P < 0.01）。在各项研究中，HPFCC的平均ΔE00为2.8 - 3.5，超过了2.7的可感知阈值，并接近3.3的临床可接受基准。使用HPFCC时，表面显微硬度增加了12.9±11.7 VHN（P < 0.001），在长期使用研究中，超显微硬度在56天内增加了110 VHN。未观察到明显的牙釉质侵蚀或牙本质粗糙度变化，敏感性发生率保持在3%以下。这些发现来自一项临床试验（n = 60）和五项体外研究（n = 20 - 80），涵盖了不同浓度的紫色素血清和凝胶。由于设计、配方和结局测量的异质性，我们进行了叙述性综合分析而非荟萃分析。尽管HPFCC的ΔE00值低于过氧化脲，但它们始终超过可感知阈值，同时保持牙釉质完整性，且在不到3%的受试者中引起敏感性，这支持HPFCC作为年轻患者的中度但安全的替代品。
