dental materials 23 (2007) 586–596
available at www.sciencedirect.com journal homepage: www.intl.elsevierhealth.com/journals/dema
External bleaching therapy with activation by heat,light or laser—A systematic review
, Thomas Attin
Department of Preventive Dentistry, Periodontology and Cariology, University of Z¨ urich, Plattenstrasse 11, CH-8032 Z¨ urich, Switzerland
Department of Operative Dentistry, Preventive Dentistry and Periodontology, Georg-August-University G¨ ottingen, G¨ ottingen, Germany
a r t i c l e i n f o
Received 17 October 2005Received in revised form4 March 2006Accepted 9 March 2006
a b s t r a c t
Externalbleachingproceduresutilizinghighlyconcentrated30–35%hydrogenper-oxide solutions or hydrogen peroxide releasing agents can be used for tooth whitening. Toenhanceoracceleratethewhiteningprocess,heat-activationofthebleachingagentbylight,heat or laser is described in the literature. The aim of the present review article was to sum-marizeanddiscusstheavailableinformationconcerningtheefﬁcacy,effectsandsideeffectsof activated bleaching procedures.
Information from all original scientiﬁc full papers or reviews listed in PubMed or ISIWeb of Science (search term: (bleaching OR brightening OR whitening OR colour) AND (lightOR laser OR heat OR activation)) were included in the review.
Existing literature reveals that activation of bleaching agents by heat, light or lasermay have an adverse effect on pulpal tissue due to an increase of intra-pulpal temperatureexceeding the critical value of 5.5
C. Available studies do not allow for a ﬁnal judgmentwhether tooth whitening can either be increased or accelerated by additional activation.
Therefore, application of activated bleaching procedures should be criticallyassessed considering the physical, physiological and patho-physiological implications.© 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
1.1. In-ofﬁce-bleaching therapies
With in-ofﬁce applied bleaching therapies, discolored, vitalteeth can be successfully whitened mostly by using highlyconcentrated bleaching regimens. In-ofﬁce-bleaching pro-cedures seem to be an appropriate alternative to home-bleaching applications with trays, foils or gels, especially inthe case of very severe discolorations, discolorations of sin-gle teeth, lack of patient compliance or if a rapid treatment isdesired. In-ofﬁce-bleaching could also be applied as a kind of boost therapy, thereby initiating the bleaching process, whichmightbecontinuedafterwardsbyhome-bleachingprocedures
[1,2].It should be noted that a single application of in-ofﬁce-bleachingisusuallynotsufﬁcienttoachieveoptimalbleaching results.This means that the in-ofﬁce-bleaching procedure
has to be repeated several times during an appointment orthat even multiple appointments are needed to obtain opti-mal results. In-ofﬁce-bleaching is usually performed using bleaching agents with high concentrations (30–35%) of H
.Due to the high peroxide concentration, the gingiva shouldbe protected by rubber dam or alternatives, such as speciallydesigned light-curing isolating pastes.Most descriptions in the literature of successful appli-cations of in-ofﬁce-bleaching therapies are case reports orstudies, in which no comparisons to well-approved meth-ods, such as home-bleaching-procedures have been done
0109-5641/$ – see front matter © 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.doi:10.1016/j.dental.2006.03.018