Is Bleaching Effective in Managing Post-orthodontic White-spot Lesions? A Systematic Review.

Gizani, Sotiria; Kloukos, Dimitrios; Papadimitriou, Aikaterini; Roumani, Theoni; Twetman, Svante (2020). Is Bleaching Effective in Managing Post-orthodontic White-spot Lesions? A Systematic Review. Oral health & preventive dentistry, 18(1), pp. 1-10. Quintessenz Verlags-GmbH 10.3290/j.ohpd.a44113

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PURPOSE White spot lesions (WSL) are common side-effects of orthodontic treatment with fixed multi-bracketed appliances. The aim of this review was to find all available literature and critically assess the evidence for the efficacy of bleaching as a method to treat or alleviate post-orthodontic WSLs in permanent teeth. MATERIALS AND METHODS Electronic databases were screened for relevant literature with the aid of predetermined search strategies. All types of studies, including randomised or nonrandomised controlled trials (RCTs or CCTs), prospective and retrospective studies, as well as in vitro studies were considered eligible for inclusion. The reference lists of all included articles were hand searched for additional studies. Two authors independently performed study selection, data extraction, and risk of bias assessment. RESULTS One RCT and 8 in vitro studies met the inclusion criteria. Seven studies were classified as having a high risk of bias while 2 in vitro studies were graded as having a moderate risk of bias. The results showed that bleaching of WSL can diminish colour disparities between carious and non-affected areas, but the certainty of the evidence was very low. The high degree of methodological heterogeneity precluded a valid interpretation of the results through pooled estimates. CONCLUSIONS The findings from the present systematic review could not support or refute bleaching as an effective method for management of post-orthodontic WSLs. Because most of the studies in this field are in vitro and solid scientific evidence of low risk of bias is scare, further prospective in vivo studies are necessary.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > School of Dental Medicine > Department of Orthodontics

UniBE Contributor:

Kloukos, Dimitrios


600 Technology > 610 Medicine & health




Quintessenz Verlags-GmbH




Renate Imhof-Etter

Date Deposited:

24 Feb 2020 15:18

Last Modified:

24 Feb 2020 15:18

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

bleaching enamel demineralisation fluoride tooth whitening white spot lesions




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