Tooth whitening in conventional orthodontic patients: a systematic review

Keywords: tooth whitening, tooth bleaching, orthodontic patients, systematic review


This systematic review aimed to identify and critically evaluate the available evidence of the appropriate moment to perform tooth whitening in conventional orthodontic patients. A systematic review in MEDLINE and SciELO databases from inception to February 2021 was carried out by two independent reviewers. Randomized clinical trials, non-randomized clinical trials, case-control, cohort, cross-sectional, case-series and reviews that focused on the application of tooth whitening during or after orthodontic treatment were considered for inclusion. The primary outcome was defined as tooth whitening during/after orthodontic treatment. The secondary outcome included the time in days after bracket debonding in which tooth whitening was performed. Risk of bias analysis was performed for each study and the findings were synthesized in a narrative summary. A total of 4 randomized clinical trials, 1 non-randomized clinical trial and 3 reviews were included in the qualitative synthesis. One study performed tooth whitening during, and three studies after orthodontic treatment. One study compared tooth whitening during and after orthodontic treatment. The time after which tooth whitening was applied following bracket debonding ranged from 7 to 90 days with a mean value of 40.2 days. All studies reported satisfactory improvements in tooth color shade during or after orthodontic treatment independent of the protocol. Low quality evidence suggests that the appropriate moment to perform tooth whitening in conventional orthodontic patients is after brackets removal with a waiting period of at least 30 days. There is not adequate evidence to support tooth whitening during conventional orthodontic treatment.


Abu Alhaija, E., Al-Abdallah, S. Y., & Taha, N. A. (2019). A comparative study of initial changes in pulpal blood flow between clear aligners and fixed orthodontic appliances. American Journal of Orthodontics and Dentofacial, 156(5), 603–610.
Ahrari, F., Akbari, M., Mohammadipour, H. S., Fallahrastegar, A., & Sekandari, S. (2020). The efficacy and complications of several bleaching techniques in patients after fixed orthodontic therapy. A randomized clinical trial. Swiss dental journal, 130(6), 493–501.
Alqahtani M. Q. (2014). Tooth-bleaching procedures and their controversial effects: A literature review. The Saudi Dental Journal, 26(2), 33–46.
Basting, R. T., Rodrigues, A. L., & Serra, M. C. (2003). The effects of seven carbamide peroxide bleaching agents on enamel microhardness over time. Journal of the American Dental Association, 134(10), 1335–1342.
Consolaro, A., Consolaro, R. B., & Francischone, L. (2013). Clarifications, guidelines, and questions about the dental bleaching "associated" with orthodontic treatment. Dental Press Journal of Orthodontics, 18(5), 4–10.
Costa, C. A., Riehl, H., Kina, J. F., Sacono, N. T., & Hebling, J. (2010). Human pulp responses to in-office tooth bleaching. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 109(4), e59–e64.
De Melo Oliveira, I., Santana, T. R., Correia, A., Fontes, L. S., Griza, S., & Faria-E-Silva, A. L. (2021). Color heterogeneity and individual color changes in dentin and enamel bleached in the presence of a metallic orthodontic bracket. Journal of Esthetic and Restorative Dentistry, 33(2), 262–268.
Dumbryte, I., Linkeviciene, L., Linkevicius, T., & Malinauskas, M. (2017). Does orthodontic debonding lead to tooth sensitivity? Comparison of teeth with and without visible enamel microcracks. American Journal of Orthodontics and Dentofacial Orthopedics, 151(2), 284–291.
Eachempati, P., Kumbargere Nagraj, S., Kiran Kumar Krishanappa, S., Gupta, P., & Yaylali, I. E. (2018). Home-based chemically-induced whitening (bleaching) of teeth in adults. The Cochrane Database of Systematic Reviews, 12(12), CD006202.
Faria-Júnior, É. M., Guiraldo, R. D., Berger, S. B., Correr, A. B., Correr-Sobrinho, L., Contreras, E. F., & Lopes, M. B. (2015). In-vivo evaluation of the surface roughness and morphology of enamel after bracket removal and polishing by different techniques. American Journal of Orthodontics and Dentofacial Orthopedics, 147(3), 324–329.
Freire, A., Pedrosa, M., Vasconselos, M., Lopes, M., Lopes, R., & Carvalho, M. (2018). Clareamento dentário durante tratamento ortodôntico. Revista Da Faculdade De Odontologia - UPF, 22(3).
Gizani, S., Kloukos, D., Papadimitriou, A., Roumani, T., & Twetman, S. (2020). Is Bleaching Effective in Managing Post-orthodontic White-spot Lesions? A Systematic Review. Oral Health & Preventive Dentistry, 18(1), 2–10.
Guzmán-Armstrong, S., Chalmers, J., & Warren, J. J. (2010). Ask us. White spot lesions: prevention and treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 138(6), 690–696.
Han, G., Hu, M., Zhang, Y. & Jiang, H. (2013). Pulp vitality and histologic changes in human dental pulp after the application of moderate and severe intrusive orthodontic forces. American Journal of Orthodontics and Dentofacial, 144(4), 518–522.
Höchli, D., Hersberger-Zurfluh, M., Papageorgiou, S. N., & Eliades, T. (2017). Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis. European Journal of Orthodontics, 39(2), 122–133.
Imani, M. M., Azizi, F., Bahrami, K., Golshah, A., & Safari-Faramani, R. (2020). In vitro bleaching effect of hydrogen peroxide with different time of exposition and concentration on shear bond strength of orthodontic brackets to human enamel: A meta-analysis of in vitro studies. International Orthodontics, 18(1), 22–31.
Jadad, E., Montoya, J., Arana, G., Gordillo, L. A., Palo, R. M., & Loguercio, A. D. (2011). Spectrophotometric evaluation of color alterations with a new dental bleaching product in patients wearing orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics, 140(1), e43–e47.
Kamber, R., Papageorgiou, S. N., & Eliades, T. (2018). Does orthodontic treatment have a permanent effect on tooth color? A systematic review and meta-analysis. Journal of Orofacial Orthopedics, 79(2), 73–82.
Knösel, M., Attin, R., Becker, K., & Attin, T. (2007). External bleaching effect on the color and luminosity of inactive white-spot lesions after fixed orthodontic appliances. The Angle Orthodontist, 77(4), 646–652.
Krug, A. Y., & Green, C. (2008). Changes in patient evaluation of completed orthodontic esthetics after dental bleaching. Journal of Esthetic and Restorative Dentistry, 20(5), 313–321.
Lunardi, N., Correr, A. B., Rastelli, A. N., Lima, D. A., & Consani, R. L. (2014). Spectrophotometric evaluation of dental bleaching under orthodontic bracket in enamel and dentin. Journal of Clinical and Experimental Dentistry, 6(4), e321–e326.
Márquez, J.F., Pedroza-Garcés, A., & Villada-Castro, M. (2012). Aclaramiento dental, durante y después de ortodoncia. CES Odontología, 25(2), 54-62.
Montenegro-Arana, A., Arana-Gordillo, L. A., Farana, D., Davila-Sanchez, A., Jadad, E., Coelho, U., Gomes, O., & Loguercio, A. D. (2016). Randomized Double-blind Clinical Trial of Bleaching Products in Patients Wearing Orthodontic Devices. Operative Dentistry, 41(4), 379–387.
Mullins, J. M., Kao, E. C., Martin, C. A., Gunel, E., & Ngan, P. (2009). Tooth whitening effects on bracket bond strength in vivo. The Angle Orthodontist, 79(4), 777–783.
Oliverio, T., Cremonini, F., Lombardo, L., & Siciliani, G. (2019). Tooth Whitening in Association with Clear Aligner Treatment. Journal of Clinical Orthodontics, 53(9), 508–517.
Rodrigues, J. L., Rocha, P. S., Pardim, S., Machado, A., Faria-E-Silva, A. L., & Seraidarian, P. I. (2018). Association Between In-Office and At-Home Tooth Bleaching: A Single Blind Randomized Clinical Trial. Brazilian Dental Journal, 29(2), 133–139.
Rodríguez-Martínez, J., Valiente, M., & Sánchez-Martín, M. J. (2019). Tooth whitening: From the established treatments to novel approaches to prevent side effects. Journal of Esthetic and Restorative Dentistry, 31(5), 431–440.
Sallum, E. J., Nouer, D. F., Klein, M. I., Gonçalves, R. B., Machion, L., Wilson Sallum, A., & Sallum, E. A. (2004). Clinical and microbiologic changes after removal of orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics, 126(3), 363–366.
Slack, M. E., Swift, E. J., Jr, Rossouw, P. E., & Phillips, C. (2013). Tooth whitening in the orthodontic practice: a survey of orthodontists. American Journal of Orthodontics and Dentofacial Orthopedics, 143(4), S64–S71.
Sword RJ, Haywood V.B. (2020). Teeth Bleaching Efficacy During Clear Aligner Orthodontic Treatment. Compend Contin Educ Dent, 41(5), e11-e16. PMID: 32369381.
Talic N. F. (2011). Adverse effects of orthodontic treatment: A clinical perspective. The Saudi Dental Journal, 23(2), 55–59.
Tredwin, C. J., Naik, S., Lewis, N. J., & Scully, C. (2006). Hydrogen peroxide tooth-whitening (bleaching) products: review of adverse effects and safety issues. British Dental Journal, 200(7), 371–376.
Triwardhani, A., Djaharu'ddin, I., & Herawan, P. A. (2019). Effectivity comparison between three different enamel remineralizing agent postfix orthodontic treatment. Journal of Clinical and Experimental Dentistry, 11(10), e906–e912.
Van Gastel, J., Quirynen, M., Teughels, W., & Carels, C. (2007). The relationships between malocclusion, fixed orthodontic appliances and periodontal disease. A review of the literature. Australian Orthodontic Journal, 23(2), 121–129.
Venkatesh, S., Ajmera, S., & Ganeshkar, S. V. (2014). Volumetric pulp changes after orthodontic treatment determined by cone-beam computed tomography. Journal of Endodontics, 40(11), 1758–1763.
Vidor, M. M., Felix, R. P., Marchioro, E. M., & Hahn, L. (2015). Enamel surface evaluation after bracket debonding and different resin removal methods. Dental Press Journal of Orthodontics, 20(2), 61–67.
Zaher, A. R., Abdalla, E. M., Abdel Motie, M. A., Rehman, N. A., Kassem, H., & Athanasiou, A. E. (2012). Enamel colour changes after debonding using various bonding systems. Journal of Orthodontics, 39(2), 82–88.
How to Cite
Hernández-Viana, S., Niño, M., Restrepo, F., & Botero, J. (2022). Tooth whitening in conventional orthodontic patients: a systematic review. Uniciencia, 36(1), 1-15.
Original scientific papers (evaluated by academic peers)

Comentarios (ver términos de uso)

Most read articles by the same author(s)