Abstract
We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.
Highlights
IntroductionDental bleaching (or whitening) has become the most sought after treatment by patients in search for esthetics
Submitted: May 13, 2017 Accepted for publication: May 22, 2017 Last revision: May 28, 2017Dental bleaching has become the most sought after treatment by patients in search for esthetics
The full-text of 234 papers were assessed and 49 papers were excluded for the following reasons: 1) 15 studies were not randomized clinical trials; 2) 7 studies were case reports; 3) 3 studies were duplicates; 4) 2 studies were abstracts; 5) 1 study was published in Korean language; 6) 4 studies were in vitro; 7) 2 studies were case series; 8) 1 study was a literature review; 9) 1 study was an ex-vivo study; 10) 1 study is currently in the recruitment phase and evaluation of tooth color; 11) 1 study evaluated the color change of the composite resin after bleaching; 12) 11 studies were not accessible
Summary
Dental bleaching (or whitening) has become the most sought after treatment by patients in search for esthetics. According to study of Al-Zaera,[1] which investigated the research subjects’ satisfaction with dental appearance, nearly 66% of the individuals were dissatisfied with the color of their teeth. Another survey conducted in Ankara, Turkey,[2] focused on the treatment of patients who were unhappy with their smile, questioning which treatment these patients would like to receive. About half of the patients suggested dental bleaching (49.9%), followed by esthetic restorations (25.4%), orthodontic treatment (24.5%), and prosthetic restorations (16.9%). The effectiveness of various protocols and materials used by dental professionals has been extensively studied in the last decades, including longevity of the bleaching outcome.[3,4,5,6] Researchers have used clinical or in vitro studies to obtain data that can Loguercio AD, Maran BM, Hanzen TA, Paula AM, Perdigão J, Reis A predict clinical performance, as some subjective factors related to the bleaching protocol, such as postoperative sensitivity and other adverse reactions, cannot be evaluated directly.[7,8,9]
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