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Title Bonding Of Orthodontic Brackets Can Be Affected By Certain Methods Of Tooth Bleaching
Clinical Question Does previous tooth bleaching affect the shear bond strength of orthodontic brackets when compared with bonding to unbleached teeth?
Clinical Bottom Line Bleaching of extracted teeth using 35% hydrogen peroxide (in-office) or 16% carbamide peroxide agents within 24 hours prior to bonding can reduce shear bond strength. No significant effect was observed if bleaching was discontinued 24 hours before bonding. See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19123701Patusco/2009Forty-five human upper premolars were randomly divided into three groups: (1) control, (2) 10% carbamide peroxide at-home bleached, and (3) 35% hydrogen peroxide in-office bleached. Inclusion criteria: intact buccal enamel surface and no pretreatment with chemical agents such as alcohol, formalin, hydrogen peroxide, or any other form of bleaching agent.In vitro study
Key resultsThe use of 10% carbamide peroxide at-home bleaching 24 hours before bonding did not significantly alter shear bond strength when compared to the control group. However, the use of 35% hydrogen peroxide in-office bleaching 24 hours before bonding significantly reduced shear bond strength.
#2) 18302472Uysal/2008Sixty noncarious mandibular premolars extracted with orthodontic indication were used in this study. Teeth with hypoplastic areas, cracks, or gross irregularities of the enamel structure were excluded. Inclusion criteria: no pretreatment with a chemical agent such as alcohol, formalin, or hydrogen peroxide or any other form of bleaching.In vitro study
Key resultsThe use of a 16% carbamide peroxide bleaching agent immediately before bonding significantly reduced the shear bond strength of teeth bonded with self-etching primer. However, immersion of bleached teeth in artificial saliva for 30 days before bonding resulted in a return to control shear bond strength.
Evidence Search "Dental Cements"[Mesh] AND "Orthodontics"[Mesh] AND "Tooth Bleaching"[Mesh], LIMITS: published in the last 3 years, Humans, English
Comments on
The Evidence
Both studies used extracted premolars, so these in vitro results may not reflect results of future in vivo studies. The two studies used different etching/bonding materials and different bleaching systems, which may have affected the results. Future in vivo studies are needed with various bonding and bleaching techniques.
Applicability Many orthodontic patients are interested in tooth bleaching and doctors must know how to advise their patients regarding tooth bleaching in order to optimize the proposed orthodontic treatment.
Specialty/Discipline (General Dentistry) (Orthodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Tooth bleaching (whitening), shear bond strength, orthodontics
ID# 281
Date of submission: 01/28/2010spacer
E-mail mckennak@uthscsa.edu
Author Kelly McKenna, DDS
Co-author(s) e-mail
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Chris Burton (San Antonio, TX) on 04/20/2012
I conducted a PubMed search on this topic in April of 2012 and found an additional, in vivo randomized control trial of 38 patients randomly assigned to different groups. The results were similar, but the author concluded that waiting 2-3 weeks to bond orthodontic brackets after bleaching (specifically with 38% hydrogen peroxide) would be prudent. The PubMed ID:19537855.
by Christopher Escott (San Antonio, TX) on 08/03/2011
Better evidence is now available in the form of an in vivo randomized controlled trial, PMID: 19537855. This research has demonstrated that brackets bonded within 24 hours after bleaching with 38% hydrogen peroxide have an increased chance for bond failure. This author found greater bonding success after waiting 2-3 weeks between bleaching and bonding; therefore, this author recommends a waiting period of 2-3 weeks between these procedures. This CAT should be updated with this new best evidence.

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