Concurrent Whitening and Orthodontic Treatment

Little is known about the potential risks and benefits of combining orthodontic treatment with teeth whitening. The evidence suggests that effective and uniform teeth whitening could occur beneath bonded orthodontic appliances if patients use whitening agents during orthodontic treatment. Objectives: The aim of this project was to evaluate whether a whitening system, when used during the final stages of orthodontic treatment, would yield results comparable to whitening alone. Methods: Forty-six patients were assigned to either the control (n=20) or experimental (n=26) groups. Three patient visits (T1, T2, T3) were required for subjects in both the control and experimental groups. The maxillary right central incisor was chosen as the tooth to be used throughout the study for shade determination and analysis. At T1, patients were given a ten day supply of The Opalescence Trèswhite™ 10% hydrogen peroxide whitening system (Ultradent Products Inc., South Jordan, UT), instructions on use, and initial shade determination was made and photographs were taken. At T2 and T3 updated photos were taken and shade determination was accomplished. The VITA Easy shade® digital shade detection system (VidentTM, Brea, CA) was used to evaluate changes in tooth shades as a result of whitening. Results: Whitening of the teeth occurred in both groups on average, but significantly more whitening was experienced in the experimental group (p < 0.004). Post treatment photos were evaluated by three professionals to assess differences in the uniformity of the shade between the control and experimental groups. There was 80% or higher agreement between evaluators. An average of 87% of teeth whitened during orthodontic treatment compared to 97% of control teeth (p < 0.01) were judged to be uniform in appearance. Conclusions: The data do not contraindicate the concurrent use of tooth whitening during orthodontic treatment.