In-Office Bleaching During Orthodontic Treatment.

Objective: To demonstrate that it is possible to pursue teeth whitening treatment protocols during orthodontic treatment with no esthetic loss.

Clinical Considerations: Many patients undergoing orthodontic treatment desire to have a straight and well aligned dentition, but also whiter teeth. For many years, it was believed that carrying out a whitening treatment with positioned orthodontic brackets in place would result in localized spots on the enamel labial surfaces of teeth. However, a deeper understanding of the bleaching process suggests that the oxidation caused by products, which results from hydrogen peroxide decomposition, are able to diffuse peripherally into the tooth structure and reach even that under the cemented brackets. Two in-office-bleaching treatments were performed in patients using orthodontic fixed braces in two or three 40-minute sessions using a 35% hydrogen peroxide.

Conclusion: In-office bleaching is possible and effective, even with orthodontic brackets in position. The teeth were successfully bleached despite the presence of brackets. All biological criteria have been fulfilled satisfying patients' expectations of aligned and whitened teeth in less time than if treatments had been performed separately, with satisfactory results and no esthetic loss.

Clinical Significance: The whitening of teeth is possible during orthodontic treatment with fixed braces without any esthetic loss. The in-office bleaching treatment with brackets in position also may act as a motivation factor, preventing patient withdrawal or treatment interruption. Therefore, at the end of the orthodontic treatment, the patient is able to display an aligned, functional and whitened smile. (J Esthet Restor Dent 29:83-92, 2017).