In-office bleaching with low/medium vs. high concentrate hydrogen peroxide: A systematic review and meta-analysis.

OBJECTIVE: To answer the following research question: "Dolow/medium hydrogen peroxide (HP) concentrations used for in-office bleaching in patients with permanent dentition have similar color change and bleaching sensitivity (BS) to high HP concentrations?" DATA: Randomized controlled trials that compared low/medium vs. high concentrate HP were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change (ΔE*ab, ΔSGU/SGU), risk, and intensity of BS, using the random-effects model. Heterogeneity was assessed with the Cochrane Q test, I2 statistics, and prediction interval. The GRADE assessed the certainty of the evidence. SOURCES: Search was performed in PubMed, Cochrane Library, BBO, LILACS, Scopus, Web of Science and grey literature on 15th September 2018 (updated on 13th May 2020). STUDY SELECTION: 25 studies remained. Five were at low RoB; thirteen were at unclear RoB, and seven were at high RoB. The risk of having BS was, on average, 33 % lower (RR = 0.67; 95 % CI 0.51 to 0.86) for low/medium concentrate HP than high HP. No significant difference in color change was detected among groups, except from the subgroup low vs. high HP for the immediate color change, but this difference is not clinically relevant. The certainty of evidence for color change was low and very low, and moderate for the BS. CONCLUSIONS: Low and medium hydrogen peroxide concentrate products for in-office bleaching have lower risk and intensity of bleaching sensitivity than the high concentrate hydrogen peroxide group, with no difference in color change efficacy. CLINICAL SIGNIFICANCE: The use of low concentrate hydrogen peroxide products may produce the same color change efficacy with the bonus of having lower risk and intensity of bleaching sensitivity. However, the ideal concentration at which this occurs is yet unknown and deserves further investigations. No funding. PROSPERO CRD42018108266.

Bleaching sensitivity with a desensitizing in-office bleaching gel: a randomized double-blind clinical trial.

OBJECTIVES: This split-mouth study assessed the bleaching sensitivity (risk and intensity) and color change after in-office bleaching using a desensitizing-containing (5% potassium nitrate) and a desensitizing-free 35% hydrogen peroxide gel. The null hypothesis was that there would be no differences between study groups regarding bleaching sensitivity. METHOD AND MATERIALS: Sixty patients participated in this split-mouth study. The subjects received desensitizing-containing hydrogen peroxide in half of the maxillary arch, and the other half received a desensitizing-free hydrogen peroxide, defined by random sequence, in two dental bleaching sessions. The bleaching sensitivity was evaluated during bleaching and from 1 h to 48 h after each bleaching session using a visual analog scale and numeric rating scale; the McNemar test, the Wilcoxon signed-rank test, and the Student-Newman-Keuls test were used for statistical analysis. The color was measured at baseline and 30 days post-bleaching, evaluated with paired t tests (P = .05). RESULTS: Statistically similar risks of bleaching sensitivity were observed (P = 1.000), but the intensity of bleaching sensitivity was lower (P < .011) on average by 1.32 visual analog scale units in the group bleached with the desensitizer-containing gel during up to 24 h assessment times. No statistical difference in color change was observed between groups (P > .321). CONCLUSION: The incorporation of 5% potassium nitrate into in-office bleaching gels does not reduce the risk of bleaching sensitivity, but it reduces its intensity slightly without jeopardizing color change.

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and a meta-analysis were performed to answer the following research question: Are there differences in the color match and surface texture of nanofilled/nanohybrid and hybrid composite in patients with direct posterior restorations? DATA: Randomized clinical trials that compared nanofilled/nanohybrid and hybrid composite in direct restoration in posterior teeth were included. For the analysis of the bias the risk of bias tool (RoB) was used. Meta-analyses of different pairs (nanofilled vs. hybrid and nanohybrid vs. hybrid composite) were conducted for surface texture and color match and other secondary outcomes at different follow-ups, using a random effects model. Heterogeneity was assessed with the Cochran Q test and I2 statistics. GRADE was used to assess the quality of the evidence. SOURCES: A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (2001-2019), unpublished and ongoing trials registries, dissertations and theses were also searched. STUDY SELECTION: 28 studies remained. No study was considered to be at low RoB; four studies were judged to have high RoB, and the remaining were judged to have unclear RoB. RESULTS: For the primary and secondary outcomes variables no significant differences were detected between nanofilled/nanohybrid restorations and hybrid composite restorations in any of the study follow-ups (p > 0.08). The body of evidence for surface texture and color match was classified as moderate or low. CONCLUSION: No evidence of difference was found between nanofilled/nanohybrid and hybrid composite in any of the clinical parameters evaluated.

Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A network systematic review and meta-analysis.

BACKGROUND: The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis. TYPES OF STUDIES REVIEWED: The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I2 statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis.

OBJECTIVES: A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?" MATERIAL AND METHODS: Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I2 statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019). RESULTS: Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses. CONCLUSION: Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes. CLINICAL RELEVANCE: If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis.

OBJECTIVES: A systematic review and a network meta-analysis were performed to answer the following research question: "Is there any light-activation protocol capable of improving color change efficacy when associated with an in-office bleaching gel in adults?" MATERIAL AND METHODS: A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without date and/or language restrictions in April 23, 2017 (updated on March 30, 2018). IADR abstracts (1990-2018), unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials conducted in adults that included at least one group treated with in-office dental bleaching with light activation were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A random-effects Bayesian-mixed treatment comparison (MTC) model was used to combine light-activated versus light-free in-office bleaching with direct light-free comparison trials. A meta-analysis with independent analysis (high- and low-concentrate hydrogen peroxide [HP]) was conducted for color change (∆E*, ∆SGU). RESULTS: After the removal of duplicates, title, and abstract screening, 28 studies remained. Nine were considered to be at a low RoB, five were at a high RoB, and the remaining were at an unclear RoB. The MTC analysis showed no significant difference in color change (ΔE* and ΔSGU) between light-activation protocols and light-free in-office bleaching, regardless of the HP concentration in the efficacy of the bleaching. CONCLUSION: No type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (PROSPERO-CRD42017078743). CLINICAL RELEVANCE: Although many times dental professionals use "laser whitening" as a form of marketing, this study confirmed that no type of light-activation for in-office bleaching can improve the bleaching efficacy.

Avaliação do manchamento e da rugosidade superficial de materiais restauradores diretos após diferentes sistemas de polimento: estudo in vitro / Assessment of surface staining and roughness of direct restorative materials after different polishing systems: in vitro study

Resumo Introdução Com o avanço estético e tecnológico dos compósitos restauradores diretos, a procura pela Odontologia Éstética tem aumentado. Objetivo Avaliar o manchamento e a rugosidade superficial dos compósitos Filtek Z350 (3M ESPE) e Filtek Bulk Fill (3M ESPE), polidos por diferentes sistemas: Disco SofLex e Disco SofLex diamantado espiral (ambos da 3M ESPE), após exposição repetitiva ao café. Material e método Neste estudo in vitro, um total de 80 discos de resina foi confeccionado, com 40 espécimes para cada compósito avaliado. Os espécimes foram ainda subdivididos em grupos (n=10) de acordo com o método de polimento ‒ SofLex e SofLex diamantado ‒ e a solução de armazenamento ‒ água deionizada (controle) e café (experimental). Após 24 horas de armazenamento em água deionizada, foi realizada a avaliação de cor e rugosidade inicial, bem como a execução dos protocolos de polimento testados. Posteriormente, os espécimes foram expostos ao processo de manchamento em café e água deionizada durante 42 dias. Após esse período, a cor e a rugosidade foram reavaliadas. Resultado A análise estatística paramétrica evidenciou que o manchamento superficial foi influenciado significativamente pelos fatores compósito e solução, mas não pelo fator polidor ou ainda por qualquer interação entre os fatores. Para o fator compósito, Filtek Z350 exibiu maior manchamento, e para o fator solução, foi observado maior manchamento para o café. Já na análise de rugosidade, não houve diferenças significativas. Conclusão Independentemente do sistema de polimento, a solução experimental de café alterou a cor de ambos os compósitos avaliados e verificou-se que a rugosidade não foi alterada.

Abstract Introduction The aesthetic and technological development of direct restorative composites has increased the search for an aesthetic dentistry. Objective Assess the surface staining and roughness of composites: Filtek Z350 (3M ESPE) and Filtek Bulk Fill (3M ESPE), polished by different systems: Disco SofLex and Disco SofLex diamond spiral (both from 3M ESPE), after repeated exposure to coffee. Material and method This study was carried out together with 80 resin discs were made, 40 articles for each study evaluated. The compounds were divided into groups (n = 10) according to the polishing method - Softex and Softex diamond, storage solution - deionized water (control) and coffee (experimental). After 24 hours of storage in deionized water, a color evaluation was performed initially, as well as the execution of the polishing protocols tested. Subsequently, the specimens were exposed to the staining process in coffee and deionized water for 42 days. After this period, the color and roughness were assessed again. Result The parametric statistical analysis showed that surface staining was affected significantly by the composite and solution factors, but not by the polisher factor or by any interaction among factors. For the composite factor, Filtek Z350 showed greater staining and for the solution factor, coffee showed greater staining. In contrast, the roughness analysis did not show significant differences. Conclusion Regardless of the polishing system, differences in composite composition affect the color stability of the composites; and coffee changes the color of both; the roughness was not altered.

Avaliação do efeito de soluções de armazenamento sobre a resistência da união adesiva à dentina de dentes bovinos sob microcisalhamento - pesquisa in vitro / Evaluation of the effect of storage solutions on the bond strength to the dentin of bovine teeth under micro-incision - in vitro research

Introdução: Com a dificuldade de obtenção de dentes humanos para estudos in vitro, autores relatam e preconizam o uso de dentes extraídos de arcadas bovinas para testar técnicas de diferentes segmentos da Odontologia. Entretanto, para que as pesquisas tenham eficácia científica, estes dentes necessitam tratamento adequado para manter suas características e simular condições in vivo. Objetivo: Analisar a resistência de união (RU) adesiva à dentina em dentes bovinos restaurados com adesivo convencional Adper® Single Bond 2 (3M ESPE, St. Paul, MN, EUA) e compósito Opallis Flow (Dentscare LTDA., Joinville, SC, BRA), tendo como fatores de estudo solução e tempo de armazenamento. Metodologia: As amostras foram congeladas sob armazenamento em 2 soluções: timol 0,1% e cloramina 0,5%, em 4 diferentes períodos: 1 semana, 1 mês, 3 meses e 6 meses. Foram obtidos 8 grupos experimentais (n=64) e 1 grupo controle (n=8), totalizando 9 grupos. Após o período de restauração, os dentes foram armazenados em estufa a 37 ºC, imersos em água destilada e, em seguida, testados em máquina de ensaios universal (EMIC DL 500, São José dos Pinhais, PR, Brasil), com análise estatística dos resultados. Resultado: A comparação entre os grupos experimentais e controle mostrou diferença estatisticamente significante (p<0,05) para o armazenamento das amostras em timol durante o período de 1 mês. Conclusão: Os fatores solução e tempo foram capazes de alterar a resistência de união adesiva à dentina bovina, observando-se que a maior média de RU foi obtida após o armazenamento na solução timol durante 1 mês (p=0,004).

Introduction: With the difficulty of obtaining human teeth for in vitro studies, authors report and recommend the use of teeth extracted from bovine arches to test techniques from different segments of Dentistry. However, for research to be scientifically effective, these teeth need adequate treatment to maintain their characteristics and to mimic conditions in vivo. Objective: Analyze the adhesive bond strength (RU) to dentin in bovine teeth restored with Adper® Single Bond 2 (3M ESPE, St Paul, MN, USA) and Opallis Flow composite adhesive (Dentscare LTDA, Joinville, SC, BRA), taking as study factors solution and storage time. Methodology: The samples were frozen under storage in 2 solutions: 0.1% thymol and 0.5% chloramine, in 4 different periods: 1 week, 1 month, 3 months and 6 months. Eight experimental groups (n = 64) and one control group (n = 8) were obtained, totaling 9 groups. After the restoration period, the teeth were stored in an incubator at 37ºC, immersed in distilled water and then tested in a universal testing machine (EMIC DL 500, São José dos Pinhais, PR, Brazil), with statistical analysis of the results. Result: The comparison between the experimental and control groups showed a statistically significant difference (p <0.05) for the storage of thymol samples during the 1 month period. Conclusion: Solution and time factors were able to change the adhesive bond strength to the bovine dentin, observing that the highest mean of RU was obtained after storage in the thymol solution for 1 month (p = 0.004).

Didática no ensino superior: desafios e perspectivas dos docentes de Odontologia da Universidade Estadual de Ponta Grossa / Didactics in higher education: challenges and perspectives of Dentistry teachers of the State University of Ponta Grossa

O objetivo deste trabalho foi avaliar a percepção de docentes do curso de Odontologia quanto as principais dificuldades enfrentadas e as habilidades imprescindíveis para o exercício do magistério superior. Para tal, foi realizada uma pesquisa qualitativa com 47 professores do curso de Odontologia da Universidade Estadual de Ponta Grossa, divididos em dois grupos: a) tempo de atuação docente inferior a 5 anos; b) tempo de atuação docente maior que 5 anos. Após a validação do questionário, este foi encaminhado para os participantes da pesquisa responderem questões abertas sobre o exercício do magistério no ensino superior. Posteriormente à coleta dos dados, foi feita a análise descritiva das informações, exploração do material e interpretação dos resultados. Nos desafios enfrentados, os docentes com mais de 5 anos de atuação citaram a responsabilidade em formar um profissional, dificuldade em motivar os alunos e aquisição de segurança para docência como os principais. Por outro lado, docentes com atuação inferior a 5 anos apontaram o relacionamento com o aluno, insegurança profissional e obtenção do equilíbrio entre a teoria e a prática como principais desafios. Com relação às dificuldades enfrentadas atualmente, as respostas foram semelhantes para os dois grupos, sendo a falta de interesse dos alunos, falta de infraestrutura e de material de apoio para ministrar as aulas, as mais citadas. As habilidades mais mencionadas pelos professores como essenciais para o exercício da profissão incluíram a paciência, didática e necessidade de constante atualização. Pôde-se concluir que os professores enfrentam dificuldades na prática docente, independentemente do tempo de atuação (AU).

The objective of this study was to evaluate the perception of teachers of the Dentistry course regarding the main difficulties faced and the skills essential for the exercise of the higher education teaching profession. For that, a qualitative research was carried out with 47 professors of the Dentistry course at the State University of Ponta Grossa, divided into two groups: a) less than 5-year teaching experience; b) over 5-year teaching experience. After the validation of the questionnaire, it was sent to the participants of the research to answer open questions about teaching in higher education. After data collection, a descriptive analysis of the information, exploration of the material and interpretation of the results were carried out. Among the challenges faced, teachers with more than 5 years of work experience cited the responsibility to train a professional, difficulty motivating students and developing selfconfidence for teaching as the main points. On the other hand, teachers with less than 5 years of experience pointed out the relationship with the student, professional insecurity and obtaining a balance between theory and practice as the main challenges. With regard to the difficulties currently faced, the responses were similar for the two groups, namely, students' lack of interest, lack of infrastructure and support material to teach classes were the most cited. The most mentioned skills by the teachers as essential to the practice of the profession included patience, didactics and the need for constant updating. The results led to the conclusion that teachers face difficulties in teaching practice regardless of the time of performance (AU).

Tooth sensitivity with a desensitizing-containing at-home bleaching gel-a randomized triple-blind clinical trial.

OBJECTIVES: Desensitizing agents are usually included in the composition of bleaching agents to reduce bleaching-induced tooth sensitivity (TS). This randomized clinical trial (RCT) evaluated the risk and intensity of TS and color change after at-home bleaching with a desensitizing-containing (3% potassium nitrate and 0.2% sodium fluoride) and desensitizing-free 10% carbamide peroxide (CP) gel (Whiteness Perfect, FGM). METHODS: A triple-blind, within-person RCT was conducted on 60 caries-free adult patients. Each participant used the gel in a bleaching tray for 3 h daily for 21 days in both the upper and lower dental arches. The absolute risk and intensity of TS were assessed daily through the 0-10 VAS and NRS scale for 21 days. Color change was recorded using shade guides (Vita Classical and Vita Bleachedguide) and the Easyshade spectrophotometer at baseline, weekly and 30 days after the end of the bleaching. The risk and intensity of TS were evaluated by the McNemar and Wilcoxon Signed Rank tests, respectively. Color change (ΔSGU and ΔE) were evaluated by the Mann-Whitney test and a paired t-test, respectively (α = 0.05). RESULTS: No difference in the TS and color change was observed (p > 0.05). CONCLUSIONS: The incorporation of potassium nitrate and sodium fluoride in 10% carbamide peroxide at-home bleaching gel tested in this study did not reduce the TS and did not affect color change (RBR-4M6YR2).

In-office dental bleaching with light vs. without light: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis were performed to answer the following research question: Does light-activated in-office vital bleaching have a greater whitening efficacy and higher tooth sensitivity (TS) in comparison with in-office vital bleaching without light when used in adults? DATA AND SOURCE: Only randomized clinical trials (RCTs) involving adults who had in-office bleaching with and without light activation were included. Controlled vocabulary and keywords were used in a comprehensive search for titles and abstracts in PubMed, and this search was adapted for Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without restrictions in May 2016 and was updated in August 2017. IADR abstracts (1990-2016), unpublished- and ongoing-trial registries, dissertations, and theses were also searched. The risk-of-bias tool of the Cochrane Collaboration was used for quality assessment. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development, and Evaluation approach. Through the use of the random effects model, a meta-analysis with a subgroup analysis (low and high hydrogen peroxide concentration) was conducted for color change (ΔE*, ΔSGU) as well as the risk and intensity of TS. STUDY SELECTION: We retrieved 6663 articles, but after removing duplicates and non-relevant articles, only 21 RCTs remained. No significant difference in ΔE*, ΔSGU, and risk and intensity of TS was observed (p > .05). For ΔE and risk of TS, the quality of the evidence was graded as moderate whereas the evidence for ΔSGU and intensity of TS was graded as very low and low, respectively. CONCLUSION: Without considering variations in the protocols, the activation of in-office bleaching gel with light does not seem to improve color change or affect tooth sensitivity, regardless of the hydrogen peroxide concentration. (PROSPERO - CRD42016037630). CLINICAL RELEVANCE: Although it is commercially claimed that in-office bleaching associated with light improves and accelerates color change, this study did not confirm this belief for in-office bleaching gels with either high or low levels of hydrogen peroxide.

Biological and mechanical degradation affecting the surface properties of aesthetic restorative

To evaluate the roughness (Ra), Knoop hardness (KHN) and change of color (ΔE) of esthetic restorative materials (Filtek Z350-composite nanoparticle; Empress Direct-composite nanohybrid and IPS e.Max-ceramic) subjected to contact with the Streptococcus mutans biofilm (biological degradation) associated with abrasion generated by tooth brushing (mechanical degradation). Methods: Ten specimens of each material were prepared, and the surface properties initial were evaluated. All specimens were exposed to Streptococcus mutans inoculum; after 7 days, surface properties were evaluated. The specimens were submitted to a 30,000 toothbrushing cycles, using a toothpaste slurry, then, surface properties were evaluated again. Data were analyzed by Proc-Mixed, One-way ANOVA, Tukey-Kramer and Tukey's tests (α = 0.05). Results: At the baseline, ceramic showed the highest Ra and KHN values; after the biological degradation the composites showed increased Ra, but KHN did not change; after the mechanical degradation, Empress showed decreased Ra and Z350 showed similar Ra, the KHN increased to both composites, and all materials had increased lightness after the mechanical degradation. Conclusions: The results suggest that, when exposed to Streptococcus mutans biofilm and toothbrush abrasion, the ceramics undergoes minimal degradation and the composites exhibited variable degradation, depending on the composition of the material (AU)

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review.

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.

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review

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.