Bleaching effectiveness of hydrogen peroxide containing titanium dioxide: A systematic review and meta-analysis

Yi-Ling Cheng; Chen Su; Bing-Jie Zhong; Hao Yu

doi:10.1016/j.jdent.2025.105692

Bleaching effectiveness of hydrogen peroxide containing titanium dioxide: A systematic review and meta-analysis

J Dent. 2025 May:156:105692. doi: 10.1016/j.jdent.2025.105692. Epub 2025 Mar 14.

Authors

Yi-Ling Cheng¹, Chen Su¹, Bing-Jie Zhong¹, Hao Yu²

Affiliations

¹ Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China; Department of Prosthodontics & Research Center of Dental Esthetics and Biomechanics, Fujian Medical University, Fuzhou, China.
² Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China; Department of Prosthodontics & Research Center of Dental Esthetics and Biomechanics, Fujian Medical University, Fuzhou, China; Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan. Electronic address: haoyu-cn@hotmail.com.

PMID: 40090402
DOI: 10.1016/j.jdent.2025.105692

Abstract

Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of incorporating titanium dioxide (TiO₂) into a hydrogen peroxide (HP) gel to increase bleaching effectiveness.

Data sources: A comprehensive search was conducted in the PubMed, Web of Science, and Scopus databases through February 12, 2024.

Study selection: The eligibility criteria included studies comparing the bleaching effectiveness of HP alone to HP with incorporated TiO₂. The risk of bias for in vitro studies was assessed using the RoBDEMAT tool, while in vivo studies were evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color difference (ΔE₀₀) and whiteness index for dentistry (WI_D). The mean difference (MD) and 95% confidence interval (CI) for the ΔE₀₀ and ΔWI_D values were calculated using a random-effects model (α=0.05).

Results: A total of 17 studies were included in this systematic review, and 5 were included in the meta-analysis. Among the 17 eligible studies, 11 were in vitro studies, and 6 were in vivo studies. The commonly used HP concentrations were 6% and 35%, and the concentrations of incorporated TiO₂ ranged from 0.2% to 10%. The meta-analysis demonstrated that incorporating TiO₂ into HP gels resulted in significantly greater ΔE₀₀ values (P=0.04; MD=0.50; 95% CI: 0.01 to 0.98) and ΔWI_D values (P=0.003; MD=2.28; 95% CI: 0.75 to 3.80) than did using HP gels alone, with the ΔWI_D exceeding the perceptible threshold.

Conclusions: HP gels with TiO₂ showed increased color and whitening index changes. However, standardized bleaching protocols, consistent color evaluation, and post-bleaching monitoring are needed for validation and study comparability. TiO₂ properties (particle size, shape, crystal phase) significantly affect gel performance, requiring further research to determine optimal parameters.

Clinical relevance: Using a low-concentration HP gel with TiO₂ may be a promising alternative to high-concentration HP bleaching, potentially minimizing the side effects.

Keywords: Hydrogen peroxide; Meta-analysis; Systematic review; Titanium dioxide; Tooth bleaching.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Humans
Hydrogen Peroxide* / administration & dosage
Hydrogen Peroxide* / therapeutic use
Titanium* / administration & dosage
Tooth Bleaching Agents* / administration & dosage
Tooth Bleaching Agents* / therapeutic use
Tooth Bleaching* / methods

Substances

Titanium
titanium dioxide
Hydrogen Peroxide
Tooth Bleaching Agents