Efetividade do ozônio no clareamento dental e no controle da sensibilidade: revisão sistemática e meta-análise

Abstract

This systematic review assessed the effectiveness of ozone (O3) in 1) the color change of in-office tooth bleaching in vital teeth and 2) the control of sensitivity. The study followed the PRISMA recommendations and Cochrane guidelines. A protocol was registered in the PROSPERO database. Seven databases were used as primary search sources: Cochrane, Embase, LILACS, PubMed, SciELO, Scopus, and Web of Science. Three additional sources were searched to partially capture the "grey literature": OATD, OpenThesis, and OpenGrey. Only randomized controlled clinical trials were included. The JBI tool was used to assess the risk of bias. Bleaching was assessed using the ΔELab color change metric comparing tooth color pre- and post-bleaching. We meta-analyzed the ΔELab and tooth sensitivity estimates per method and calculated the absolute standardized mean difference using random-effect models. The GRADE tool assessed the quality of the evidence across the studies. The search revealed 12703 results published between 1955 and 2020. Only four studies met the eligibility criteria and were included for qualitative and quantitative analyses. All studies assessed ΔELab considering a time interval of either 24 or 48 hours. Three studies also analyzed post-bleaching tooth sensitivity using the Visual Analogue Scale. The total sample included 129 patients treated with tooth bleaching: 47 in the control group [38% hydrogen peroxide - (HP)]; and 72 in the intervention group (29 of them treated only with O3 and 43 treated with O3 associated with HP). The ΔELab estimates ranged from 1.28 when ozone therapy was used alone to 6.93 when was combined with HP. Two studies compared O3 and HP alone, but their bleaching ability was similar (SMD=-0.02; 95%CI: -0.54; 0.49). The bleaching effectiveness for the combination of O3 and HP compared to HP alone was also similar (SMD=0.38; 95%CI: -0.04; 0.81). The control sensitivity was also similar (SMD=0,6; 95%CI: -2.02; 0.82). The GRADE tool assessed three outcomes (Bleaching effectiveness - O3 vs HP; Bleaching effectiveness O3 + HP vs HP, and Tooth sensitivity). All outcomes were classified as a very low level of certainty. Thus, based on limited evidence, we concluded that the use of O3 (alone or associated) was not superior to the conventional use of HP for the bleaching, but and sensitivity of vital teeth.