{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:41:54Z","timestamp":1770745314310,"version":"3.49.0"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Coatings"],"abstract":"<jats:p>This systematic review aimed to describe and characterize internal tooth bleaching techniques, conventional (walking-bleach) and combined (inside\u2013outside), referring to their efficacy. The research was conducted on the main databases: PubMed, Cochrane Library, EMBASE, and Web of Science. Only randomized controlled trials and cohort studies were considered, on humans of 18 years old or older. A Population, Intervention, Comparison, Outcome (PICO) question was designed to evaluate the scientific evidence. The quality of each randomized controlled trial and cohort study was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions and the Methodological Index for Non-Randomized Studies (ROBINS-I), respectively. The walking-bleach and the combined techniques were both effective at the end of the treatment, obtaining similar aesthetic results. Regardless of the technique used, internal tooth bleaching is an effective procedure, with good aesthetic results, in the treatment of non-vital teeth. The cervical barrier is a standard of care in internal bleaching techniques and should be used. Considering the similarity in the esthetic results obtained in both techniques, the concentrations used for both, and since the biocompatibility of the bleaching agent is more important than its efficiency or speed in obtaining results, the combined technique should be considered the method of choice rather than the walking-bleach technique.<\/jats:p>","DOI":"10.3390\/coatings10010061","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T04:06:51Z","timestamp":1578629211000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Non-Vital Tooth Bleaching Techniques: A Systematic Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2924-7926","authenticated-orcid":false,"given":"Ana Sofia","family":"Coelho","sequence":"first","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CIMAGO\u2014Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CNC.IBILI, University of Coimbra, 3000 Coimbra, Portugal"}]},{"given":"Lara","family":"Garrido","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"}]},{"given":"Mariana","family":"Mota","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-5417","authenticated-orcid":false,"given":"Carlos Miguel","family":"Marto","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CIMAGO\u2014Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CNC.IBILI, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Experimental Pathology Institute, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"}]},{"given":"In\u00eas","family":"Amaro","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5759-5557","authenticated-orcid":false,"given":"Eunice","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CIMAGO\u2014Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CNC.IBILI, University of Coimbra, 3000 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-4173","authenticated-orcid":false,"given":"Anabela","family":"Paula","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CIMAGO\u2014Center of Investigation on Enviromnent, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, 3000 Coimbra, Portugal"},{"name":"CNC.IBILI, University of Coimbra, 3000 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.jdent.2017.09.006","article-title":"Tooth colour and whiteness: A review","volume":"67S","author":"Joiner","year":"2017","journal-title":"J. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1111\/joor.12194","article-title":"Contributions of dental colour to the physical attractiveness stereotype","volume":"41","author":"Montero","year":"2014","journal-title":"J. Oral Rehabil."},{"key":"ref_3","first-page":"912368","article-title":"Satisfaction with appearance and the desired treatment to improve aesthetics","volume":"2013","year":"2013","journal-title":"Int. J. Dent."},{"key":"ref_4","first-page":"306","article-title":"Bleaching of nonvital teeth. A clinically relevant literature review","volume":"120","author":"Zimmerli","year":"2010","journal-title":"Schweiz. Mon. Zahnmed."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.joen.2007.12.020","article-title":"Nonvital tooth bleaching: A review of the literature and clinical procedures","volume":"34","author":"Plotino","year":"2008","journal-title":"J. Endod."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1046\/j.1365-2591.2003.00667.x","article-title":"Review of the current status of tooth whitening with the walking bleach technique","volume":"36","author":"Attin","year":"2003","journal-title":"Int. Endod. J."},{"key":"ref_7","first-page":"332","article-title":"A simple bleaching technique using sodium perborate","volume":"27","author":"Spasser","year":"1961","journal-title":"N. Y. State Dent. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.23736\/S0026-4970.18.04190-0","article-title":"In-office and walking bleach dental treatments on endodontically-treated teeth: 25 years follow-up","volume":"67","author":"Amato","year":"2018","journal-title":"Minerva Stomatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.14219\/jada.archive.1997.0406","article-title":"A technique for bleaching nonvital teeth: Inside\/outside bleaching","volume":"128","author":"Settembrini","year":"1997","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"204","DOI":"10.12968\/denu.2004.31.4.204","article-title":"Managing discoloured non-vital teeth: The inside\/outside bleaching technique","volume":"31","author":"Poyser","year":"2004","journal-title":"Dent. Update"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/jerd.12152","article-title":"Review of the Mechanism of Tooth Whitening","volume":"27","author":"Kwon","year":"2015","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"242","DOI":"10.2174\/1874210601610010242","article-title":"Clinical and Spectrophotometric Evaluation of LED and Laser Activated Teeth Bleaching","volume":"10","author":"Pantaleo","year":"2016","journal-title":"Open Dent. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.prosdent.2017.03.004","article-title":"Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up","volume":"119","author":"Lise","year":"2018","journal-title":"J. Prosthet. Dent."},{"key":"ref_14","first-page":"96","article-title":"Clinical efficacy of 35% carbamide peroxide and sodium perborate in intracoronal bleaching of discoloured non-vital teeth","volume":"12","author":"Umanah","year":"2013","journal-title":"J. Med. Biomed. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/00004770-200202000-00003","article-title":"Effect of hydrogen peroxide and sodium perborate on biomechanical properties of human dentin","volume":"28","author":"Chng","year":"2002","journal-title":"J. Endod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1034\/j.1600-9657.2003.00112.x","article-title":"Effect of internal bleaching agents on dentinal permeability of non-vital teeth: Quantitative assessment","volume":"19","author":"Carrasco","year":"2003","journal-title":"Dent. Traumatol."},{"key":"ref_17","unstructured":"Higgins, J.P.T., and Green, S. (2019, November 11). Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). Available online: Handbook-5-1.cochrane.org."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3013","DOI":"10.1007\/s00784-018-2389-y","article-title":"Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: A randomized clinical trial","volume":"22","author":"Bersezio","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_19","first-page":"334","article-title":"Intracoronal bleaching of discolored non-vital teeth","volume":"28","author":"Bizhang","year":"2003","journal-title":"Oper. Dent."},{"key":"ref_20","first-page":"148","article-title":"Clinical evaluation of nonvital tooth whitening and composite resin restorations: Five-year results","volume":"3","author":"Deliperi","year":"2008","journal-title":"Eur. J. Esthet. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/edt.12109","article-title":"Evaluation of patient satisfaction after non-vital bleaching in traumatized discolored intact anterior teeth","volume":"30","author":"Gupta","year":"2014","journal-title":"Dent. Traumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/aej.12015","article-title":"Clinical comparison between the bleaching efficacy of light-emitting diode and diode laser with sodium perborate","volume":"40","author":"Kocak","year":"2014","journal-title":"Aust. Endod. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"596","DOI":"10.2341\/16-133-C","article-title":"Effectiveness and Impact of the Walking Bleach Technique on Esthetic Self-perception and Psychosocial Factors: A Randomized Double-blind Clinical Trial","volume":"42","author":"Bersezio","year":"2017","journal-title":"Oper. Dent."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1002\/j.0022-0337.2010.74.8.tb04942.x","article-title":"Influence of the ICDAS e-learning program for occlusal caries detection on dental students","volume":"74","author":"Diniz","year":"2010","journal-title":"J. Dent. Educ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jdent.2010.07.005","article-title":"Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: An in vitro study","volume":"38","author":"Mitropoulos","year":"2010","journal-title":"J. Dent."}],"container-title":["Coatings"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6412\/10\/1\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:19:22Z","timestamp":1760361562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6412\/10\/1\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,9]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1]]}},"alternative-id":["coatings10010061"],"URL":"https:\/\/doi.org\/10.3390\/coatings10010061","relation":{},"ISSN":["2079-6412"],"issn-type":[{"value":"2079-6412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,9]]}}}