Impact of nanostructured additives in tooth bleaching agents on enhancing color change and reducing side effects: a scoping review.

OBJECTIVES: This study aimed to determine whether incorporating nanostructured additives into bleaching agents enhances efficacy and reduces side effects while identifying gaps for further investigation. METHODS: A comprehensive search was conducted in electronic databases, including PubMed/Medline, Embase, Scopus, and ISI Web of Science. Two reviewers independently screened articles based on predefined criteria, resolving discrepancies through discussion or consultation with a third reviewer. Data extraction focused on key details, including study design, interventions, and outcomes. RESULTS: Twenty-one articles were reviewed, consisting of nine clinical studies, one in vivo/in situ study, and 11 in vitro studies on tooth bleaching protocols. Hydrogen peroxide was the most commonly used bleaching agent. The primary nanostructured additives studied were titanium dioxide nanoparticles, polymeric carbamide peroxide nanoparticles, chitosan nanoparticles, nano-hydroxyapatite, SiO2/MgO/Fe2O3 nanocomposite spheres, and nano-bioactive glass. Most studies demonstrated an enhanced bleaching effect, reduced bleaching sensitivity, decreased cytotoxicity, reduced hydrogen peroxide penetration into the pulp chamber, and protection of the tooth surface against mineral and structural loss when nanostructured additives were incorporated into the bleaching agent. CONCLUSIONS: Incorporating nanostructured additives into tooth-bleaching agents improved efficacy and reduced side effects, especially with titanium oxide nanoparticles. Further clinical studies and systematic reviews are needed to establish strong evidence for safe clinical practice. CLINICAL RELEVANCE: Including nanostructured additives in bleaching agents, such as titanium oxide nanoparticles, might be a valuable approach to enhancing the bleaching potential while reducing bleaching sensitivity and cytotoxicity, offering safer alternatives for clinical protocols.