The objective of this article was to systematically review the literature to determine how effective tooth whitening procedures are when carried out in tandem with orthodontic clear aligners. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Online searches of PubMed, Medline via Ovid, Science Direct, the Cochrane database of systematic reviews via Ovid, Scopus, and Google Scholar as well as manual searches of the references of the selected articles were conducted. Clinical studies which assessed the efficacy of dental bleaching using orthodontic clear aligners were included in the present study. Data from the included studies were extracted and assessed for risk of bias using the Cochrane risk of bias tool. Three studies met the inclusion and exclusion criteria and were included in this study. One study compared the efficiency of tooth bleaching between clear aligners and conventional bleaching trays. One study evaluated the effectiveness of dental bleaching using clear aligners by comparing the tooth shade of those patients to a control group of patients who did not receive dental bleaching during orthodontic clear aligner treatment. One study evaluated the effectiveness of different concentrations of different bleaching agents using clear aligners. All the included studies showed an improved tooth shade when using clear aligners as bleaching trays.

The high aesthetic demands of patients have increased their requests to align their teeth using clear aligners, including Invisalign. Patients also want to have their teeth whitened for the same purpose; the use of Invisalign as a bleaching tray at night has been reported in few studies. However, whether 10% carbamide peroxide affects the physical properties of Invisalign is unknown. Therefore, the objective of this study was to evaluate the effect of 10% carbamide peroxide on the physical properties of Invisalign when used as a bleaching tray at night. Twenty-two unused Invisalign aligners (Santa Clara, CA, USA) were used to prepare 144 specimens to test their tensile strength, hardness, surface roughness, and translucency. The specimens were divided into four groups: a testing group at baseline (TG1), a testing group after application of bleaching material at 37 °C for 2 weeks (TG2), a control group at baseline (CG1), and a control group after immersion in distilled water at 37 °C for 2 weeks (CG2). Statistical analysis was conducted using a paired t-test, Wilcoxon signed rank test, independent samples t-test, and Mann–Whitney test to compare samples in CG2 to CG1, TG2 to TG1, and TG2 to CG2. Statistical analysis showed no statistically significant difference between the groups for all physical properties, except for hardness (p-value < 0.001) and surface roughness (p-value = 0.007 and p-value < 0.001 for the internal and external surface roughness, respectively), which revealed a reduction in hardness values (from 4.43 ± 0.86 N/mm2 to 2.2 ± 0.29 N/mm2) and an increase in surface roughness (from 1.6 ± 0.32 Ra to 1.93 ± 0.28 Ra and from 0.58 ± 0.12 Ra to 0.68 ± 0.13 Ra for the internal and external surface roughness, respectively) after 2 weeks of dental bleaching. Results showed that Invisalign can be used for dental bleaching without excessive distortion or degradation of the aligner material. However, future clinical trials are required to further assess the feasibility of using Invisalign for dental bleaching.