Vital Ağartma Tedavileri
Özet
Vital ağartma tedavileri, artan estetik beklentileri karşılamak amacıyla diş hekimliğinde sıkça talep edilen, restoratif uygulamalara kıyasla konservatif ve düşük maliyetli yöntemlerdir. Bu işlem, diş yapısındaki organik pigmentlerin kimyasal ajanlarla okside edilerek diş renginin açılması esasına (Kromofor Teorisi) dayanır. Geçmişi 18. yüzyıla kadar uzanan bu tedaviler; hekim kontrolünde ofiste (ofis tipi), hekim tavsiyesiyle evde (evde tipi) veya bireyin kendisi tarafından hekim kontrolü olmaksızın (OTC) uygulanabilmektedir. Tedavide kullanılan aktif ajanların başında alkali ortamda serbest oksijen radikalleri salarak renkleşmeleri çözen hidrojen peroksit gelir; ayrıca üre ve hidrojen peroksite ayrışan karbamid peroksit ile sodyum perborat, klor dioksit ve doğal bitki özütleri de tercih edilmektedir. Klinik etkinliği artırmak amacıyla jellerin içeriğine kıvam arttırıcılar, taşıyıcılar ve koruyucuların yanı sıra hassasiyeti azaltıp remineralizasyonu destekleyen florür, potasyum nitrat ve ACP-CPP gibi maddeler eklenmektedir. Ajanlar tek başına uygulanabileceği gibi plazma ark, LED, lazer, termokataliz, kimyasal kataliz veya ozon gibi yöntemlerle aktive edilerek de kullanılabilir. Ofis ve ev tiplerinin kombine edilmesi renk stabilitesini artırırken; diş macunu, Gargara ve şerit gibi hekim kontrolü dışındaki ürünler ise genellikle yüzeyel lekelerin giderilmesinde etkilidir. Sonuç olarak vital ağartma, doğru vaka analizi ve uygun materyal seçimiyle diş yapısına zarar vermeden hasta memnuniyetini artıran güvenli bir uygulamadır.
Vital bleaching treatments are highly demanded, conservative, and cost-effective methods in dentistry aimed at meeting increasing aesthetic expectations compared to restorative procedures. This process is based on the Chromophore Theory, which involves bleaching the tooth color by oxidizing the organic pigments within the enamel and dentin structures using chemical agents. Historically dating back to the 18th century, these treatments can be performed in the office under clinician control (in-office), at home by the patient via clinician recommendation (at-home), or without clinician control using over-the-counter (OTC) products. The primary active agent used is hydrogen peroxide, which releases free oxygen radicals in an alkaline environment to dissolve discolorations; additionally, carbamide peroxide, which decomposes into urea and hydrogen peroxide, as well as sodium perborat, chlorine dioxide, and natural plant extracts are preferred. To enhance clinical efficacy, agents are formulated with thickeners, carriers, and preservatives, alongside substances like fluoride, potassium nitrate, and ACP-CPP to minimize sensitivity and support remineralization. Bleaching agents can be applied alone or activated using light sources, lasers, thermocatalysis, chemical catalysis, atmospheric pressure cold plasma, or ozone to accelerate the reaction. Combining in-office and at-home techniques improves color stability, whereas OTC products like whitening toothpastes, rinses, and strips are generally effective for removing superficial stains. In conclusion, vital bleaching is a safe procedure with no significant adverse effects on tooth structure when combined with the clinician's comprehensive understanding of etiology and appropriate approach selection.
Referanslar
Călin DL. In offıce vıtal dental bleachıng: a case report and lıterature synthesıs. Romanian Journal of Functional & Clinical, Macro-& Microscopical Anatomy & of Anthropology/Revista Româna de Anatomie Functionala si Clinica, Macro si Microscopica si de Antropologie. 2020;19(1):42-50.
Joiner A. The bleaching of teeth: a review of the literature. Journal of Dentistry. 2006;34(7):412-419.
Koruk D, Kırzıoğlu Z. Diş beyazlatma tedavisinin güvenilirliği. Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2010;11(1):29-37.
Özel Y, Özel E, Attar N, Aksoy G. Dişhekimliğinde beyazlatma. Ege Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2007;28:33-40.
Haywood VB. Nightguard vital bleaching. Quintessence International. 1989;20:173-176.
Dutra A, Frary J, Wise R. Higher‐order needs drive new growth in mature consumer markets. Journal of Business Strategy. 2004;5:26-34.
Greenwall L. Bleaching Techniques in Restorative Dentistry: An Illustrated Guide. London: CRC Press; 2001.
Haywood VB. History, safety, and effectiveness of current bleaching techniques and applications of the nightguard vital bleaching technique. Quintessence International (Berl). 1992;23(7):471-488.
Atkinson CB. Fancies and some facts. Dental Cosm. 1892;34:968-972.
Bartlett DW. Bleaching discoloured teeth. Dental Update. 2001;28(1):14-18.
Haywood VB, Drake M. Research on whitening teeth makes news. North Carolina Dental Journal. 1990;7(2):9.
Dahl JE, Pallesen U. Tooth bleaching—a critical review of the biological aspects. Critical Reviews Oral Biology & Medicine. 2003;14(4):292-304.
Kwon SR, Wertz PW. Review of the mechanism of tooth whitening. Journal of Esthetic and Restorative Dentistry. 2015;27(5):240-257.
Carey CM. Tooth whitening: what we now know. Journal of Evidence Based Dental Practice. 2014;14:70-76.
Goldstein RE, Garber DA. Complete dental bleaching. Chicago: Quintessence Publishing (IL); 1995.
Alacam T. Endodonti. Ankara: Özyurt Yayınevi; 2012.
Joiner A, Thakker G. In vitro evaluation of a novel 6% hydrogen peroxide tooth whitening product. Journal of Dentistry. 2004;32:19-25.
Ethylenedıamıne T, Part E. Scıentıfıc commıttee on toxıcıty, ecotoxıcıty and the envıronment (cstee). Brussels; 2003.
Mena-Serrano AP, Parreiras SO, Nascimento EMS do, et al. Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber. Operative Dentistry. 2015;40(2):76-82.
Elfallah HM, Bertassoni LE, Charadram N, et al. Effect of tooth bleaching agents on protein content and mechanical properties of dental enamel. Acta Biomaterialia. 2015;20:120-128.
Féliz-Matos L, Hernández LM, Abreu N. Dental bleaching techniques; hydrogen-carbamide peroxides and light sources for activation, an update. Mini review article. The Open Dentistry Journal. 2014;8:264-268.
Arın H. Farklı sodyum perbarat tiplerinin intrakoronal ağartma ve dentin geçirgenliği üzerine etkileri. Doktora tezi. Selçuk Üniversitesi Diş Hekimliği Fakültesi. Konya. 2000.
Moraes RR, Marimon JLM, Schneider LFJ, et al. Carbamide peroxide bleaching agents: effects on surface roughness of enamel, composite and porcelain. Clinical Oral Investigations. 2006;10(1):23-28.
Asal Çalı A. İntrakoronal beyazlatmada karbamid peroksit jellerin servikal bölgeye penetrasyonunun değerlendirilmesi. Doktora tezi. Ankara Üniverisitesi Sağlık Bilimleri Enstitüsü. Ankara. 2011.
Peixoto AC, Vaez SC, Pereira NA de R, et al. High-concentration carbamide peroxide can reduce the sensitivity caused by in-office tooth bleaching: a single-blinded randomized controlled trial. Journal of Applied Oral Science. 2018;26:e20170573.
Luque-Martinez I, Reis A, Schroeder M, et al. Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis. Clinical Oral Investigations. 2016;20(7):1419-1433.
Bulut H, Turkun M, Kaya AD. Effect of an antioxidizing agent on the shear bond strength of brackets bonded to bleached human enamel. American Journal of Orthodontics and Dentofacial Orthopedics. 2006;129(2):266-272.
Arı H, Üngör M. In vitro comparison of different types of sodium perborate used for intracoronal bleaching of discoloured teeth. International Endodontic Journal. 2002;35(5):433-436.
Affairs ADAC on S. Tooth whitening/bleaching: treatment considerations for dentists and their patients. Dental Association Council on Affairs - Chicago ADA. 2009.
Ablal MA, Adeyemi AA, Jarad FD. The whitening effect of chlorine dioxide—An in vitro study. Journal of Dentistry. 2013;41:76-81.
Chakravarthy PK, Acharya S. Efficacy of extrinsic stain removal by novel dentifrice containing papain and bromelain extracts. Journal of Young Pharmacists. 2012;4(4):245-249.
Gopinath S, James V, Vidhya S, et al. Effect of bleaching with two different concentrations of hydrogen peroxide containing sweet potato extract as an additive on human enamel: An in vitro spectrophotometric and scanning electron microscopy analysis. Journal of Conservative Dentistry. 2013;16(1):45-49.
Rodrigues JA, Oliveira GPF, Amaral CM. Effect of thickener agents on dental enamel microhardness submitted to at-home bleaching. Brazilian Oral Research. 2007;21:170-175.
Gökay O, Müjdeci A, Algin E. In vitro peroxide penetration into the pulp chamber from newer bleaching products. International Endodontic Journal. 2005;38(8):516-520.
Joshi SB. An overview of vital teeth bleaching. Journal of Interdisciplinary Dentistry. 2016;6(1):3-13.
Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: A literature review. Saudi Dental Journal. 2014;26(2):33-46.
Giniger M, Macdonald J, Ziemba S, et al. The clinical performance of professionally dispensed bleaching gel with added amorphous calcium phosphate. The Journal of the American Dental Association. 2005;136(3):383-392.
Petersson LG. The role of fluoride in the preventive management of dentin hypersensitivity and root caries. Clinical Oral Investigations. 2013;17(1):63-71.
Attin T, Betke H, Schippan F, et al. Potential of fluoridated carbamide peroxide gels to support post-bleaching enamel re-hardening. Journal of Dentistry. 2007;35(9):755-759.
Poulsen S, Errboe M, Mevil YL, et al. Potassium containing toothpastes for dentine hypersensitivity. Cochrane Database Systematic Reviews. 2006;(3).
Matis BA, Cochran MA, Eckert GJ, et al. In vivo study of two carbamide peroxide gels with different desensitizing agents. Operative Dentistry. 2007;32(6):549-555.
Suemori T, Kato J, Nakazawa T, et al. Effects of light irradiation on bleaching by a 3.5% hydrogen peroxide solution containing titanium dioxide. Laser Physis Letters. 2008;5(5):379-383.
Hyland BW, McDonald A, Lewis N, et al. A new three-component formulation for the efficient whitening of teeth (carbamide plus). Clinical Oral Investigations. 2015;19(6):1395-1404.
Kalyana P, Shashidhar A, Meghashyam B, et al. Stain removal efficacy of a novel dentifrice containing papain and bromelain extracts–an in vitro study. International Journal of Dental Hygiene. 2011;9(3):229-233.
Al Batayneh O. clinical applications of tooth mousse [TM] and other CPP-ACP products in caries prevention: evidence-based recommendations. Smile Dental Journal. 2009;4(1):8-12.
AlKahtani RN. The implications and applications of nanotechnology in dentistry: A review. Saudi Dental Journal. 2018;30(2):107-116.
Mellgren T, Qin T, Öhman-Mägi C, et al. Calcium phosphate microspheres as a delivery vehicle for tooth-bleaching agents. Journal of Dental Research. 2018;97(3):283-288.
Maran BM, Ziegelmann PK, Burey A, et al. Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis. Clinical Oral Investigations. 2019;23(4):1499-1512.
Gallinari MO, Fagundes TC, da Silva LM, et al. A new approach for dental bleaching using violet light with or without the use of whitening gel: study of bleaching effectiveness. Operative Dentistry. 2019;44(5):521-529.
Downs JC, Convissar RA, Anagnostaki E, et al. Lasers in fixed prosthetic and cosmetic reconstruction. In: Principles and Practice of Laser Dentistry. Elsevier. 2011:139-156.
Marcondes M, Gandolfi Paranhos MP, Spohr AM, et al. The influence of the Nd: YAG laser bleaching on physical and mechanical properties of the dental enamel. Journal of Biomedical Materials Research Part B Applied Biomaterials. 2009;90(1):388-395.
De Moor RJG, Verheyen J, Diachuk A, et al. Insight in the chemistry of laser-activated dental bleaching. The Scientific World Journal. 2015;2015.
Buchalla W, Attin T. External bleaching therapy with activation by heat, light or laser—a systematic review. Dental Materials. 2007;23(5):586-596.
Chen J-H, Xu J-W, Shing C-X. Decomposition rate of hydrogen peroxide bleaching agents under various chemical and physical conditions. The Journal of Prosthetic Dentistry. 1993;69(1):46-48.
Choi H, Kim K-N, You E-M, et al. Tooth whitening effects by atmospheric pressure cold plasmas with different gases. Japanese Journal of Applied Physics. 2013;52(11S):11NF02.
Kong MG, Kroesen G, Morfill G, et al. Plasma medicine: an introductory review. New Journal of Physics. 2009;11(11):115012.
Boztaş G, Ömürlü H. Restoratif diş hekimliğinde ozon tedavileri. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2014;24(3):158-168.
Perincek SD, Duran K, Korlu AE, et al. An investigation in the use of ozone gas in the bleaching of cotton fabrics. Ozone Science & Engineering. 2007;29(5):325-333.
Gurgan S, Cakir FY, Yazici E. Different light-activated in-office bleaching systems: a clinical evaluation. Lasers in Medical Science. 2010;25(6):817-822.
Al Shethri S, Matis BA, Cochran MA, et al. A clinical evaluation of two in-office bleaching products. Operative Dentistry. 2003;28(5):488-495.
Marshall K, Berry TG, Woolum J. Tooth whitening: current status. Compendium of Continuing Education in Dentistry (Jamesburg, NJ 1995). 2010;31(7):486-492.
Dostalova T, Jelinkova H, Housova D, et al. Diode laser-activated bleaching. Brazilian Dental Journal. 2004;15:1-3.
Luk K, Tam L, Hubert M. Effect of light energy on peroxide tooth bleaching. The Journal of the American Dental Association. 2004;135(2):194-201.
Esener İT. Diş ağartma yöntemlerine bir bakış. Cumhuriyet Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2003;1:64-66.
Önal B. Restoratif diş hekimliğinde maddeler ve uygulamaları. İzmir: Ege Üniversitesi Diş Hekimliği Fakültesi Yayınları; 2004.
Türkün LŞ. Diş beyazlatmasında kullanılan bir office materyalinin klinik performansinin değerlendirilmesi. Bitirme tezi. Ege Üniversitesi Diş Hekimliği Fakültesi. İzmir. 2011.
Allen K, Agosta C, Estafan D. Using microabrasive material to remove fluorosis stains. The Journal of the American Dental Association. 2004;135(3):319-323.
Croll TP. Enamel microabrasion for removal of superficial dysmineralization and decalcification defects. The Journal of the American Dental Association. 1990;120(4):411-415.
Thickett E, Cobourne MT. New developments in tooth whitening. The current status of external bleaching in orthodontics. Journal of Orthodontics. 2009;36(3):194-201.
Sulieman M. An overview of bleaching techniques: 2. Night guard vital bleaching and non-vital bleaching. SADJ: Journal of the South African Dental Association=Tydskrif van die Suid-afrikaanse Tandheelkundige Vereniging. 2006;61(8):352-354.
Haywood van B. Current status of nightguard vital bleaching. Compendium. 2000;21(28):10-17.
Bernardon JK, Sartori N, Ballarin A, et al. Clinical performance of vital bleaching techniques. Operative Dentistry. 2010;35(1):3-10.
Burrell KH. ADA supports vital tooth bleaching—but look for the seal. The Journal of the American Dental Association. 1997;128:3S-5S.
Şişmanoğlu S. An overview of vital tooth bleaching. Aurum Journal of Health Sciences. 2020;2(2):115-139.
Attin T, Muller T, Patyk A, et al. Influence of different bleaching systems on fracture toughness and hardness of enamel. Operative Dentistry Washıngton-. 2004;29(2):188-195.
Directive C. 84/EU. Oficial Journal of the European Union. 2011;2011:36-38.
Alkahtani R, Stone S, German M, et al. A review on dental whitening. Journal of Dentistry. 2020;100:103423.
Tao D, Sun JN, Wang X, et al. In vitro and clinical evaluation of optical tooth whitening toothpastes. Journal of Dentistry. 2017;67:25-28.
Donly KJ, Segura A, Henson T, et al. Randomized controlled trial of professional at-home tooth whitening in teenagers. General Dentistry. 2007;55(7):669-674.
Kishta-Derani M, Neiva G, Yaman P, et al. In vitro evaluation of tooth-color change using four paint-on tooth whiteners. Operative Dentistry. 2007;32(4):394-398.
Lo EC, Wong AH, Mcgrath C. A randomized controlled trial of home tooth-whitening products. American Journal of Dentistry. 2007;20(5):315-318.
Demarco FF, Meireles SS, Masotti AS. Over-the-counter whitening agents: a concise review. Brazilian Oral Research. 2009;23:64-70.
