Diş Hekimliğinde Ağartma
Özet
Estetik beklentilerin artmasıyla birlikte diş ağartma ve beyazlatma tedavilerine olan talep günümüzde oldukça yoğunlaşmıştır. Diş hekimliğinde ağartma kavramı 1800'lü yıllara dayanmakta olup, süreç içerisinde hidrojen peroksit, karbamid peroksit ve sodyum perborat gibi çeşitli aktif ajanlar ve uygulama teknikleri geliştirilmiştir. Tedavi planlamasında; renklenmenin içsel veya dışsal kaynaklı nedenleri, hastanın periodontal durumu ve mevcut restorasyonları detaylı analiz edilmelidir. Kliniklerde uygulanan ofis tipi yöntemlerde hızlı sonuç almak adına yüksek konsantrasyonlu ajanlar tercih edilirken, hekim denetimindeki ev tipi yöntemlerde kişiye özel plaklarla daha düşük konsantrasyonlu ürünler uzun süreli uygulanmakta ve bu yöntemin daha etkin ve güvenli olduğu belirtilmektedir. Ağartma mekanizması, peroksitlerin mine ve dentine difüzyonu ile renklenmeye yol açan organik kromoforları oksitlemesi esasına dayanır. Tedavi sonrasında mine sertliğinde azalma, pürüzlülük, mineral kaybı ve dentin hassasiyeti gibi potansiyel yan etkiler görülebilmektedir. Bu olumsuz etkileri ve mikroyapısal hasarları en aza indirmek amacıyla, kazein fosfopeptid-amorf kalsiyum fosfat (CPP-ACP) ve nano-hidroksiapatit gibi remineralizasyon ajanlarının kullanımı ile yeni nesil bitkisel katkı maddeleri önerilmektedir. Başarılı bir sonuç ve renk stabilitesi için hastaların işlem sonrasında renklendirici diyet bileşenlerinden ve asitli gıdalardan kaçınmaları kritik önem taşımaktadır.
With the rise in aesthetic expectations, the demand for tooth bleaching and whitening treatments has significantly increased today. The concept of bleaching in dentistry dates back to the 1800s, and various active agents such as hydrogen peroxide, carbamide peroxide, and sodium perborat, along with different application techniques, have been developed over time. In treatment planning, the intrinsic or extrinsic causes of discoloration, the patient's periodontal status, and existing restorations must be analyzed thoroughly. While in-office methods utilize high-concentration agents for rapid results, dentist-supervised at-home techniques apply lower-concentration products via custom trays over longer periods, which is reported to be more effective and reliable. The bleaching mechanism is based on the diffusion of peroxides into enamel and dentin to oxidize the organic chromophores causing discoloration. Post-treatment side effects including reductions in enamel hardness, increased roughness, mineral loss, and dentin hypersensitivity may occur. To minimize these adverse effects and microstructural damage, the use of remineralization agents like casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and nano-hydroxyapatite, alongside new-generation herbal additives, is recommended. For a successful outcome and color stability, it is critically important for patients to avoid staining dietary components and acidic foods following the procedure.
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