Clinical protocol in combined whitening tretment of vital teeth

Izbjeljivanje vitalnih zubi mora se provoditi vrlo pedantno kako ne bi došlo do iritacije pulpe. Oni se mogu izbjeljivati na 3 načina: izbjeljivanjem u ordinaciji pod strogim nadzorom stomatologa, izbjeljivanjem kod kuće i njihovom kombinacijom. Odabir najpodobnije tehnike za pacijenta ovisi prije svega o etiologiji i intenzitetu obojenja. Postupak se provodi kemijskim sredstvima kao što su vodikov peroksid i karbamidov peroksid, a može biti potpomognut primjenom svijetla ili topline. Kombinirana tehnika izbjeljivanja vitalnih zubi u novije vrijeme postaje sve popularnija. Dokazala se izrazito učinkovitom i neinvazivnom metodom, a dobiveni su rezultati jako dobri i dugotrajni. Zubi se prvo tretiraju 6% vodikovim peroksidom u ordinaciji, a zatim 16% karbamidovim peroksidom kod kuće, u prethodno individualno izrađenoj udlagi, kroz period od dva do tri tjedna. Rizik od nastanka nuspojava na tvrdim i mekim tkivima usne šupljine sveden je na minimum. Prema Direktivi Europske Unije (2011/84/EU), donja dobna granica za izbjeljivanje zubi iznosi 18 godina. Tom se Direktivom definirala koncentracija vodikovog peroksida koju smiju koristiti stomatolozi, odnosno pacijenti pod njihovim nadzorom, a iznosi od 0,1 do 6 %. Nisu svi pacijenti dobri kandidati za postupak izbjeljivanja. Zato je potrebno napraviti temeljiti klinički pregled, te utvrditi postojanje indikacija i kontraindikacija. Ponekad samo saniranje karijesnih lezija, profesionalno čišćenje tvrdih i mekih naslaga te poliranje abrazivnom pastom daje zadovoljavajuće rezultate. Najbolji rezultati izbjeljivanja postižu se na onim zubima koji imaju svijetla žućkasta i smeđa obojenja, a najslabije se izbjeljuju tamno plave i sive nijanseVital teeth whitening must be carried out very thoroughly in order to avoid pulp irritation. Teeth whitening can be done in three ways: intensive whitening in the office under the strict supervision of a dentist, whitening at home and a combination of these two tehniques. Choosing the most appropriate tehnique for the patient depends primarly on the etiology of the discoloration. The process is carried out with chemical agents such as hydrogen peroxide and carbamide peroxide, and can be aided by the application of light or heat. The combined technique of whitening vital teeth has become increasingly popular in recent times. It has proven to be a very effective and non-invasive method, and the results are very good and long lasting. The teeth are first treated with 6% hydrogen peroxide in the office and then with 16% carbamide peroxide at home, in previously individually prepared splinters, for a period of two to three weeks. The risk of side effects on hard and soft tissues of the oral cavity is minimized. According to the Directive of the European Union (2011/84/ EU), the lower age limit for teeth whitening is 18 years. This Directive defines the concentration of hydrogen peroxide that can be used by dentists or patients under their supervision, ranging from 0.1 to 6%. Not all patients are good candidates for the bleaching process. Therefore, a thorough clinical examination should be made and indications and contraindications established. Sometimes just repairing caries lesions, professionally cleaning hard and soft deposits and polishing with an abrasive paste gives satisfactory results. The best whitening results are achieved on those teeth that have light yellowish and brown discolorations, and the weakest whiten in dark blue and gray shades