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2.

2 Mecanismul de actiune al peroxidului

Explicarea fenomenului de albire a dintilor cu ajutorul peroxidului are la baza teoria


cromoforilor. Aceasta se bazeaza pe interactiunea dintre peroxide (H2O2) si
cromatoforii organic din structura dintilor. Cromatoforii au un surplus de electroni
care, atunci cand peroxidul intalneste pete, isi transforma lanturile in structure mai
simple sau isi altereaza proprietatile optice diminuind aspectule petei.

Pentru a intelege modul in care decurge albirea, trebuie discutate trei faze:
1) Difuzia peroxidului aplicat de la exterior in email si dentina;
2) Interactiunea petelor cu peroxidul;
3) Modificarile morfologice pe suprafata si in interiorul dintelui ce pot duce la
modificari optice.

2.2.1 Faza 1: Difuzia

A doua lege a difuziei a lui Fick stipuleaza ca difuzia unei molecule este
proportionala cu suprafata, coeficientul de difuzie si concentratia si este inver
proportional cu distanta.

Astfel mai multe studii au aratat imbunatatiri ale difuziei peroxidului prin:
concentratii mai mari de peroxide, aplicare prelungita, cresterea temperaturii, tubulii
dentari mai mari la tineri, activarea luminoasa.

Teoria sustine ca, dat fiind faptul ca peroxidul este solubil in apa, difuzia acestor
molecule are locprin spatiile interprismatice ale emailului si tubulii dentinali. Aceasta
difuzie nu are loc pasiv, ci este determinate de un gradient de concentratie determinat
de afinitatea chimica a fiecaui tesut dentinal.

De aceea este important sa se identifice concentratia optima pentru albire si timpul de


aplicare astfel incat sa se minimizeze microleziunele sin struntuta dentara fara se se
afecteze eficacitatea albirii.

2.2.2 Faza 2: Interactiunea

Indiferent daca este aplicat direct sau prin intermediul unor reactii chimice, peroxidul
elibereaza oxygen active, rata de eliberare depinzand de temperature, concentratia
peroxidului, pH si prezenta unor catalizatori.

Oxigenul activ este atras de zonele bogate in electroni din zona moleculelor de pete
unde reactia reduce culoarea sau indeparteaza molecula rezultata.

Conform teoriei peroxidul se deplaseaza de la suprafata in email si dentina iar


actiunea oxidative are loc numai la nivelui cromatoforilor organic pana cand se atinge
un punct de saturatie (prag de albire). Opinia este ca depasirea acetui punct de
saturatie poate duce la compromiterea structurii dentare. Unele studii arata ca
peroxidul interactioneaza cu componentele organice si anorganice ale emailului si
dentine mult inaintea atingerii punctului de saturatie.

Chiar daca multe studii arata ca peroxidul nu influenteaza structura chimica a


emailului si a dentine dincolo de o relevant clinica, unele studii sugereaza ca ar
produce mofificari semnifinative ale raportului calciu/potasiu, traduse prin alterari ale
componentelor anorganice ale hidroxiapatitei.

In principiu trebuie plecat de la idea ca peroxidul interactioneaza cu toate


componentele emailului si ale dentine, ceea ce duce la necesitatea gasirii unui
echilibru in aplicarea acestuia.

2.2.3 Faza 3: Modificarea suprafetei si a culorii Surface Change and Color

In final, din punct de vedere fizic, albirea dintilor consta in cresterea luminozitatii si
reducerea cromoforilor din zona galben- albastru si rosu-verde (conform CIE Lab
system).

. The separate contributions


of enamel and dentin on tooth color have been evaluated, with some studies
placing more emphasis on the role of dentin (Kwon et al. 2013 ; Wiegand et al. 2005 ;
Kugel et al. 2007 ). Nevertheless, enamel characteristics also play a key role in the
optical properties of the tooth. Enamel contributes to the overall tooth color by
decreasing the translucency of the tooth, masking the color of the underlying dentin
(Kawamoto and Tsujimoto2004 ; Ma et al. 2009 , 2011 ). Changes in the enamel
have been attributed to micromorphological alterations through deproteinization,
demineralization, and oxidation of the most superficial enamel layer (Eimar et al.
2011 ; Ma et al. 2009 , 2011 ). This changes the density of enamel making the
distribution of enamel crystals less compact and potentially increasing its refractive
index (Li et al. 2010 ; Ma et al. 2011 ).

Determining how subtle enamel surface changes affect the tooth has been an area
of interest. Studies have found that rough surfaces create a more diffuse reflection,
turning the object brighter, whereas a smooth surface leads to more specular
reflection.

Additionally, an increase in back scattering of short wavelengths, reflected as


bluish-white, plays a considerable role in the light scattering of teeth (Joiner 2004 ).
This is most easily demonstrated by the whitish color change in early caries lesions
due to the increased opacity of the tooth enamel (Ma et al. 2009 , 2011 ; Vieira et al.
2008 ). Further, some studies suggest tooth color change that is associated with tooth
whitening is mainly due to mineral loss rather than the breakdown of chromophores
(Jiang et al. 2007 ; Kwon et al. 2002 ; Lee et al. 2006 ; McCracken and Haywood
1996 ). The subsequent uptake of minerals after tooth whitening and the reversal of
the treatment substantially support this suggestion (Li et al. 2010 ).
Because of the impact of surface changes on the appearance of tooth color,
changes in surface topography have been extensively investigated. SEM and AFM
studies showed increased roughness and surface irregularities upon whitening
treatment (Ben-Amar et al. 1995 ; Bitter and Sanders 1993 ; Hosoya et al. 2003 ;
McGuckin et al. 1992 ; Pedreira De Freitas et al. 2010 ; Pinto et al. 2004 ; Shannon et
al. 1993 ; S.R. KwoYeh et al. 2005 ; Zalkind et al. 1996 ). Notably, most of these
changes have not been seen in studies where a remineralizing agent or saliva was used
as a storage medium (Duschner et al. 2006 ; Haywood et al. 1991 ; Joiner et al. 2004 ;
Scherer et al. 1991 ; Turkun et al. 2002 ; White et al. 2003 ). Thus, continued research
on the effects of whitening treatments on surface and tooth color changes are
necessary to order to prescribe treatments that will have long-lasting effects with
minimal changes to the overall structure of the tooth.

This up-to-date review of the literature illustrates that tooth whitening occurs in
three distinct phases, challenging the validity of the widely accepted “chromophore
effect” as the dominant mechanism of hydrogen peroxide. As such, this theory must
be modified to reflect the true complexity of the mechanisms that drive whitening.
Indeed, stains are not determined by the properties of the organic staining molecules
alone but are also affected by micromorphologic alterations on the tooth surface and
within the tooth structure; thus, whitening likely affects intact enamel and dentin
microstructures, an underrecognized concern (Kwon and Wertz 2016 ). In future
studies, an appreciation of the complexity of the tooth whitening process will
spearhead innovation toward materials and techniques that meet the ever-growing
interest in safely obtaining a brighter smile.