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1. ????? ?a? S?s?e??? ?e??a?s?? ??a te????????? ded???a

3. ?????? ??a ?e???te?a ?a??e?a

4. St? s??????? a?ta????st??? a???? ?? ??T???? S????? ???????G??S ???S ????????????? p??e? ?a e??a?: - ? e??st?p???s? t?? d??at?t?t?? e??p???t?s?? t?? as?e??? - ? ?????????? a?a???s? t?? pa?e??e??? ?p??es??? a?a?e????ta? t?? ?p?????ta e??p??s?. - ? d?asf???s? ??a??p???t???? e?s?d?at?? ??????S S????S: a???s? t?? es?d?? ?a? t?? ?at????? d??at?t?t?? t?? ?d??t?at?e??? p??se?????ta? ????? as?e?e??.

5. ? a??a??e??? a?ta????s?? ?a? ? ?da t?? ep???? apa?te? t? ???s? ???? te????????? ?a? ?????? ??a ?a d?at???s??e ?a? ?a a???s??e t?? e??as?e? a?.

6. ??? p??e? ?a a????e? t? d?s?????? ????; One of the best ways to initiate a reaction at a carbon to carbon double bond is to use a free radical. Oxygen free radicals are, relatively, easy to create from compounds that are commercially available and inexpensive.One of the best ways to initiate a reaction at a carbon to carbon double bond is to use a free radical. Oxygen free radicals are, relatively, easy to create from compounds that are commercially available and inexpensive.

7. ????? e?e??e??? ????? ???????? Common compounds that can be used to generate an oxygen free radical include: hydrogen peroxide which has been used in teeth whitening for about 100 years. Organic Peroxides which have become fashionable in teeth whitening relatively recently because of their increased stability and, therefore, increased shelf life. Inorganic Peroxide salts which have become fashionable recently in teeth whitening chewing gum because of they are a water soluble solid that can be mixed into the gum. When chewed the salt dissolves and releases the peroxide. The most common inorganic peroxide salt in use today is Calcium Peroxide. The most common organ peroxide in use today is Carbamide Peroxide. Carbamide Peroxide is also known as Urea Peroxide because it is, in essence, a Urea molecule coordinated to a hydrogen peroxide molecule. Carbamide Peroxide has found a place in dentistry in take home bleaching products. The coordination of the Urea molecule to the hydrogen peroxide molecule yields a compound that, relative to hydrogen peroxide, is quite stable. This ensures an acceptable shelf life for bleaching products. By weight, Carbamide peroxide is only 1/3 as potent as hydrogen peroxide, it is therefore of little use in clinical procedures. Hydrogen peroxide is the mainstay in clinical procedures, it is three times more potent than carbamide peroxide and has a long, 100 year, history of whitening teeth effectively and safely in the dentists office.Common compounds that can be used to generate an oxygen free radical include: hydrogen peroxide which has been used in teeth whitening for about 100 years. Organic Peroxides which have become fashionable in teeth whitening relatively recently because of their increased stability and, therefore, increased shelf life. Inorganic Peroxide salts which have become fashionable recently in teeth whitening chewing gum because of they are a water soluble solid that can be mixed into the gum. When chewed the salt dissolves and releases the peroxide. The most common inorganic peroxide salt in use today is Calcium Peroxide. The most common organ peroxide in use today is Carbamide Peroxide. Carbamide Peroxide is also known as Urea Peroxide because it is, in essence, a Urea molecule coordinated to a hydrogen peroxide molecule. Carbamide Peroxide has found a place in dentistry in take home bleaching products. The coordination of the Urea molecule to the hydrogen peroxide molecule yields a compound that, relative to hydrogen peroxide, is quite stable. This ensures an acceptable shelf life for bleaching products. By weight, Carbamide peroxide is only 1/3 as potent as hydrogen peroxide, it is therefore of little use in clinical procedures. Hydrogen peroxide is the mainstay in clinical procedures, it is three times more potent than carbamide peroxide and has a long, 100 year, history of whitening teeth effectively and safely in the dentists office.

8. S???es? s???????? ?e??a?t???? pa?a???t??

11. ?? d???? ap?d??s?? t?? H2O2 Peroxide have different spontaneous reaction pathways. For simplicity sake and because it is most pertinent to the rest of our discussion we will examine hydrogen peroxide, although the other peroxide following the exact same or very similar pathways. The first is spontaneous decomposition. In this pathway hydrogen peroxide directly decomposes to water and oxygen gas. The second spontaneous reaction generates a free radical oxygen. Decomposition is, far and away, the most common pathway and, unfortunately, it is useless for teeth whitening because no free radical is formed. Spontaneous free radical formation, as we have seen, is responsible for tooth whitening. Unfortunately, relative to decomposition, spontaneous free radical formation is rare.Peroxide have different spontaneous reaction pathways. For simplicity sake and because it is most pertinent to the rest of our discussion we will examine hydrogen peroxide, although the other peroxide following the exact same or very similar pathways. The first is spontaneous decomposition. In this pathway hydrogen peroxide directly decomposes to water and oxygen gas. The second spontaneous reaction generates a free radical oxygen. Decomposition is, far and away, the most common pathway and, unfortunately, it is useless for teeth whitening because no free radical is formed. Spontaneous free radical formation, as we have seen, is responsible for tooth whitening. Unfortunately, relative to decomposition, spontaneous free radical formation is rare.

12. 1. ? ?d?? t?? d??spas?? Lets look a little closer at both pathways. First lets look at spontaneous decomposition. Spontaneous decomposition occurs, simplistically, when two hydrogen peroxide molecules collide and their orientation is correct. The correct orientation for decomposition is tail oxygen to tail oxygen. When the two oxygen atoms meet, they form a bond between themselves and release the remnant water molecule. Now two very stable compounds remain; molecular oxygen (a gas) and water. This reaction is reversible but the energy levels favor molecular oxygen and water. Lets look a little closer at both pathways. First lets look at spontaneous decomposition. Spontaneous decomposition occurs, simplistically, when two hydrogen peroxide molecules collide and their orientation is correct. The correct orientation for decomposition is tail oxygen to tail oxygen. When the two oxygen atoms meet, they form a bond between themselves and release the remnant water molecule. Now two very stable compounds remain; molecular oxygen (a gas) and water. This reaction is reversible but the energy levels favor molecular oxygen and water.

13. 2. ? ?d?? d???????a? e?e??e??? ????? The spontaneous production of free radical oxygen from hydrogen peroxide is a dissociation. Simply put the tail oxygen pops off and on. It is a true equilibrium, meaning it is reversible. The energy state favors the hydrogen peroxide molecule over the water plus free radical. As energy is added to the system more of the free radicals will be produced. One must also remember that spontaneous decomposition also occurs and the energy level (chemical kinetics) greatly favor spontaneous decomposition over the production of a free radical. Once the free radical is formed in can immediately re-associate with the water molecule, or another molecule, to reform hydrogen peroxidebefore it has an opportunity to impact with a staining molecule.The spontaneous production of free radical oxygen from hydrogen peroxide is a dissociation. Simply put the tail oxygen pops off and on. It is a true equilibrium, meaning it is reversible. The energy state favors the hydrogen peroxide molecule over the water plus free radical. As energy is added to the system more of the free radicals will be produced. One must also remember that spontaneous decomposition also occurs and the energy level (chemical kinetics) greatly favor spontaneous decomposition over the production of a free radical. Once the free radical is formed in can immediately re-associate with the water molecule, or another molecule, to reform hydrogen peroxidebefore it has an opportunity to impact with a staining molecule.

14. ?e?at?s?? t?? a?t?d?as?? t?? e?e??e??? ????? If the oxygen free radical does impact with a staining molecule, it will react with with the staining molecule as depicted in 1 and described earlier. One other termination event occurs as is depicted in number 2. If two free radical oxygen atoms bump into one another, they will form bonds to each other and will be lost to oxygen gas. Oxygen gas can, therefore, be created by either spontaneous decomposition or by spontaneous dissociation. This generation of oxygen gas is responsible for the confusion created in the dental whitening community with regard to the belief that the addition of heat and/or light increases the efficacy of the whitening process. As you have witnessed, the addition of heat and/or light does not increase, proportionally, the creation of free radical oxygen. Hence, the addition of heat and/or light only has little effect on efficacy of whitening, although it does, in fact, hasten the process.If the oxygen free radical does impact with a staining molecule, it will react with with the staining molecule as depicted in 1 and described earlier. One other termination event occurs as is depicted in number 2. If two free radical oxygen atoms bump into one another, they will form bonds to each other and will be lost to oxygen gas. Oxygen gas can, therefore, be created by either spontaneous decomposition or by spontaneous dissociation. This generation of oxygen gas is responsible for the confusion created in the dental whitening community with regard to the belief that the addition of heat and/or light increases the efficacy of the whitening process. As you have witnessed, the addition of heat and/or light does not increase, proportionally, the creation of free radical oxygen. Hence, the addition of heat and/or light only has little effect on efficacy of whitening, although it does, in fact, hasten the process.

15. ????? ?e??a?s?? ??a t? sp?t? - ?pe???e?d?? t?? ?d??????? 4 9,5% e ??????a - ?pe???e?d?? t?? ?a?a?d??? 10 22% e ??????a

17. ????e?s??a d?s????a e ?e??a?t??? ?????

18. S???de?t??? p?????ta ?e??a?s?? ??a t? sp?t?

19. Y???? ?e??a?s?? ??a t? ?at?e?? ?pe???e?d?? t?? ?d??????? (?2?2) - S???e?t??se?? 25%, 35%, 38%

20. E?de??t??? ????? ?e??a?s?? st? ?at?e?? e ? ????? s???e?????? s?s?e?? ?palescence Boost, Ultradent (38% H2O2) Opalescence Xtra, Ultradent (35% H2O2 ) WHITEsmile XTRA, WHITEsmile GmbH (38% H2O2) Yotuel Office, BioCosmetics SL, (35% H2O2 )

21. ?e??a?t??? ?e?? p?? ????? ?atas?e?aste? ??a ???s? st? ?at?e?? ????? ep?d?as? f?te???? p???? de? p??pe? ?a ???s??p?????ta? pa??????a e ??p??a ap? a?t?? ??at? ? a???s? t?? ?e????as?a? p??e? ?a e??a? a?e???e??t? ?a? ??a ep??a?? ??a t? ??t???t?ta t?? p??f?? (p.?. ?palescence Xtra) ? de? ?a ??e? ?a???a ep?p??s?et? ?e??a?t??? ap?t??esa ? ???s? t??? a?t?. To ????? ?palescence Xtra ???? t?? -?a??t???? p?? pe????e? fa??eta? ?t? ??e? t?? ??a??t?ta ?a ap????f? e????e?a st? f?sa t?? ??at??-p?e f?t??. ??t? p??a?? s?a??e? ?t? p??e? ?a ???s??p????e? pa??????a e s?s?e?? p?? e?p?pe? st? f?sa a?t? e ?a??te?a te???? ap?te??sata ?e??a?s?? se s??s? e t? a? ???s??p??e?t? ??? t??. ?p?p??s?eta ? a???s? t?? ?e????as?a? sta es?te???? st??ata t?? d??t??? ???? t?? -?a??t???? fa??eta? ?t? e??a? ????te?? se s??s? e ?????? ?e??a?t????? pa?????te? e??a? ?st?s? ???t? st? ???? ???? t?? p??f?? Luk K.,et al: JADA 2004;135:194-201 ???ast???a?? ap?te??sata

23. ? e?a?s??s?a t?? d??t??? a?t?et?p??eta? e f????? ? e ??t???? ????? 3-5% t?p??et???? st??? at?????? ??????e? ??a 10-30 ?ept? ? ???s? p???e?s???? d?s?a???? e ta ????? a?t? (p.?. UltraEZ ?a? Flor-Opal, t?? Ultradent ? Fluoro-Guard t?? ?aster-dent). S?st??eta? ? pa??????? ???s? ???a? p?? pe????e? RecaldentTM - CPP-ACP (f?sf?pept?d?? t?? ?a?e????-???f? f?sf????? as?st??)(p.?. GC Tooth mousse). WHITEsmile Mousse (????t??? 30%, 1450ppm f???????? ????? ?a? 4,3% ??t???? ?????). Pereira & Chava, 2001; Giniger et al., 2005; ??t????d?? 2008

24. ?pe???e?d?? t?? ?a?a?d??? (35 %) ?pe???e?d?? t?? ?d??????? (35%) ?pe?????? ??t??? ?et?a???d?? ?pe?????? ??t???: a??e??? e apesta???? ?e?? ?et?a???d?? ?pe?????? ??t???: a??e??? e d????a 3% H2O2 ?pe?a???a???? ??t???: a??e??? e apesta???? ?e?? ?pe?a???a???? ??t???: a??e??? e d????a 30% H2O2 (S?????? ??e?????ta? 2 ??. a?? s??ed??a)

25. ??de??t??? ep????? s?e??sata t?? a????? ??a ?e??a?s? e?d?d??t??? ?e?ape????? d??t??? ???s? e t?? pe??pat?t??? te?????: Opalescence Endo 35% ?pe???e?d?? t?? ?d??????? (s?s?e?as?a 2 ? 1,2 ml) ???s? e t?? f?t??ata??t??? te????? ?palescence Xtra Boost (38% ?pe???e?d?? t?? ?d???????) ?.a. s?e??sata ?2?2 35% p?? p??te????ta? e s?s?e?? a???????, LED ? p??sat?? X??s? e t?? ??d?-??? ????? te????? ?palescence Xtra Boost (38% ?pe???e?d?? t?? ?d???????) ?palescence Quick (45% ?pe???e?d?? t?? ?a?a?d???)

26. ?? s?s?e??? ?e??a?s?? e??a? ?a efa???? t?? s???????? te???????a? p?? e s?st? ???s? p????? ?a p??sf????? s?a?t??? st? ?d??t?at?e?? ?a? t??? as?e?e?? a? t???????? t?? a?t?st????? ???e f??? p??t??????? ?e??a?s?? ?a? s??????? asfa?e?a?

27. 15% t?? as?e??? p?? ???s??p????? t?? te????? t?? ?e??a?s?? st? sp?t? de? e??a? ??a??p??????? ap? t? ap?t??esa (Clinical Research Associates,2000) ?????a ?a? pe??ss?te??? as?e?e?? a?a??t??? ???????te?a p?? ?e??? d??t?a.

28. Bas???? a???? ?e??a?s?? a?e???t?ta ap? t?? ep??e??e?sa s?s?e??

29. 1. S?s?e??? a???????

31. S?st?a ?e??a?s?? ?????? f?t?? (a???????) BEYOND

33. 3. S?s?e??? LED-?????e? d??d??

34. F???t?? s?s?e??? ?e??a?s?? t?p?? LED Whitesmile accelerator (p??sa???eta? st?? ?d?a pe????e? 14 ?????e? Led) ?t???? s?s?e?? ?e??a?s?? ??a t? sp?t?

37. 2. S?s?e??? p??sat??

39. S?e??s? ? ?e??a?s? e ???s? s?s?e??? p??sat?? a????e? t? ep????t? ap?t??esa t?s? sta ep?fa?e?a?? ?s? ?a? sta a??te?a st??ata t?? ?d??t???? ?st?? a??????ta? t? te???? t??? ???a. Nakamura T.,et al: J Oral Rehabil 2001;28:1080-4 ?p?? ?a? e ???e? ???s???e? s?s?e??? ?e??a?s?? e t?? s?s?e??? p??sat?? p???a?e?ta? af?d?t?s? t?? ?st?? e ap?t??esa ?a efa?????ta? ta d??t?a FO????????? (??t????d?? 2008)

40. S?e??s? ????s? t?? ?e????as?a? st?? p??f? et? ap? ???s? tess???? t?p?? ???????: 0,9 oC et? 40 sec e LED 3,6 oC et? 40 sec e s?at??? ?????a a??????? 1,9 oC et? 10 sec e ?????? ??tas?? ?????a a??????? 6,4 oC et? 10 sec e ?????a p??sat??

41. 4.S?s?e?? ?pe???d??? a?t??????a?

42. ????? ??at?? e?p?p??

45. 5. S?s?e?? ?pe????? QuickWhite

48. S?s?e??? laser

49. S?s?e??? laser ??a ?e??a?s? Laser a????: e e?p?p? sta 488nm. ??e??e?t?ata: ???? ???? ??at??-f?t???a ?????? e????e?a?. ??t??eta ?? s?s?e??? a???????, p??sat?? ?a? ???e? s?s?e??? p?? a??????? t? ?e????as?a e?p?p??? ?a? a??ata ?e???? ??ata st? ?p?????? (750nm-1mm) e ????te??? e????e?a? f?t???a ?a? ????? ?e???? ?a?a?t??a. ?????pt??? p?? ap??? ?????? a??s?de?. ?p?t??esa e??a? ? ????te?? a???s? t?? ?e????as?a? ap? ????? t??? t?p??? ????e?. ??e? e?a??te?? ap?te?esat???t?ta ?ta? ???s??p??e?ta? ?e??a?t??? ????? e p?e ???a. ???d??? laser: e e?p?p? sta 980-nm. ??p??s?p?? t?? t?p?? a?t?? e??a? t? ????e? GaAIAS ?a? KTP. To ?e??a?t??? ????? p??pe? ?a ??e? ???a ???????. Laser CO2: e e?p?p? sta 10.600nm, st? f?sa t?? ?p???????

50. ?st????? st???e?a ?e??a?s?? e laser ? ?e??a?s? e laser e??a? pat??ta t?? Yarborough, ? ?p???? e?s??a?e st?? a???? t? 1996, t? Brite Smile ??a ???s? e t? ILT Argon laser ?a? t? ?LT Genesis 2000 CO2 laser (Ion Laser Technology). To 1998, ? eta??e?a ILT a?ad????a?????e. To 1999, e t? ???a Brite Smile Co (Walnut Creek,CA) ???a?e ta p??t?????a ?e??a?s?? e laser ?a? p???? ???s??p??e? ??a ?e??a?s? t?? d??t??? s?s?e?? p??sat?? e t? ????? Brite Smile

51. S?s?e?? Laser ??P ?e???? ???? ??at?? a?t??????a?: 532 nm ?? ??a???? ???sta???? ?.?.?. (p?t?s?? t?t???? f?sf????) Id?a?te?a ????f??? laser-te????? ?da???? ??a ???s? d??t??? e tet?a??????? ??e??e?t?ata F?t?????? (??? f?t??e???? a?t?d?as?) se a??a???? pH ?a d??t?a de? af?dat????ta? ? ad??p?????ta? ?? ???e? ???????? e?s?????? se e?a??te?? ???? st??? ?d??t????? ?st???. Me?a??te?? d????e?a ?e??a?t???? ap?te??sat?? laser d?p??? s????t?ta?. ???at?t?ta d???????a? s??e???? s???? pa??? (CW) ? d?a??pt?e??? s???? pa??? (???? ? epa?a?aa??e???). ??t? e????ta? t?? stad?a?? ap??es? e????e?a? (?e??t?ta?) st??? ?st???. ?e? p???a?e?ta? ??? ???? a???s?? t?? ?e??t?ta?. ?e????? ?e??a?s?? t?? ?a? s??ed??a? ?p??e? ?a ???s??p????e? st?? pe???d??t??????? ?e?ape?t???, ???? ?e????????? a?a??? ?st?? ?a? t?? e?d?d??t?a, ??a t? ?e?ape?a t?? ?pe?e?a?s??s?a? (?) ?e?????t?a ????? ??st?? a????? t?? s?s?e???

52. ???S??? ? ???s? s?s?e??? ?p??????? a?t??????a? ?a? t? laser CO2 p???a???? e?a??te?? fa???e???? a??a?? st? ???a t?? d??t??? ???? t?? a???s?? t?? ?e????as?a? ?a? t?? epe???e??? af?d?t?s?? t?? d??t???. ?p??e????? de ??? t?? pa??et?? t?? f?te???t?ta? t?? d??t??? ?a? ??? t? ???a t??. ??t? ??a??p??e? t?? as?e?? ??at? ??pe? ??a ?es? ap?t??esa t? ?p??? ??? te???? e???eta? se ?a ed??da. G?a t? ???? a?t? p??pe? ? d?ad??as?a ?a ?????????eta? e ???s? ?e??a?t???? pa?????ta e ??????e? st? sp?t?. Luk K., et al: 2004;135:194-201

53. S?e??s? ??a t?p??? s??ed??a st? ?at?e?? e ???s? s?s?e??? laser ??a ?e??a?s? d??e? se s?a?t??? a?? ????te?? ep????t? ap?te??sata ap?t? d?? p??t?????a ?e??a?s?? t?? d??t??? st? sp?t?. Jones A., Diaz-Arnold A., Vargas M., Cobb D: J Esthet Dent 1999;11:87-94

54. T? ?e??a?t??? ?e?? ?e?t????e? ?? ???t??? st?? a???s? t?? ?e????as?a?. ?? pe??ss?te?e? s?s?e??? ?e??a?s?? de? a?e????? t? ?e????as?a ??? t?? ep????d???? ??a t?? p??f? ?????. ???s??? p??pe? ?a d??eta? st? ???s? t?? s?s?e??? p??sat?? ?a? laser se p???? ?s??.

55. ? te????? ?e??a?s?? e e?d??? s?s?e?? e??a? ?a??te?? ap? t?? s?at???? e??d???;

58. ??????? ap?te??sata ?e t?? pe??ss?te?e? s?s?e??? ?e??a?s?? s?pt?ata ?pe?e?a?s??s?a? ? p???? e?d??eta? ?a pa?at??????? ?sa st?? ep?e?e? 24 ??e? ap? t? ???s?. ??de????ta? ? ???s? t?? ape?a?s??t?p???t???? p?????t?? p?? ?p?????? st?? s?s?e?as?e? t?? s?st??t?? ? ????? s?et???? p?????t?? t?? a?????. ? efa???? ???eta? e?te e p???e?s????? ??????e? t?? ep????? ? e t?p???t?s? t?? ?????? t??? e?at???e?????? ??????e? t?? as?e??. ?ta? ?? as?e?e?? e??a? e??e??? t?? p??a??? s?a?t?? a?t?d???? e pe??ss?te?? a????. ? ??tas? e?p?p?? t?? s?s?e??? e??a? a?t? p?? ?a?????e? se e???? a?? t? ????? a????? t?? as?e?? st? d?ad??as?a. S?pt?ata ?pe?e?a?s??s?a? ?a? p???? pa?at?????ta? s?????? sta ????te?a se ??e??? d??t?a t?? f?a???. S?st??eta? ? ???s? pa?s?p???? ap? ta pe??ss?te?a s?st?ata ?e??a?s??, p??? ap? t? d?ad??as?a. ? d?ad??as?a p??e? ?a epa?a??f?e? et? ap? ?a ed??da. ?pa?te?ta? a?st???? pe?????s?? t?? ?ata????s?? a?????, ?af? ts?????? ?a? a?a???t???? t?p?? Cola ap? t??? as?e?e?? ??a t?? ep?e?e? ap? t? s??ed??a 48 ??e?.

59. ???e?????e t?? as?e?? ??a t?? d??at?t?te? ?a? ta p?e??e?t?ata/e???e?t?ata t?? te?????? ?a? ea????aste ?t? ??e? ?ata??e? p????? t? d?ad??as?a p?? ?a a????????e?. St?? p??sp??e?a a? ?a pe?s??e t?? as?e??, de? p??pe? ?a d????????e ?pe??????? p??sd???e? ??at? t? ap?t??esa t?? ?e??a?s?? p??e? ?a e??a? p???ep?e?? a??? de? e??a? p???????!

60. ?e????t???? ??e??e? Te???t??? ? a???s? t?? ?e????as?a t?? p??f?? p?? s???de?e? t? ???s? s?s?e??? ?e??a?s?? p??e? ?a e???e?: -e?????ta? t? ????? a?t??????s?? -a??????ta? t? p???? t?? st??at?? t?? ?e??a?t???? pa?????ta -a??????ta? t?? ap????f?s? f?t?? ap? t? ?e??a?t??? pa?????ta ??a e?????ta? t? d??d?s? t?? e????e?a? sta d??t?a (p.?. ???s? d???e?d??? t?? t?ta???? st? f?t??ata??t? t?? ?e??a?t???? pa?????ta-s?st?a GC ?i??) ?? e????t???? e?e???t???? p??sp??e?e? p??pe? ?a st?af??? st?? ap?de??? ap?te?esat???t?ta? ?a? asf??e?a? ???? p??t??????? ?e??a?s??

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