Farbkorrekturen durch Bleichverfahren

Einleitung

Aufhellungstherapien (Bleichtherapien) von Zähnen stellen einen Teil der ästhetischen Zahnbehandlung dar (Abb. [1]). Während durch Nahrungs- und Genussmittel ausgelöste externe Verfärbungen im Rahmen professioneller Zahnreinigungen entfernt werden können, stellten interne Diskolorationen vitaler oder avitaler Zähne in der Vergangenheit häufig eine Indikation zur restaurativen Versorgung (Überkronung, Veneer, Verblendung mit direkten Verfahren) dar. Als Alternativtherapie zur Korrektur von Zahnverfärbungen oder farbverändernden Strukturanomalien bietet sich in den letzten Jahren zunehmend das Bleichen einzelner oder mehrerer Zähne an, wobei grundsätzlich zwischen Methoden zur Bleichung vitaler (externes Bleichen) und avitaler Zähne (internes Bleichen) unterschieden wird.

Abb. 1 Das Bleichen von Zähnen gehört heute fest zum Repertoire der ästhetischen Zahnheilkunde. Bildquelle: Digital Vision, Symbolbild.

Beim Bleichen wird eine chemisch aktive Substanz verwendet, die die Farbe von Farbpigmenten durch eine Redoxreaktion abschwächt oder verändert. In der Regel handelt es sich bei den eingesetzten Präparaten um Wasserstoffperoxid (H₂O₂) oder Wasserstoffperoxid-abspaltende Substanzen. Das H₂O₂ kann in Radikale (H^•, O^•, OH^•, HO₂ ^•), Hydroxyl- (OH⁻) oder Perhydroxyl-Ionen (OOH⁻) zerfallen, die dann für die eigentliche chemische Reaktion mit einer farbgebenden Substanz verantwortlich sind [[1]]. Bei den ausgelösten chemischen Reaktionen kann es sich um Redox-Reaktionen handeln, bei denen Farbpigmente oxidiert oder reduziert werden und dadurch ihren Farbcharakter verlieren. Auch sind Spaltungen farbiger Moleküle möglich (z. B. Tetrazyklin). Ein weiterer Angriffspunkt der Peroxide sind ungesättigte C=C‐Doppelbindungen.

Merke: Die durch wasserstoffperoxidhaltige Substanzen ausgelöste Bleichreaktion wird durch Radikale gesteuert, die eine chemische Reaktion auslösen.

Literatur

• 1 Feinman R A, Madray G, Yarborough D. Chemical, optical, and physiologic mechanisms of bleaching products: a review.  Pract Periodontics Aesthet Dent. 1991;  3 32-36
• 2 Arens D. The role of bleaching in esthetics.  Dent Clin North Am. 1989;  33 319-336
• 3 Kielbassa A M, Wrbas K T. Extrinsische und intrinsische Zahnverfärbungen. Teil 1: Ursachen.  Zahnärztl Welt. 2000;  109 177-183
• 4 Plotino G, Buono L, Grande N M, Pameijer C H, Somma F. Nonvital tooth bleaching: a review of the literature and clinical procedures.  J Endod. 2008;  34 394-407
• 5 Andreasen F M. Transient apical breakdown and its relation to color and sensibility changes after luxation injuries to teeth.  Endod Dent Traumatol. 1986;  2 9-19
• 6 Heithersay G S. Invasive cervical resorption following trauma.  Aust Endod J. 1999;  25 79-85
• 7 Heithersay G S. Invasive cervical resorption: an analysis of potential predisposing factors.  Quintessence Int. 1999;  30 83-95
• 8 Patterson S, Mitchell D. Calcific metamorphosis of the dental pulp.  Oral Surg Oral Med Oral Pathol. 1965;  20 94-101
• 9 Amir F A, Gutmann J L, Witherspoon D E. Calcific metamorphosis: a challenge in endodontic diagnosis and treatment.  Quintessence Int. 2001;  32 447-455
• 10 West J D. The aesthetic and endodontic dilemmas of calcific metamorphosis.  Pract Periodontics Aesthet Dent. 1997;  9 289-293 quiz 294
• 11 van der Burgt T P, Mullaney T P, Plasschaert A J. Tooth discoloration induced by endodontic sealers.  Oral Surg Oral Med Oral Pathol. 1986;  61 84-89
• 12 van der Burgt T P, Plasschaert A J. Bleaching of tooth discoloration caused by endodontic sealers.  J Endod. 1986;  12 231-234
• 13 Kim S T, Abott P V, McGinley P. The effects of Ledermix paste on discoloration of mature teeth.  Int Endod J. 2000;  33 227-232
• 14 Glockner K, Ebeleseder K. Indikationen und Grenzfälle für das Bleichen von devitalen Frontzähnen.  Quintessenz. 1993;  44 519-527
• 15 Abou-Rass M. The elimination of tetracycline discoloration by intentional endodontics and internal bleaching.  J Endod. 1982;  8 101-106
• 16 Abou-Rass M. Long-term prognosis of intentional endodontics and internal bleaching of tetracycline-stained teeth.  Compend Contin Educ Dent. 1998;  19 1034-1032 1044
• 17 Aldecoa E A, Mayordomo F G. Modified internal bleaching of severe tetracycline discoloration: a 6-year clinical evaluation.  Quintessence Int. 1992;  23 83-89
• 18 Frazier K B. Nightguard bleaching to lighten a restored, nonvital discolored tooth.  Compend Contin Educ Dent. 1998;  19 810-813
• 19 Swift Jr E J. Treatment of a discolored, endodontically treated tooth with home bleaching and composite resin.  Pract Periodontics Aesthet Dent. 1992;  4 19-21
• 20 Liebenberg W H. Intracoronal lightening of discolored pulpless teeth: a modified walking bleach technique.  Quintessence Int. 1997;  28 771-777
• 21 Bizhang M, Heiden A, Blunck U, Zimmer S, Seemann R, Roulet J F. Intracoronal bleaching of discolored non-vital teeth.  Oper Dent. 2003;  28 334-340
• 22 Barthel C R, Strobach A, Briedigkeit H, Gobel U B, Roulet J F. Leakage in roots coronally sealed with different temporary fillings.  J Endod. 1999;  25 731-734
• 23 Rotstein I, Zalkind M, Mor C, Tarabeah A, Friedman S. In vitro efficacy of sodium perborate preparations used for intracoronal bleaching of discolored non-vital teeth.  Endod Dent Traumatol. 1991;  7 177-180
• 24 Weiger R, Kuhn A, Lost C. In vitro comparison of various types of sodium perborate used for intracoronal bleaching of discolored teeth.  J Endod. 1994;  20 338-341
• 25 Rotstein I, Mor C, Friedman S. Prognosis of intracoronal bleaching with sodium perborate preparations in vitro – 1-year study.  J Endod. 1993;  19 10-12
• 26 Warren M A, Wong M, Ingram T A. In vitro comparison of bleaching agents on the crowns and roots of discolored teeth.  J Endod. 1990;  16 463-467
• 27 Ho S, Goerig A C. An in vitro comparison of different bleaching agents in the discolored tooth.  J Endod. 1989;  15 106-111
• 28 Freccia W F, Peters D D, Lorton L, Bernier W E. An in vitro comparison of nonvital bleaching techniques in the discolored tooth.  J Endod. 1982;  8 70-77
• 29 Rotstein I, Friedman S. pH variation among materials used for intracoronal bleaching.  J Endod. 1991;  17 376-379
• 30 Kehoe J C. pH reversal following in vitro bleaching of pulpless teeth.  J Endod. 1987;  13 6-9
• 31 Weiger R, Kuhn A, Lost C. Effect of various types of sodium perborate on the pH of bleaching agents.  J Endod. 1993;  19 239-241
• 32 Frysh H, Bowles W H, Baker F, Rivera-Hidalgo F, Guillen G. Effect of pH on hydrogen peroxide bleaching agents.  J Esthet Dent. 1995;  7 130-133
• 33 Kinomoto Y, Carnes D L, Ebisu S. Cytotoxicity of intracanal bleaching agents on periodontal ligament cells in vitro.  J Endod. 2001;  27 574-577
• 34 Horn D J, Hicks M L, Bulan-Brady J. Effect of smear layer removal on bleaching of human teeth in vitro.  J Endod. 1998;  24 791-795
• 35 Smith J J, Cunningham C J, Montgomery S. Cervical canal leakage after internal bleaching.  J Endod. 1992;  18 476-481
• 36 Dishman M V, Covey D A, Baughan L W. The effects of peroxide bleaching on composite to enamel bond strength.  Dent Mater. 1994;  10 33-36
• 37 Miles P G, Pontier J P, Bahiraei D, Close J. The effect of carbamide peroxide bleach on the tensile bond strength of ceramic brackets – an in-vitro study.  Am J Orthod Dentofacial Orthop. 1994;  106 371-375
• 38 Attin T, Hannig C, Wiegand A, Attin R. Effect of bleaching on restorative materials and restorations – a systematic review.  Dent Mater. 2004;  20 852-861
• 39 Cavalli V, Reis A F, Giannini M, Ambrosano G M B. The effect of elapsed time following bleaching on enamel bond strength of resin composite.  Oper Dent. 2001;  26 597-602
• 40 Lai S C, Mak Y F, Cheung G S, Osorio R, Toledano M, Carvalho R M, Tay F R, Pashley D H. Reversal of compromised bonding to oxidized etched dentin.  J Dent Res. 2001;  80 1919-1924
• 41 Amato M, Serena Scaravilli M, Farella M, Riccitiello F. Bleaching teeth treated endodontically: long-term evaluation of a case series.  J Endod. 2006;  32 376-378
• 42 Glockner K, Hulla H, Ebeleseder K, Stadtler P. Five-year follow-up of internal bleaching.  Braz Dent J. 1999;  10 105-110
• 43 Anitua E, Zabalegui B, Gil J, Gascon F. Internal bleaching of severe tetracycline discolorations: four-year clinical evaluation.  Quintessence Int. 1990;  21 783-788
• 44 Feiglin B. A 6-year recall study of clinically chemically bleached teeth.  Oral Surg Oral Med Oral Pathol. 1987;  63 610-613
• 45 Glockner K, Ebeleseder K. 3-Jahres-Nachuntersuchungsergebnisse nach Internal-Bleaching.  Stomatologie. 1996;  93 347-350
• 46 Brown G. Factors influencing successful bleaching of the discolored root-filled tooth.  Oral Surg Oral Med Oral Pathol. 1965;  20 238-244
• 47 Howell R A. The prognosis of bleached root-filled teeth.  Int Endod J. 1981;  14 22-26
• 48 Harrington G W, Natkin E. External resorption associated with bleaching of pulpless teeth.  J Endodont. 1979;  5 344-348
• 49 Lado E A, Stanley H R, Weisman M I. Cervical resorption in bleached teeth.  Oral Surg Oral Med Oral Pathol. 1983;  55 78-80
• 50 Attin T, Muller T, Patyk A, Lennon A M. Influence of different bleaching systems on fracture toughness and hardness of enamel.  Oper Dent. 2004;  29 188-195
• 51 Papa J, Cain C, Messer H H. Moisture content of vital vs endodontically treated teeth.  Endod Dent Traumatol. 1994;  10 91-93
• 52 Matis B A. Degradation of gel in tray whitening.  Compend Contin Educ Dent Suppl. 2000;  S28 S31-25 quiz S49
• 53 Matis B A, Gaiao U, Blackman D, Schultz F A, Eckert G J. In vivo degradation of bleaching gel used in whitening teeth.  J Am Dent Assoc. 1999;  130 227-235
• 54 Matis B A, Yousef M, Cochran M A, Eckert G J. Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration.  Oper Dent. 2002;  27 12-18
• 55 Cadenaro M, Breschi L, Antoniolli F, Mazzoni A, Di Lenarda R. Influence of whitening on the degree of conversion of dental adhesives on dentin.  Eur J Oral Sci. 2006;  114 257-262
• 56 Matis B A, Cochran M A, Eckert G, Carlson T J. The efficacy and safety of a 10 % carbamide peroxide bleaching gel.  Quintessence Int. 1998;  29 555-563
• 57 Matis B A, Wang Y, Eckert G J, Cochran M A, Jiang T. Extended bleaching of tetracycline-stained teeth: a 5-year study.  Oper Dent. 2006;  31 643-651
• 58 Hannig C, Duong S, Becker K, Brunner E, Kahler E, Attin T. Effect of bleaching on subsurface micro-hardness of composite and a polyacid modified composite.  Dent Mater. 2007;  23 198-203
• 59 Polydorou O, Monting J S, Hellwig E, Auschill T M. Effect of in-office tooth bleaching on the microhardness of six dental esthetic restorative materials.  Dent Mater. 2007;  23 153-158
• 60 Polydorou O, Hellwig E, Auschill T M. The effect of at-home bleaching on the microhardness of six esthetic restorative materials.  J Am Dent Assoc. 2007;  138 978-984 quiz 1022
• 61 Haywood V B, Leonard R H, Nelson C F, Brunson W D. Effectiveness, side effects and long-term status of nightguard vital bleaching.  J Am Dent Assoc. 1994;  125 1219-1226
• 62 Ziebolz D, Helms K, Hannig C, Attin T. Efficacy and oral side effects of two highly concentrated tray-based bleaching systems.  Clin Oral Investig. 2007;  11 267-275
• 63 Haywood V B. Treating sensitivity during tooth whitening.  Compend Contin Educ Dent. 2005;  26 11-20
• 64 Attin T, Manolakis A, Buchalla W, Hannig C. Influence of tea on intrinsic colour of previously bleached enamel.  J Oral Rehabil. 2003;  30 488-494
• 65 Attin T. Sicherheit und Anwendung von Bleichtherapien mit Carbamidperoxid.  Dtsch Zahnärztl Z. 1998;  53 11-16
• 66 Haywood V. Nightguard vital bleaching: current concepts and research.  J Am Dent Assoc. 1997;  128 Suppl 19S-25S
• 67 Hasson H, Ismail A I, Neiva G. Home-based chemically-induced whitening of teeth in adults.  Cochrane Database Syst Rev. 2006;  CD006202
• 68 Gerlach R, Zhou X. Vital bleaching with whitening strips: summary of clinical research on effectiveness and tolerability.  J Contemp Dent Pract. 2001;  2 1-16
• 69 Matis B A, Hamdan Y S, Cochran M A, Eckert G J. A clinical evaluation of a bleaching agent used with and without reservoirs.  Oper Dent. 2002;  27 5-11
• 70 Kirsten G A, de Lima A A, Ignacio S A, Souza E M. Effect of reservoirs on gingival inflammation after home dental bleaching.  Quintessence Int. 2009;  40 195-202
• 71 Matis B A, Cochran M A, Eckert G. Review of the effectiveness of various toothwhitening systems.  Oper Dent. 2009;  34 230-235
• 72 Baik J W, Rueggeberg F A, Liewehr F R. Effect of light-enhanced bleaching on in vitro surface and intrapulpal temperature rise.  J Esthet Restor Dent. 2001;  13 370-378
• 73 Bruzell E M, Johnsen B, Aalerud T N, Dahl J E, Christensen T. In vitro efficacy and risk for adverse effects of light-assisted tooth bleaching.  Photochem Photobiol Sci. 2009;  8 377-385
• 74 Polydorou O, Hellwig E, Hahn P. The efficacy of three different in-office bleaching systems and their effect on enamel microhardness.  Oper Dent. 2008;  33 579-586
• 75 Marson F C, Sensi L G, Vieira L C, Araujo E. Clinical evaluation of in-office dental bleaching treatments with and without the use of light-activation sources.  Oper Dent. 2008;  33 15-22
• 76 Caviedes-Bucheli J, Ariza-Garcia G, Restrepo-Mendez S, Rios-Osorio N, Lombana N, Munoz H R. The effect of tooth bleaching on substance P expression in human dental pulp.  J Endod. 2008;  34 1462-1465
• 77 Perdigao J, Francci C, Swift E J, Ambrose W W, Lopes M. Ultra-morphological study of the interaction of dental adhesives with carbamide peroxide-bleached enamel.  Am J Dent. 1998;  11 291-301
• 78 McCracken M S, Haywood V B. Demineralization effects of 10 percent carbamide peroxide.  J Dent. 1996;  24 395-398
• 79 Crews K M, Duncan D, Lentz D, Gordy F M, Tolbert B. Effect of bleaching agents on chemical composition of enamel.  Miss Dent Assoc J. 1997;  53 20-21
• 80 Attin T, Schmidlin P R, Wegehaupt F, Wiegand A. Influence of study design on the impact of bleaching agents on dental enamel microhardness: a review.  Dent Mater. 2009;  25 143-157
• 81 Seghi R R, Denry I. Effects of external bleaching on indentation and abrasion characteristics of human enamel in vitro.  J Dent Res. 1992;  71 1340-1344
• 82 Wiegand A, Otto Y A, Attin T. In vitro evaluation of toothbrushing abrasion of differently bleached bovine enamel.  Am J Dent. 2004;  17 412-416
• 83 Wiegand A, Schreier M, Attin T. Effect of different fluoridation regimes on the microhardness of bleached enamel.  Oper Dent. 2007;  32 610-615
• 84 Attin T, Kielbassa A M, Schwanenberg M, Hellwig E. Effect of fluoride treatment on remineralization of bleached enamel.  J Oral Rehabil. 1997;  24 282-286
• 85 Attin T, Betke H, Schippan F, Wiegand A. Potential of fluoridated carbamide peroxide gels to support post-bleaching enamel re-hardening.  J Dent. 2007;  35 755-759
• 86 Alves E, Alves F, Campos Ede J, Mathias P. Susceptibility to carieslike lesions after dental bleaching with different techniques.  Quintessence Int. 2007;  38 404-409
• 87 Attin T, Kocabiyik M, Buchalla W, Hannig C, Becker K. Susceptibility of enamel surfaces to demineralization after application of fluoridated carbamide peroxide gels.  Caries Res. 2003;  37 93-99
• 88 Kraigher A, van der Veen M, Potocnik I. Caries occurrence in rats after bleaching with 10 % carbamide peroxide in vivo.  Caries Res. 2006;  31 643-651
• 89 White D J, Kozak K M, Zoladz J R, Duschner H J, Gotz H. Effects of tooth-whitening gels on enamel and dentin ultrastructure – a confocal laser scanning microscopy pilot study.  Compend Contin Educ Dent Suppl. 2000;  S29-S34
• 90 Oltu U, Gurgan S. Effects of three concentrations of carbamide peroxide on the structure of enamel.  J Oral Rehabil. 2000;  27 332-340
• 91 Cherry D V, Bowers Jr D E, Thomas L, Redmond A F. Acute toxicological effects of ingested tooth whiteners in female rats.  J Dent Res. 1993;  72 1298-1303
• 92 Redmond A F, Cherry D V, Bowers D E. Acute illness and recovery in adult female rats following ingestion of a tooth whitener containing 6 % hydrogen peroxide.  Am J Dent. 1997;  10 268-271
• 93 Dahl J E, Becher R. Acute toxicity of carbamide peroxide and a commercially available tooth-bleaching agent in rats.  J Dent Res. 1995;  74 710-714
• 94 Li Y. Tooth bleaching using peroxide-containing agents: current status of safety issues.  Compend Contin Educ Dent. 1998;  19 783-786 788 790, passim quiz 796
• 95 Hannig C, Zech R, Henze E, Dreier S, Attin T. Peroxide release into saliva from five different home bleaching systems in vivo.  Am J Dent. 2005;  18 13-18
• 96 Hannig C, Zech R, Henze E, Dorr-Tolui R, Attin T. Determination of peroxides in saliva – kinetics of peroxide release into saliva during home-bleaching with Whitestrips and Vivastyle.  Arch Oral Biol. 2003;  48 559-566
• 97 Hannig C, Willenbucher S, Becker K, Mahony C, Attin T. Recovery of peroxides in saliva during home bleaching – influence of smoking.  J Oral Rehabil. 2006;  33 533-541
• 98 Tredwin C, Naik S, Lewis N, Scully C. Hydrogen peroxide tooth-whitening (bleaching) products: review of adverse effects and safety issues.  Br Dent J. 2006;  200 371-376
• 99 Dahl J E, Pallesen U. Tooth bleaching – a critical review of the biological aspects.  Crit Rev Oral Biol Med. 2003;  14 292-304