Choice aesthetic and medical
Whatever therapeutic aesthetic envisaged, it must follow a path marked out by
consulting a professional oral health by integrating into a therapeutic approach focuses on four key imperatives: biological, functional, mechanical and aesthetic.

These requirements can not be isolated from each other: it is to achieve a comprehensive therapeutic approach, often multidisciplinary, leading to a "treatment plan" coherent. It is now for dentists, capital of promoting aesthetics in all its forms, but always with a medical approach meet the demand of patients.


Techniques for clarification: where do we stand?
The clarification is a "phenomenon of depth" and not "a surface phenomenon,"
based on the effect of two active ingredients, carbamide peroxide and hydrogen
peroxide. These assets must cross the barrier of the enamel to go knocking at
the interface between the dentin (ivory) and enamel, substances (colored
molecules) called chromospheres to eliminate them. In terms of clarity, and
according to the desired results, the concentration of active ingredient is
therefore capital, but also and above all the time and the surface of contact
with the tooth to allow for the release of the active ingredient through the
enamel.

Today, the dentist has two main modes of possible explanation: the mode
"ambulatory" and the "chair". All treatments are most often painless, but dental
sensitivities may appear depending on the type chosen for clarification and
concentration of active ingredient chosen.

Ambulatory Mode
– Compression gutters in the dental office and ambulatory monitoring
This is the most widespread technique. The gutters manufactured by the dental
surgeon or dentist in dental practices are delivered to the patient for
outpatient treatment. The first phase took place clarification chair directly
carried out by the dentist under compression gutters with carbamide peroxide
concentrated to 35%. This is called the effect "starter / booster" for
clarification. Followed by a clarification outpatient basis carbamide peroxide
concentrated at 10%, 16% or 22%. The patient leaves at the end of this meeting
at his home with the same set of gutters.

The carbamide peroxide, called today with the highest security in terms of
safety, is concentrated at 10% and patient loads directly in its gutters fitted
with small reservoirs on the external surfaces of the teeth. He bears daily
(preferably overnight) for about 4 to 6 hours in a row. The treatment lasts
about 3 weeks for stable results for 4 to 5 years, without any sensitivity
post-operative dental or almost.

This technique has the advantage of remaining relatively "soft" with little
effect on aggressive dental structures and a very good effectiveness on stains.

• Mode "Armchair"
– Hydrogen peroxide and gutters
The dentist may find it useful to use this technique to activate the process of
clarification for patients "hurry". The active ingredient is used this time of
hydrogen peroxide with a concentration varies between 15% and 35%. It is loaded
into gutters specific isolation after a very careful of surrounding tissue. The
risk of burning them, even reversible, is not trivial at this concentration of
hydrogen peroxide.

– The high-energy lamps
The use of conventional halogen lamps, plasma or use of laser Argon is also
proposed to activate the dissociation of the active and increase its
effectiveness.

The results are pretty conclusive immediately, but unsustainable in time for an
obvious reason: the contact time of the active ingredient on the tooth is too
low even at high concentrations. Moreover, very often, a post-operative
sensitivity is seen making necessary prescription anti-inflammatory.

Currently, new protocols being put forward the use of high-energy lamps (Xenon
Arc with a capacity of 300 w) coupled with hydrogen peroxide to 35% for 20
minutes the chair and followed by outpatient treatment of 5 days with gutters
and carbamide peroxide at 10% or 16%. The first results from 1 year seem very
encouraging, but the decline clinic is still insufficient so far.

What against-indications?
In patients with tooth wear increased, (enamel altered by abrasion), the effects
of the active ingredients can pose risks to biological, and particularly in
"Pulp".

When the collars are highly bare, the active ingredient can easily cross the
barrier dentine to reach the pulp, ie reach the vasculo-nervous system that
irrigates the tooth. Again the risks are high-level pulp.

Finally, when a patient presents many restorations (composites, amalgam or
other) ill-suited and showing sealing major defects, then it is necessary to
resume their adaptation, and their rehabilitation program after clarification.
The patient must of course be notified before the beginning of his treatment.