Publication: Evaluación clínica del peróxido de hidrógeno al 6% y al 25% para el blanqueamiento dental en consulta.
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2020
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Abstract
El 20 de septiembre de 2011 se aprobó la Directiva 2001/84/UE por la que se modificaba la Directiva 76/768/CEE, relativa a los productos cosméticos, para adaptar su anexo III al progreso técnico, en ella se establecía una nueva limitación del uso del peróxido de hidrógeno como agente blanqueante, siendo 6% el nuevo valor permitido para tratamientos de blanqueamiento domiciliario (Diario Oficial de la Unión europea 2011). Concentraciones superiores al 6% no son consideradas como producto cosmético y solo pueden ser utilizadas en consultas bajo supervisión profesional.
Diferentes organismos sanitarios están valorando la retirada de altas concentraciones de peróxido de hidrógeno para blanqueamientos dentales. Es por ello que se están realizando múltiples estudios para evaluar la efectividad y seguridad de este tratamiento utilizando para ello concentraciones más conservadoras de peróxido de hidrógeno. Diversos autores como Souza coinciden en el riesgo que el uso de altas concentraciones de peróxido de hidrógeno conlleva, lo cual coincide con las conclusiones obtenidas por Roderjan y colaboradores en su estudio sobre los cambios histopatológicos en la pulpa de incisivos inferiores tras un tratamiento de blanqueamiento (Souza y cols. 2010) (Roderjan y cols. 2014). En cuanto a efectividad de blanqueamiento se apreciaban diferencias entre concentraciones del 6 y 35%, siendo esta última la que más efecto blanqueante tenía (Bortolatto y cols. 2016).
Existen estudios in vitro que muestran un menor daño pulpar cuando se emplean concentraciones inferiores del producto (Soares y cols. 2014). Conclusiones similares se obtuvieron en otros estudios como el de Ferraz en 2018 que evalúan la efectividad y seguridad del blanqueamiento a concentración del 6%, concluyendo que, aunque este producía menor nivel de sensibilidad cuando era comparado con peróxido de hidrógeno al 15%, se obtenía mayor efecto a más concentración (Ferraz y cols. 2018). Por otro lado, existen estudios que evalúan la misma cuestión y concluyen que a concentraciones del 15% de peróxido de hidrógeno no se muestran diferencias en el potencial de blanqueamiento cuando era comparado con concentraciones del 35% (Martin y cols. 2013). En la misma línea de pensamiento encontramos estudios como el de Bersezio y colaboradores que, tras dos años del blanqueamiento con peróxido de hidrógeno al 6% el color se mantenía constante y que, aunque existían diferencias en la tonalidad entre el 6 y el 25% cuando eran medidas con espectrofotómetro, al usar el sistema VITA classical® estas no eran significativas Bersezio y cols. 2018).
Ante esta heterogeneidad de conclusiones, se decidió evaluar la capacidad de llevar a cabo un blanqueamiento efectivo, utilizando como agente blanqueante peróxido de hidrógeno al 6%, comparándolo con el 25% que se utilizaba anteriormente, activando el blanqueamiento con la lámpara Philips Zoom® que, aunque existen estudios que defienden la eficacia de otros sistemas de fotoactivación (Polydorou y cols. 2013), (Hahn y cols. 2012), tal y como demuestran diversos estudios, la lámpara Philips Zoom® ha demostrado ser el sistema de fotoactivación con mejores resultados del mercado (Calatayud y cols. 2010), (Gallinari y cols. 2019), (Bortolatto y cols. 2016), manteniendo la estabilidad de color a largo plazo (Vilsósola y cols. 2017).
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