THE RELATIONSHIP AND INTERACTION BETWEEN THE SEVERITY OF CARIES, ENAMEL FUNCTIONAL RESISTANCE, AND BONE TISSUE CONDITION ON THE RESULTS OF TEETH WHITENING

Abstract

The use of bleaching systems to remove discoloration is one of the key dental procedures aimed at improving the aesthetic appearance of teeth. The main components of such systems are hydrogen peroxide and carbamide peroxide. The whitening process can be influenced by various factors: first of all, the number of teeth present in the oral cavity, the CFE index, which correlates with the hygienic condition of the oral cavity, enamel resistance, gingivitis index, and the intensity of hyperesthesia. Given the null hypothesis regarding the absence of differences between whitening agents, the aim of our study is to evaluate therapeutic outcomes by analyzing the dynamics of the studied parameters that determine the relationship between processes in the hard tissues of the teeth and bone tissue density parameters. For clinical studies, patients were divided into two experimental groups. The first group included patients who were treated with 25% hydrogen peroxide gel—a total of 34 people, which is 52.3%. The second group included patients who were treated with 44% carbamide peroxide gel, numbering 31 people (47.7%). The study also recorded a gender difference, the average age of participants in the first group was 29.2±0.508 years, while in the second group—28.9±0.506 years. To achieve the goal, several research methods were applied, namely: the CFE index, which was determined during a clinical dental examination to quantitatively assess the involvement of the hard tissues of the teeth by the carious process, taking into account the number of decayed, filled, and extracted teeth; initial manifestations of caries in the form of areas of demineralization, white and pigmented spots were not taken into account. TER tes twas carried out to assess the functional resistance of enamel according to the method of Okushko V. R. and Kosareva L. I. (1983). Standardized dental photography was carried out for the purpose of documentary recording and objective comparative assessment of the color characteristics of teeth before and after professional whitening using a smartphone, a specialized lighting device "Smile Lite MDP" ("Smile line") and an individual color scale "Vita Bleached Guide 3D-Master". Digital computed tomography was used to assess the structural characteristics of bone tissue, and quantitative and qualitative assessment of its density was carried out by the method of histogram analysis of certain areas of orthopantomographic images using the software "Corel Photo-Point" and the device "ORTHO-PHOS XG/Ceps" (Sirona Dental Systems GmbH). According to the results of our observations, based on the data from constructing multiple regression, it was found that bone density, which we can determine using CT scans, has a direct relationship with the number of filled, extracted, and carious teeth, which will further affect tooth sensitivity after the whitening procedure. An inverse relationship between tooth color and the number of carious cavities was established at p= -0.053, which indicates a weak interaction, but, in agreement with these results with bone density, it is necessary to pay attention to them and offer the patient less aggressive whitening systems. When studying the model with the predictors of the study (TER test, bone density, enamel thickness), the interrelation and interdependence of the TER test and enamel thickness were revealed. Conclusions.The established relationships between clinical and structural indicators can be used to personalize the choice of a professional whitening system and minimize the risk of adverse effects on the hard tissues of the teeth and the oral mucosa. Before performing the procedure, it is advisable to take into account the CFE index, enamel thickness and bone density, determined by the results of a comprehensive dental and radiological examination. At the same time, the effectiveness of tooth whitening can be achieved regardless of the type of whitening system, while the risk of structural changes in hard tissues and inflammatory reactions is determined by its characteristics and the initial dental status of the patient.