Turkiye Klinikleri Journal of Dental Sciences

.: REVIEW
Çürük Yönetiminde Güncel Remineralizasyon Ajanları
Current Remineralizing Agents in Caries Management
Berkant SEZERa, Betül KARGÜLa
aMarmara Üniversitesi Diş Hekimliği Fakültesi, Pedodonti ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2020;26(3):472-86
doi: 10.5336/dentalsci.2019-71685
Article Language: TR
Full Text
ÖZET
 Diş çürüğü; bilimsel gelişmeler, ağız hijyen alışkanlıklarındaki iyileşme ve yeni koruyucu ajanların artışına rağmen birçok ülkede önemli bir halk sağlığı sorunu olmaya devam etmektedir. Son 30 yılda, diş çürüğü ve çürüğün ilerleyişi hakkındaki bilgiler kayda değer biçimde artmıştır. Diş sert dokularında meydana gelen demineralizasyon ve remineralizasyon, ağız içinde belirli bir denge hâlindedir ve bu dengenin demineralizasyon yönünde bozulması, çürük oluşumunu başlatmaktadır. Demineralizasyon ve remineralizasyon süreçlerinden oluşan döngü, çürüğün prognozunu belirlemektedir. Demineralizasyon, minenin kristal yapıdaki yüzeyinden başlarken, remineralizasyon ise bu kavitasyon gözlenmeyen lezyonların doğal olarak onarılması olarak tanımlanabilir. Son 20 yılda yapılan çürük araştırmaları, çürük lezyonların remineralizasyonu üzerine odaklanmıştır. Minimal girişimsel diş hekimliği, tam olarak bu noktada, özellikle çürük lezyonu oluşmadan, diş sert dokularını korumaya ve mevcut demineralize/hipomineralize alanları remineralize etmeye yönelir. Remineralizasyon, temelde tükürük içerisindeki iyonlar aracılığıyla gerçekleşirken, çeşitli yöntem ve uygulamalarla remineralizasyon artırılabilmektedir. Klinik olarak, farklı iyon teknolojileri, çeşitli biyoaktif ajanlar, şeker alkolleri, kalsiyum ve fosfat kaynaklı ajanlar ve bitkisel ürünler, remineralizasyonu sağlamada kullanılabilmektedir. Bu derlemede, minimal girişimsel diş hekimliği kapsamında kullanılan güncel demineralizasyon engelleyici ve remineralizasyon sağlayıcı ajanlarla bu ürünlerle ilgili yapılan araştırmaların sunulması amaçlanmıştır. Başlangıç çürük lezyonlarıyla demineralize/hipomineralize alanların remineralizasyonu için yeni ürün ve yöntemlerin gelişimi, diş hekimliğine yeni tedavi seçenekleri ve faydalar sunmaktadır.

Anahtar Kelimeler: Remineralizasyon; demineralizasyon; koruyucu diş hekimliği
ABSTRACT
 Despite advances in scientific knowledge, improved hygiene regimens and the increasing of new commercial preventative agents, dental caries continues to be a major public health problem in most countries. Over the last 30 years, there has been considerable increase in knowledge and understanding of the progress of caries through tooth structure. Demineralization and remineralization in the oral cavity is in equilibrium and deterioration of balance in favor of demineralization commences the development of caries. The caries process is resulting from many cycles of demineralization and remineralization. Demineralization begins at the crystal surface of the enamel and remineralization is the natural repair process for non-cavitated lesions. In the past two decades, caries research has been focused on the methodology for remineralization of carious lesions. At this point, minimal intervention dentistry tends to preserve dental hard tissues especially without the formation of caries lesions and remineralize existing demineralized/hypomineralized areas. Remineralization is naturally achieved by salivary ions, and it can be enhanced by various methods and applications. There are several caries preventive agents and remineralization agents used in dental clinic, such as ionic technologies, various bioactive agents, sugar alcohols, calcium-phosphate based materials and herbal agents. In this review, it is aimed to present the current demineralization preventive agents and remineralization agents used in minimal intervention dentistry and the researches about these products. The continued development of new agents and methods for remineralization of white spots lesions and demineralized/hypomineralized lesions offers new therapeutic options and benefits to the dental profession.

Keywords: Remineralization; demineralization; preventive dentistry
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  98. Salman NR, ElTekeya M, Bakry N, Omar SS, El Tantawi M. Comparison of remineralization by fluoride varnishes with and without casein phosphopeptide amorphous calcium phosphate in primary teeth. Acta Odontol Scand. 2019;77(1):9-14. [Crossref]  [PubMed] 
  99. Reynolds EC. Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides. Spec Care Dentist. 1998;18(1):8-16. [Crossref]  [PubMed] 
  100. Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV, et al. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res. 2008;87(4):344-8. [Crossref]  [PubMed] 
  101. Manton DJ, Walker GD, Cai F, Cochrane NJ, Shen P, Reynolds EC, et al. Remineralization of enamel subsurface lesion in situ by the use of three commercially available sugar-free gums. Int J Pediatr Dent. 2008;18(4):284-90. [Crossref]  [PubMed] 
  102. Bullappa D, Puranik MP, Uma SR. Casein phosphopeptide-amorphous calcium phosphate: a review. Int J Dent Health Sci. 2015;2(1):116-25.
  103. Memarpour M, Soltanimehr E, Sattarahmady N. Efficacy of calcium- and fluoride- containing materials for the remineralization of primary teeth with early enamel lesion. Microsc Res Tech. 2015;78(9):801-6. [Crossref]  [PubMed] 
  104. Zhou C, Zhang D, Bai Y, Li S. Casein phosphopeptide-amorphous calcium phosphate remineralization of primary teeth early enamel lesions. J Dent. 2014;42(1):21-9. [Crossref]  [PubMed] 
  105. Pithon MM, Baião FS, Sant'Anna LID, Tanaka OM, Cople-Maia L. Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: a systematic review. J Investig Clin Dent. 2019;10(2):e12391. [Crossref]  [PubMed] 
  106. Rai N, Sandhu M, Sachdev V, Sharma R. Evaluation of remineralization potential of beverages modified with casein phosphopeptide-amorphous calcium phosphate on primary and permanent enamel: a laser profiler study. Int J Clin Pediatr Dent. 2018;11(1):7-12. [Crossref]  [PubMed]  [PMC] 
  107. Mendes AC, Restrepo M, Bussaneli D, Zuanon AC. Use of casein amorphous calcium phosphate (CPP-ACP) on white-spot lesions: randomised clinical trial. Oral Health Prev Dent. 2018;16(1):27-31. [PubMed] 
  108. Karabekiroğlu S, Ünlü N, Küçükyilmaz E, Şener S, Botsali MS, Malkoç S, et al. Treatment of post-orthodontic white spot lesions with CPP-ACP paste: a three year follow up study. Dent Mater J. 2017;36(6):791-7. [Crossref]  [PubMed] 
  109. Indrapriyadharshini K, Madan Kumar PD, Sharma K, Iyer K. Remineralizing potential of CPP-ACP in white spot lesions - a systematic review. Indian J Dent Res. 2018;29(4):487-96. [Crossref]  [PubMed] 
  110. Pai D, Bhat SS, Taranath A, Sargod S, Pai VM. Use of laser fluorescence and scanning electron microscope to evaluate remineralization of incipient enamel lesions remineralized by topical application of casein phospho peptide amorphous calcium phosphate (CPP-aCP) containing cream. J Clin Pediatr Dent. 2008;32(3):201-6. [Crossref]  [PubMed] 
  111. Wierichs RJ, Stausberg S, Lausch J, Meyer-Lueckel H, Esteves-Oliveira M. Caries-preventive effect of NaF, NaF plus TCP, NaF plus CPP-ACP, and SDF varnishes on sound dentin and artificial dentin caries in vitro. Caries Res. 2018;52(3):199-211. [Crossref]  [PubMed] 
  112. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res. 1997;76(9):1587-95. [Crossref]  [PubMed] 
  113. Yazicioğlu O, Yaman BC, Güler A, Koray F. Quantitative evaluation of the enamel caries which were treated with casein phosphopeptide-amorphous calcium fluoride phosphate. Niger J Clin Pract. 2017;20(6):686-92. [Crossref]  [PubMed] 
  114. Llena C, Leyda AM, Forner L. CPP-ACP and CPP-ACFP versus fluoride varnish in remineralisation of early caries lesions: a prospective study. Eur J Paediatr Dent. 2015;16(3):181-6. [PubMed] 
  115. Tavassoli-Hojjati S, Atai M, Haghgoo R, Rahimian-Imam S, Kameli S, Ahmaian- Babaki F, et al. Comparison of various concentrations of tricalcium phosphate nanoparticles on mechanical properties and remineralization of fissure sealants. J Dent (Tehran). 2014;11(4):379-88. [PubMed] 
  116. Ekambaram M, Mohd Said SNB, Yiu CKY. A review of enamel remineralisation potential of calcium- and phosphate-based remineralisation systems. Oral Health Prev Dent. 2017;15(5):415-20. [PubMed] 
  117. Rezvani MB, Atai M, Rouhollahi MR, Malekhoseini K, Rezai H, Hamze F, et al. Effect of nano-tricalcium phosphate and nanohydroxyapatite on the staining susceptibility of bleached enamel. Int Sch Res Notices. 2015;5;2015:935264. [Crossref]  [PubMed]  [PMC] 
  118. Brunton PA, Davies RPW, Burke JL, Smith A, Aggeli A, Brookes SJ, et al. Treatment of early caries lesions using biomimetic self-assembling peptides - a clinical safety trial. Br Dent J. 2013;215(4):E6. [Crossref]  [PubMed]  [PMC] 
  119. Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of carious lesions using self-assembling peptides. Adv Dent Res. 2018;29(1):42-7. [Crossref]  [PubMed] 
  120. Kind L, Stevanovic S, Wuttig S, Wimberger S, Hofer J, Müller B, et al. Biomimetic remineralization of carious lesions by self-assembling peptide. J Dent Res. 2017;96(7):790-7. [Crossref]  [PubMed] 
  121. Silvertown JD, Wong BPY, Sivagurunathan KS, Abrams SH, Kirkham J, Amaechi BT, et al. Remineralization of natural early caries lesions in vitro by P11-4 monitored with photothermal radiometry and luminescence. J Investig Clin Dent. 2017;8(4). [Crossref]  [PubMed] 
  122. Schlee M, Schad T, Koch JH, Cattin PC, Rathe F. Clinical performance of self-assembling peptide P11-4 in the treatment of initial proximal carious lesions: a practice-based case series. J Investig Clin Dent. 2018;9(1). [Crossref]  [PubMed] 
  123. Üstün N, Aktören O. Analysis of efficacy of the self-assembling peptide-based remineralization agent on artificial enamel lesions. Microsc Res Tech. 2019;82(7):1065-72. [Crossref]  [PubMed] 
  124. Sullivan RJ, Charig A, Blake-Haskins J, Zhang YP, Miller SM, Strannick M, et al. In vivo detection of calcium from dicalcium phosphate dihydrate dentifrices in demineralized human enamel and plaque. Adv Dent Res. 1997;11(4):380-7. [Crossref]  [PubMed] 
  125. Wefel JS, Harless JD. The use of saturated DCPD in remineralization of artificial caries lesions in vitro. J Dent Res. 1987;66(11):1640-3. [Crossref]  [PubMed] 
  126. Zhang YP, Din CS, Miller S, Nathoo SA, Gaffar A. Intra-oral remineralization of enamel with a MFP/DCPD and MFP/silica dentifrice using surface microhardness. J Clin Dent. 1995;6(2):148-53. [PubMed] 
  127. Sullivan RJ, Masters J, Cantore R, Roberson A, Petrou I, Stranick M, et al. Development of an enhanced anticaries efficacy dual component dentifrice containing sodium fluoride and dicalcium phosphate dihydrate. Am J Dent. 2001;14 Spec No:3A-11A. [PubMed] 
  128. Kitasako Y, Tanaka M, Sadr A, Hamba H, Ikeda M, Tagami J, et al. Effects of a chewing gum containing phosphoryloligosaccharides of calcium (POs-Ca) and fluoride on remineralization and crystallization of enamel subsurface lesions in situ. J Dent. 2011;39(11):771-9. [Crossref]  [PubMed] 
  129. Tanaka T, Kobayashi T, Takii H, Kamasaka H, Ohta N, Matsuo T, et al. Optimization of calcium concentration of saliva with phosphoryl oligosaccharides of calcium (POs-Ca) for enamel remineralization in vitro. Arch Oral Biol. 2013;58(2):174-80. [Crossref]  [PubMed] 
  130. To-o K, Kamasaka H, Nishimura T, Kuriki T, Saeki S, Nakabou Y, et al. Absorbability of calcium from calcium-boundphosphoryl oligosaccharides in comparison with that from various calcium compounds in the rat ligated jejunum loop. Biosci Biotechnol Biochem. 2003;67(8):1713-8. [Crossref]  [PubMed] 
  131. Cury JA, Simões GS, Del Bel Cury AA, Gonçalves NC, Tabchoury CPM. Effect of a calcium carbonate-based dentifrice on in situ enamel remineralization. Caries Res. 2005;39(3):255-7. [Crossref]  [PubMed] 
  132. Rege A, Heu R, Stranick M, Sullivan RJ. In vitro study of the effect of a dentifrice containing 8% arginine, calcium carbonate and sodium monofluorophosphate on acid-softened enamel. J Clin Dent. 2014;25(1 Spec No A):A3-6. [PubMed] 
  133. Sullivan RJ, Rege A, Corby P, Klaczany G, Allen K, Hershkowitz D, et al. Evaluation of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate to repair acid-softened enamel using an intra-oral remineralization model. J Clin Dent. 2014;25(1 Spec No A):A14-9. [PubMed] 
  134. Finn SB, Frew RA, Leibowitz R, Morse W, Man-son-Hing L, Brunelle J, et al. The effect of sodium trimetaphosphate (TMP) as a chewing gum additive on caries increments in children. J Am Dent Assoc. 1978;96(4):651-5. [Crossref]  [PubMed] 
  135. O'Mullane DM, Kavanagh D, Ellwood RP, Chesters RK, Schafer F, Huntington E, et al. A three-year clinical trial of a combination of trimetaphosphate and sodium fluoride in silica toothpaste. J Dent Res. 1997;76(11):1776-81. [Crossref]  [PubMed] 
  136. Danelon M, Takeshita EM, Sassaki KT, Delbem ACB. In situ evaluation of a low fluoride concentration gel with sodium trimetaphosphate in enamel remineralization. Am J Dent. 2013;26(1):15-20. [PubMed] 
  137. Gonçalves RS, Scaffa PMC, Giacomini MC, Rabelo Buzalaf MA, Honório HM, Wang L, et al. Use of sodium trimetaphosphate in the inhibition of dentin matrix metalloproteinases and as a remineralizing agent. J Dent. 2018;68:34-40. [Crossref]  [PubMed] 
  138. Gonçalves RS, Scaffa PMC, Giacomini MC, de Mattos Pimenta Vidal C, Honório HM, Wang L. Sodium trimetaphosphate as a novel strategy for matrix metalloproteinase inhibition and dentin remineralization. Caries Res. 2018;52(3):189-98. [Crossref]  [PubMed] 
  139. Takeshita EM, Danelon M, Castro LP, Cunha RF, Delbem ACB. Remineralizing potential of a low fluoride toothpaste with sodium trimetaphosphate: an in situ study. Caries Res. 2016;50(6):571-8. [Crossref]  [PubMed] 
  140. Manarelli MM, Delbem ACB, Binhardi TDR, Pessan JP. In situ remineralizing effect of fluoride varnishes containing sodium trimetaphosphate. Clin Oral Investig. 2015;19(8):2141-6. [Crossref]  [PubMed] 
  141. Manarelli MM, Delbem ACB, Lima TMT, Castilho FCN, Pessan JP. In vitro remineralizing effect of fluoride varnishes containing sodium trimetaphosphate. Caries Res. 2014;48(4):299-305. [Crossref]  [PubMed] 
  142. Buzalaf MAR, Pessan JP, Honório HM, Ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci. 2011;22:97-114 [Crossref]  [PubMed] 
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  146. Mainwaring PJ, Naylor MN. A four-year clinical study to determine the caries-inhibiting effect of calcium glycerophosphate and sodium fluoride in calcium carbonate base dentifrices containing sodium monofluorophosphate. Caries Res. 1983;17(3):267-76. [Crossref]  [PubMed] 
  147. Carvalho TS, Peters BG, Rios D, Magalhães AC, Sampaio FC, Buzalaf MAR, et al. Fluoride varnishes with calcium glycerophosphate: fluoride release and effect on in vitro enamel demineralization. Braz Oral Res. 2015;29:S1806-83242015000100287. [Crossref]  [PubMed] 
  148. Rezende KM, Zuim JP, Carvalho TS, Côrrea MS, Bönecker M. Can babies oral wipes with fluoride and/or calcium glycerophosphate prevent cariogenic demineralization? An in-vitro study. Minerva Stomatol. 2017;66(5):226-31. [PubMed] 
  149. Sezer B, Tuğcu N, Durmus B, Bekiroglu N, Kargula B. Efficacy of mineral containing gel for remineralization in MIH-affected incisors: a 3-months clinical study. 64th ORCA Congress. Caries Res. 2017;(51):362.

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1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com