Today, the majority of children will reach adulthood without suffering from caries. Incipient carious lesions can be treated with adhesive restorative materials.
Aesthetic Dentistry—A Treatment Concept
Aesthetic treatment, like any other dental treatment, consists of four phases:
Phase 1: Systemic Phase
This phase starts before the treatment begins. Its purpose is to protect both the therapist as well as the patient. Risk patients, for example patients with diabetes mellitus and cardiovascular or blood diseases, are identified before the actual treatment starts. This step includes consultations with the physician treating the patient.
Phase 2: Hygiene Phase
The goal of this phase is to establish a clean oral cavity to secure a healthy basis for the subsequent phase.
Phase 3: Corrective Phase
Dental and aesthetic corrections are carried out during this phase.
Phase 4: Maintenance Phase
During this phase, the finished reconstructions are checked as well as the overall health of the oral cavity.
14 Systematic treatment planning
Aesthetic treatment should only be carried out upon completion of the hygiene phase. Its actual long-term success is ensured by the maintenance phase (see also Figs. 10 and 11).
The Necessity of Caring for Aesthetic Restorations
The longevity of many tooth-colored restorations can be as good as that of metal restorations. Prerequisites for success is careful planning of the treatment, skillful use of the materials, and a maintenance phase that is adapted to the individual restoration. To ensure success, the patient, the dentist, and the dental hygienist must be aware of the specific demands of a particular treatment or material.
Most aesthetic restorations consist of resins, ceramics, glasses, or a combination of these materials. Materials rich in resins (composites, resin cements, resin-reinforced glass ionomers and compomers) have a higher rate of wear and are subject to chemical degradation. Ceramics have a greater risk of fracturing and may be etched by some oral hygiene articles. Before beginning any treatment, the dentist and the patient should discuss the advantages and disadvantages of the different restorative materials and coordinate professional and home-care oral hygiene procedures accordingly.
Professional Tooth Cleaning in Patients with Aesthetic Restorations
It is very important that the dental hygienist and the entire dental practice team use established methods when performing professional tooth cleaning, scaling, root planing, polishing, and different fluoride applications that are needed for existing restorations. Removal of plaque, tartar, and bacterial toxins from root surfaces can be carried out manually or mechanically.
After the first examination, which is executed by the dentist in collaboration with the dental hygenist, an individual treatment plan is drawn up. The plan is developed for the patient, based on the seriousness and type of the patient's disease.
Manual Scaling
Manual scaling performed using metal curets does not damage a bonded restoration to the same extent as ultrasonic scales, assuming that the therapist takes certain precautions. These precautions include first identifying the margins of the restoration. Dentists and the dental hygienists have learned to carry out scaling and root planing with the cutting edge of the curet in the periodontal pocket and in firm contact with the tooth surface, moving the curet in a coronal direction. Such a technique causes the curet to slide over the margins of the restoration and could result in parts of the restoration being torn off and the restoration, with its resin-filled marginal gap, loosening and eroding.
A simple modification of this scaling technique is to move the scaler along and parallel to the restoration margin. By doing so, less damage is caused in the marginal area. Scaling and root planing at the margin of bonded restorations must be performed carefully and very consciously.
—Recommended curets: Gracey curets
—Working direction: horizontal
—Avoid scalers because they generate poor tactile feeling.
15 Using curets on nonrestored teeth
The usual curet technique involves the curet being inserted into the sulcus and pulled in a coronal direction, with the cutting edge along the tooth surface. The tooth surface can thus be scaled and planed. This action can only be recommended for nonrestored teeth, as otherwise there is a danger of restoration margins being damaged.
16 Using curets on restored teeth
The curet should not be moved along the root in a coronal direction, but in a direction parallel to the restoration margin. This prevents damage to the margins of the restorations.
Scaling using Powered Instruments
Scaling is also performed with sonic and ultrasonic devices. Many dentists and dental hygienists use such scalers, since they can remove calculus more quickly. At the same time, therapeutic irrigation of the sulcus can be performed with the spray of the scaler.
If handled improperly, ultrasonic devices can damage all types of restorations. They can chip ceramics, cause abrasion of composites, increase the surface roughness of all restorations, and destroy the adhesive joint between tooth and restoration. Because of these drawbacks, sonic and ultrasonic instruments should be avoided in patients who have several bonded restorations. If necessary, however, the appliances should be used with great caution, and margins of tooth-colored restorations should not be touched.
Consequently, it is necessary to inform patients with aesthetic restorations that they should have their teeth cleaned professionally more frequently to avoid a large accumulation of plaque, calculus, and stain and it does not become necessary to use larger equipment to remove these mechanically. If the patient visits the practice at shorter recall intervals, less tartar will accumulate and, consequently, less aggressive methods are needed to remove it. Thus, manual scaling becomes simpler and less time-consuming. The risk of injurying a restoration margin decreases. At the same time, it is possible to check and detect secondary caries lesions at an early stage.
17 Ultrasonic devices and composites
This composite surface has been destroyed by an ultrasonic device. The result is discoloration and accelerated degradation of the restoration.
18 Ultrasonic devices and ceramics
Ultrasonic scalers can damage all-ceramic crowns, veneers, and inlay margins.
Air Polishing Devices
Discolorations are usually removed by polishing, conducted with rotating instruments, brushes, and rubber cups. Additionally, air-powered abrasive devices are also available. The air polishing abrasive appliances (CaviJet, ProphyJet, AirFlow, and AirScaler) are very efficient at eliminating dark stains in concave tooth surfaces and in areas that are difficult to access. However, their abrasive power prohibits them from being used near restorations of any types. Their use should be exclusively restricted to natural, unfilled tooth surfaces.
Polishing Teeth
The