Avoid using ultrasonic devices for removing calculus and also air polishing units. Finishing strips and disks must also be used with great caution.
Since, ideally, a good composite restoration is invisible, the margins of the restoration should be marked on the treatment card.
Recommended polishing pastes:
—Proxyt
—CCS Prophylaxepaste; RDA 40
Fluoride Treatments
At each recall, the patient's teeth should be fluoride treated. For this purpose the dental hygienist uses stannous, and sodium fluorides. Stannous fluorides should not be used with tooth-colored restorations because they can etch their surfaces. The problem with such etching is especially pronounced with ceramic surfaces. If an IPS Empress veneer whose surface is painted a great deal is exposed too frequently to an acidic stannous fluoride, the ceramic surface can gradually be attacked and the surface color can be dissolved. Therefore, as a general rule, neutral sodium fluorides should be used in the practice.
Recommended fluorides:
—Blend-A-Med fluoride gel
—Oral-B Neutra-Foam
—ACT dental rinse
19 Effect of air abrasives on restorations
The surface of this composite restoration (hybrid) has been damaged by the use of air abrasive equipment.
Left: Abrasion of the ceramic surface using air abrasive equipment.
20 Influence of various polishing techniques on restorations
A deep groove has been polished into this composite surface by using a prophylactic rubber cup and an abrasive polishing paste.
left: Abrasion of a microfilled composite surface with a ProphyJet.
Home Care—Patients with Aesthetic Restorations
A patient with tooth-colored restorations should be given clear instructions by the dentist or dental hygienist on how to perform oral hygiene at home. Given the quantity of products offered in drug stores, it may be difficult for patients to select the right toothpaste and toothbrush for their home care.
Toothbrushes
Patients with many tooth-colored restorations must use very soft toothbrushes. The toothbrush can easily abrade composite restorations in particular.
Some patients have difficulties with plaque control and therefore need to be recalled more frequently.
If patients have problems with their oral hygiene, it may be helpful to recommend an electric toothbrush. Electric toothbrushes with rotating soft bristles are reliable and effective.
Toothpastes
A large number of different products are available, including toothpastes that specifically remove tartar, those that are good for the gingiva, and those that whiten the teeth. Toothpastes are available as pastes or gels. Most toothpastes contain fluoride, while some also contain baking soda and peroxides. Patients should be informed that gel toothpastes are less abrasive than pastes. A toothpaste with low abrasivity should be used. Often, pastes that make teeth white are more abrasive and should therefore be avoided. Toothpastes containing stannous fluoride can lead to discoloration of composite surfaces. Colgate Gel is an example of a gel toothpaste that has a low abrasivity and contains sodium fluoride.
21 Etched ceramic surface
This ceramic surface was treated with an amine fluoride gel. Amine fluoride and stanuous fluoride with a very low pH value are present in many toothpastes and prophylactic pastes. A sodium fluoride toothpaste with neutral pH value should preferably be used on ceramic restorations.
22 Samples of oral hygiene products
A large variety of oral hygiene articles are available in supermarkets. The dentist or dental practice staff must give clear advice to patients with aesthetic restorations on how to choose suitable oral hygiene products.
Mouthwashes
Many mouthwashes have a very high alcohol content. The alcohol can soften resins and after some time they can cause the resin surface to dissolve. Therefore, nonalcoholic products should be used.
Generally, two groups of mouthwash are recommended:
—mouthwashes with fluoride
—mouthwashes with an antiplaque additive
Mouthwashes containing chlorhexidine are not recommended. Chlorhexidine causes discoloration of the tooth surface. This discoloration increasingly appears at the bonded sites and on resin surfaces and is very difficult to remove. If mouth rinses containing chlorhexidine must be used, local application of a gel is recommended to minimize the discoloration.
Additional Aids
Many patients use dental floss, proxabrushes, and toothpicks. The use of dental floss is usually completely harmless if the patient has been taught a proper technique by the dental hygienist. The use of toothpicks is not recommended. An oral irrigator is quite safe, as long as no chemicals are used that discolor or dissolve resin surfaces.
Diet
The patient should receive nutritional advice including a list of foods that often cause tooth surface discolorations or dissolve ceramic surfaces. Patients will only rarely change their diet. They should, nevertheless, know which nutritional parameters may change the color of tooth surfaces, particularly resin surfaces or cement joints.
Smokers
Cigarette smoke leads to a pronounced discoloration of the tooth surface, particularly of resin surfaces. Smokers should be recalled frequently.
Oral Habits
Bruxism, chewing of ice cubes, and chronic biting on objects such as toothpicks, fountain pens, etc. lead to the loss of tooth substance. The patient must be made aware of this.
If the patient cannot break these habits, damage can occur not only to natural dentition, but also to any restorations. The patient should be informed, verbally and then in writing, of the necessity of attending recall sessions at the practice at shorter intervals due to particular life-style factors (smoking, oral habits, dietary factors, etc.).
23 Recommended oral hygiene aids for patients with all-ceramic restorations
In principle, patients should use as soft a toothbrush as possible. Many patients with high aesthetic claims show pronounced abrasive defects. A suitable power toothbrush can prevent further progression of such abrasive defects. Additionally, a low abrasive toothpaste with neutral pH value containing sodium fluoride should preferably be used. Mouthwashes containing chlorhexidine should be avoided because of their strong tendency to stain the teeth.