Care Considerations for Esthetic Restorations
Dental professionals need to have an understanding of how to properly maintain and care for the patient’s restorations. Through the years it has been maintained that polishing should be “selective” to remove the stain the clinician was not able to remove during scaling. The theory was that polishing was performed for esthetic purposes. However, with the new generation of polishing pastes there has been a paradigm shift that polishing can also be considered therapeutic.
The evidence suggests that conventional prophylaxis pastes have the potential to increase the surface roughness of resin composite, hybrid ionomer and compomer restorative materials. Therefore, Warren and colleagues advise that routine polishing during prophylaxis should be avoided.8 However, the clinician must evaluate the needs of the patient and form an individualized care plan using evidence-based information to provide optimal care for the patient. For example, a patient may have ceramic crowns in the anterior region that have a glaze in place to achieve the correct color match.36 If the clinician is not careful, the glaze can be removed during the polishing procedure. Therefore, it is good practice to use the finest grit possible to remove deposits and if a medium or coarse grit is necessary, the procedure should be completed with the finest polish in order to leave the surfaces as smooth as possible.32
Manufacturers are developing prophy pastes that are safe to use on the new esthetic restorations. This new generation of prophy pastes that contain either Calprox, aluminum oxide, or xylitol and fluoride can be used safely on esthetic restorations when the “fine” grit is selected.22 In addition, the desensitizing paste is perfect for the patient who might be experiencing sensitivity and biofilm accumulation near the cervical restoration. These pastes contain 8% arginine and calcium carbonate and are safe to use on resin composite, porcelain, amalgam, gold and dental enamel.16
Proper adaptation of instruments is crucial in order to prevent scratches, fractures, or chips on the teeth and/or dental materials. Scaling procedures should be performed carefully, and sites that are rough following the procedure may have to be re-polished to prevent plaque accumulation.11 Any areas of roughness will increase bacterial adhesion. In fact, research has shown a positive correlation between surface roughness and the amount of S. mutans that adheres to the restoration.12,13 The accumulation of biofilm can lead to gingival inflammation and recurrent caries, which will decrease the longevity of the restoration.32