Wednesday, January 22, 2014

Prophylaxis Pitfalls with All-Ceramic Restorations Submitted by Dr. Damon Adams

Routine polishing of high-gloss ceramic surfaces, using abrasive prophylaxis pastes, should be avoided; their overuse will abrade the ceramic glaze on porcelains. The American Dental Hygienists’ Association (ADHA) takes the following position regarding polishing procedures. Polishing should not be considered simply a routine procedure. In addition, it should be offered only when a dental hygienist or dentist determines a specific need for it (Jan. 2003; 17(1):20-21). ADHA justifies its position on the “little therapeutic benefit” produced by polishing. A true prophylaxis (with prevention of disease) is achievable in the vast majority of cases without polishing.

Prophy pastes will eventually lead to breakdown of resin-luting cements at the margin of ceramic veneers and onlays, and cause surface roughness. In addition, it is important to educate your patients on the use of abrasive toothpastes that contain silica particles.

Ultrasonic scalers are often employed to make hygiene procedures faster and easier, but realize that this technology can damage certain all-ceramic restorations. Take great care when using an ultrasonic scaler around the fragile margins and bonded porcelain-cement-tooth interfaces of any all-ceramic restoration, especially bonded veneers (leucite reinforced / lithium disilicate / feldspathic porcelains). Settings that are too high (aggressive) or unltrasonic energy left in contact too long in any one area can be highly destructive to the long-term integrity of the restoration.

Another area of concern is when using acidulated fluoride rinses or pastes. Acidulated fluoride (unlike sodium fluoride) can cause surface etching/roughness on glazed ceramic surfaces, resulting in increased staining and decreased luster. Only neutral fluorides should be used in patients with glazed all-ceramic restorations, with the exception of polished unglazed all-zirconia restorations.

Dr. Adams is the current Editor in Chief of Dentistry Today, and member of the ADA, AGD, AACD, SCAD, and the National Association of Dental Laboratories.
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