by Karen Kaiser
Even as an avid aquarist, I find moving a large aquarium to be a tedious task; draining the tank, packing pumps and power filters, and wrapping air lines are part of the routine. Transporting the fish is a sensitive issue and unwelcome stress on the fish. My last move proved fatal for poor Freddie, my fish, or so I thought. While reassembling my aquarium, I discovered Freddie had wedged himself into the intake tube, leaving his gills without water for quite some time. The once hardy goldfish lay lifeless, and, as the fish keeper, I was saddened because I had allowed Freddie to slip into this fatal predicament.
My father, who was helping me move, picked up poor Freddie, squeezed the side of his little gills, opened his mouth, and gently puffed air into his mouth. Amazingly, my father thrust the fish back into the freshly filled aquarium, and Freddie swam! Fish CPR, who would have thought?
Another type of CPR can work for your patients. When their fillings lack luster, their porcelain restorations need resuscitating, or their composites need tender care, consider performing CPR - Cosmetic Polishing Restorative(tm) - which is manufactured by IC Care.
Patients are startled when you say you're about to use CPR on them. It's an attention getter! Use this prime opportunity to discuss their cosmetic restorations, any wearing surfaces, and the benefits of having them cosmetically enhanced with polish. Traditional coronal (selective) polish procedures are performed on natural tooth surfaces, then CPR restorative is applied to stained and worn restorations. When the paste is applied to restorations, the natural luster will return. The surface anatomy will remain unchanged because the paste has a small particle size.
CPR restorative is loaded in a familiar unit-dose cup and fits a prophy ring for easy use. The convenient, single-use cup, which differs from many syringe and jar delivery systems, eliminates multiple use items that require disinfecting. CPR paste is compatible with composite materials and is not specifically formulated towards any one composite matrix. Many companies advocate using only their polishing systems as working the best on their composites. Not so with CPR. It's a universal polish which hygienists can easily implement into their recare routines.
When a worn down restoration is noted during the oral exam, ask the patient if the tooth surface feels rough to their tongue. You may find the patient has been dealing with dull resin or porcelain and believes this worn surface is normal. Use the intraoral camera to show how punished sites appear prior to the polishing. Taking before and after images with the intraoral camera will further display evidence of the cosmetic imperfections of the restorations.
After completing the polish, additional treatment may be discussed if the procedure did not meet expectations. Unfortunately, aged composite materials are sometimes too dull and non-reflective, even after cosmetic polishing. Discuss with your patient the modern methods and composite materials available to improve esthetics.
CPR restorative paste benefits the porcelain surface after the crown has undergone minor adjustments. When the bite needs to be adjusted or the patient presents with opposing wear from crown to crown contact, polishing with CPR paste can improve the porcelain by restoring a glaze-like surface. If a natural tooth opposes a restored tooth polishing, the restoration will benefit the natural tooth by reducing abrasion and smoothing the surface. Once patients experience a cosmetic polish on a mouthful of needy restorations, they will request repeat procedures at subsequent recare visits.
Composite restorations are a combination of glass and silica filler particles. These components increase the strength of the filling and improve the ability of the composite material to buff when polished. Older, small particle composites have been replaced by hybrids - durable microfills and nano-particle materials that can easily hold a surface gloss when appropriately polished.
Traditional, pumice-derived prophy paste can actually mar and scratch the surfaces of composites, ceramics, veneers, and fixed bridgework, leaving a rough, dull appearance. Performing coarse paste prophylaxis is a disservice to composite restorations because the abrasive grit leaves the resin porous. Porosity leaves the restoration vulnerable to a plaque attack, prone to staining, and jeopardizes its margin longevity.
Application of CPR requires a polishing cup or brush. If you use a standard prophy cup, polishing must be done with a constant tap-and-lift motion on the composite material because heat buildup may occur and possibly cause composite damage. Restorative paste loaded in a standard prophy cup forms almost a "suction cup" effect on the restoration surface. A prophy brush or designed polishing/buff cup (latch variety) will prove most successful. CPR is a particularly thick and creamy consistency that has a reduced splatter. A dry restoration allows the product to remain undiluted by not introducing saliva. This also calls for a vigorous final rinse to wash the paste from the patient's mouth. When asked, patients often comment that the paste was pleasant (a mild mint flavor), and they never felt a gritty texture in their mouth.
Because of the composition of CPR paste (aluminum oxide), it can be tried not only on composites and porcelain, but also on tarnished amalgams. The result will be fillings that shine like the tinsel on holiday trees. Closely examine the alloys (using magnification) after the polish and note any areas that have fracture lines undetected during the visual exam because they were disguised by stains. Show the patient any breakdown of margin integrity and use the opportunity to discuss replacement of older amalgams with tooth colored restorations.
Because they want whiter teeth, patients are accepting procedures that cosmetically enhance their smiles and bring them closer to a brighter dentition. A product such as CPR fits this strategy. Old composites and crowns are still dull and stained during whitening procedures and in need of revitalization, and your patients want those restorations enhanced. So incorporate a cosmetic polish and bring shade improvement to those restorations through stain removal. The result is a brighter composite restoration to complement the whiter smile.
When margin-stained composite restorations or scratched veneers or crowns need new life breathed in them, consider a restorative paste like CPR - a high-shine solution that improves luster and safeguards the integrity of composite and ceramic restorations. Developed for use during the hygiene appointment, CPR restorative is a reviving service that revitalizes cosmetic work.
Have a heart. Give cosmetic restorations CPR.
The author did not receive compensation for product endorsement. For more information on CPR restorative, visit www.iccare.net.
Karen Kaiser,RDH, graduated form St. Louis' Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and is an evaluator for Clinical Research Associates. She can be contacted at [email protected]