Recognition of the different restorative options will tell a hygienist what polishing agents to use and what results can be expected.
Kristine A. Hodsdon, RDH, BS
The multi-colored and textured fabric of esthetics has intertwined itself in the tapestry of dentistry and dental hygiene. The public has accepted and is demanding procedures based on quality and appearance. Dr. David Hornbrook of PAC-live, an esthetic continuum, has described himself and fellow cosmetic dentists as "smile designers." In lieu of this, I feel confident in creating the name "smile keepers" to portray esthetic dental hygienists. Contemporary dental hygiene practice requires that a dental hygienist have the depth and breadth of knowledge and skills in smile design and esthetic principles. "Esthetic hygiene" is delivering tangible and intangible hygiene services within the comprehensive framework of theories and best practices of esthetic dentistry.
Properly polishing cosmetic treatments is a service that can preserve and prolong the longevity of the treatment. However, the selection of polishing systems for the "total smile complex" can be difficult. The differences in the size, shape, number of filler particles, the type of resin, the varying porcelain or ceramic materials, and the adhesion to natural tooth structure may make any one system incapable of creating a high shine on all esthetic solutions. Clinicians must first identify between natural tooth structure, small particle composite, microfill, hybrid, resin ionomer, compomer, and porcelain/ceramic restorations.
Recognition of the different restorative options will tell a hygienist what polishing agents to use and what results can be expected. This will save time in trying to reproduce a gloss that will never happen. If you are having trouble getting the desired results with your current methods, check with the manufacturer of the restorative material for polishing guidelines and product suggestions. Studies suggest that pairing a specific restorative material with a matching polishing system produces the smoothest surfaces.
Generally, to bring a surface gloss to restorations, the polishing system includes the application of aluminum-oxide or diamond paste. Evidence shows that conventional prophy paste may roughen, scratch, and dull the surface of tooth-colored restorative material. Coarse prophy paste may also cause premature plucking of glass or silica filler particles from the resin matrix (organic paste) of composites, leaving a porous surface. Excessive wear, staining, and premature breakdown of the restoration may occur.
In the area of polishing cups vs. prophy cups, the literature is not consistent. Some sources state that polishing pastes should be used on flexible buffing cups, points, or discs/wheels, rather than regular prophy cups. It has been suggested that regular prophy cups may generate too much heat and cause damage to composite materials. However, other reports mention that latch-type, webbed prophy cups tend to polish better than disposable prophy angles.
So, faced with rival approaches, what should the foot soldiers of esthetic hygiene do? Based on my research of the patchwork of such arguments and proofs, I recommend using buffing cups or points when performing esthetic polishing. However, if not available, the next choice would be soft, webbed prophy cups.
Begin the process by determining the extent of polishing necessary, evaluating the restoration and tooth-stain accumulation. A tooth or restoration that exhibits no stain, still has its luster, and the only goal is plaque removal, can be polished with gentle toothpaste and a slow-speed handpiece or soft, manual toothbrush. Supersmile, invented by Dr. Irwin Smigel, is a tooth polish, which has Calprox as its main ingredient. Supersmile nonabrasively dissolves the protein pellicle layer and is safe for both natural tooth structures and esthetic cases. Another product, Proxyt, manufactured by Ivoclar-Vivadent, comes in three grits ? fine, medium, and coarse. The fine grit is gentle enough for all tooth-colored restorations. Supersmile, however, receives other OkudosO because it come in single-use packages. It would be helpful if other manufacturers would add siblings to their polishing lines in the form of individual polishing packets. These packets would allow for easier integration into the hygiene treatment gallery.
Aluminum-oxide paste can be used on composite resins, gold, and tooth structure. Begin to polish with extra-fine composite paste. It works best in a wet environment; remem-
ber to continually add water to the buffing cup. Distribute polish adequately over the entire surface and use a light, intermittent stroke contacting the restorative/tooth surface for no more than 15-30 seconds each. Our goal is for restoration renewal, not recontouring or margin obliteration. Carry paste interproximally with floss and rinse to clear the area.
If stain removal is the goal and a paste alone did not achieve the desired results, then it may be necessary to move on to more aggressive techniques. Selections in the process of finding the solution include varying paste grits, rotary rubber polishing instruments, and strips ? all in grades ranging from extra-fine through coarse. Rinse away the polishing agents/particles between the levels of coarseness in order to avoid continually abrading the surface. Once stain removal is achieved, the final stage should be reversing the process and finish polishing with the least abrasive polish and instrument. At the conclusion of each esthetic-management session, administer a neutral sodium-fluoride application.
Porcelain and ceramic, as long as it was glazed or properly polished prior to seating it, keeps its gloss indefinitely. Stain removal from glaze porcelain can also be achieved using the grits of Proxyt. Polish only with an aluminum-oxide paste on porcelain or ceramic restorations when resin cement or cementum is exposed. If the gloss is gone and only porcelain or ceramic is exposed, then use a diamond polishing paste on felt wheels or a Robinson wheel. Diamond paste is best used in a dry environment, so use of cotton rolls is essential. With the appropriate polishing system, follow the same protocol and instrument sequence as outlined previously.
Interproximal stain removal can be universally achieved with aluminum-oxide polishing strips. Start with the finest grade and graduate to the next coarsest grade until the stain is gone. Then complete the process by reversing the sequence and graduate to the finest grade until the restoration is smooth.
What clinicians must also keep in mind is that some of these treatments may never have the same luster they had the day they were placed. In fact, depending on the material used, they may actually appear esthetically displeasing, even after appropriate polishing techniques, but are still functional. However, in other instances, the restoration may require replacing. It becomes effective hygiene management when the difference can be assessed.
It is my wish that, as we begin to gain knowledge in esthetic hygiene, we do not lose sight of its most important attribute: Education. Do not incorporate any new protocol, technique, or product without first educating yourself and your client on the why, what, and how. Knowledge grows when shared and grows when used.
Polishing procedures are not meant to be built-in silently. For instance, talk with your clients about why the new polish is more compatible with their dentistry or let them know that, from now on, the Opolishing partO will no longer feel like a Osandy beachO in their mouths. Polishing services need to be valued by the client by making them aware that such procedures can keep their esthetic restorations looking their best for as long as possible.
References available upon request.
Kristine A. Hodsdon, RDH, BS presents seminar nationally about esthetic hygiene. Her company, Dental Essence, is based in Hudson, N.H. She can be e-mailed at [email protected].