Creating & Maintaining Beautiful Smiles

In second part of series, JP Institute offers tips for ultrasonic scaling around porcelain restorations.

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Dr. Chris Pescatore
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In second part of series, JP Institute offers tips for ultrasonic scaling around porcelain restorations.
by Kimberly R. Miller, RDH, BS

In the January 2005 issue of RDH, Peggy Sprague, RDH, wrote the first part of this article as an introduction to JP Institute’s “Veneer Care System.” The article, which had the same title as this, addressed using a team approach in order to assist the patient with acceptance and follow through of an individualized recare strategy. Additionally, we outlined a minimum of eight variables, supported by a variety of visual aids, which need to be considered when qualifying the proper interval for the patient. Implementation of these key strategies results in greater patient compliance with fewer no-shows and cancellations and also creates a stronger base of patients that refer other patients just like themselves.

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A swab containing benzalkonium chloride is tissue friendly and reduces sensitivity.
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Since dental hygienists play such a critical role in the maintenance and longevity of today’s enhanced smiles, the second half of this article will address the three most common clinical concerns when providing supportive therapy around all porcelain restorations and veneers. First, is it acceptable and safe to use power-driven instruments or ultrasonics near all porcelain margins? Second, how can I proceed with ultrasonic instrumentation when the patient complains of marginal sensitivity? And, third, how frequently and with what products do I polish?

The current standard of care calls for using a combination of ultrasonic instrumentation and hand instrumentation. State-of-the-art, tunable power-driven scalers are not only safe and acceptable around all porcelain restorations, as discussed in this article, they also provide the acoustic turbulence necessary to break up the biofilm matrix and bacterial cells. It is important to always follow the use of hand instruments with ultrasonic instrumentation.

When using power-driven scalers around all porcelain restorations there are some noteworthy precautions that must be followed. Always use the lowest possible stroke width, which is accomplished by turning the power knob on your unit all the way down, and always use the thinnest insert available to complete the task at hand.

There are many power-driven scalers on the market; however, not all of them allow the clinician to tune the unit appropriately for use around porcelain margins. You should check with the manufacturer of your unit to determine the parameters. The Dentsply Sustained Performance Scaling (SPS) Unit provides a comfort zone for the patient and allows use of the Slimline inserts at a very small elliptical stroke width while consistently delivering 30k cycles per second to the sulcus or periodontal pocket. If you prefer piezo technology, the EMS or Satellec units provide a wide tip selection with a small linear stroke path while still delivering the desired power to accomplish root debridement and biofilm disruption/removal. This lower setting keeps the patient much more comfortable and supports increased patient compliance for the use of ultrasonics during hygiene visits. The small stroke width also decreases the chance of the instrument contacting the ‘all porcelain’ margin with enough force to cause a chip or break in the porcelain.

Caution is required however as you enter the sulcus or periodontal pocket. During our certification curriculum, workshops and in-office training, The JP Institute teaches the following technique:

• Disengage the instrument by lifting your foot off the rheostat.
• Place the instrument tip in the sulcus or periodontal pocket.
• Engage the instrument staying in the subgingival space.
• Treat the pocket to completion.
• Finish by disengaging the instrument before exiting the subgingival area.
• Do not run the activated tip over the porcelain margin at any time.

Using this technique will considerably reduce the risk of ‘nicking’ the porcelain margin. Understanding how the stroke width affects the active portion of the instrument tip during Ultrasonic instrumentation as well as implementing the above precautions will greatly reduce the chance of damage to the porcelain margin. A hands-on course to refine your technique is a great contribution to your professional development and patient care.

Clinical data strongly supports using power-driven scalers, however, the patients who experience sensitivity during ultrasonic instrumentation are always a challenge. The solution to this challenge lies in technique, tip selection, power or stroke width (which we discussed above), patient communication, and the application of a desensitizing product.

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Polishing can be administered prior to ultrasonic scaling.
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In order for patients and hygienists to perceive value in the use of ultrasonic instrumentation in combination with hand scaling they must first understand how the acoustic turbulence created by ultrasonic scalers, like water in a blender, can increase the clinical benefit. Often both patients and hygienists perceive the use of power-driven scalers to be a “time saver.” However, once there is an understanding that use of ultrasonic technology provides superior bacterial disruption, the clinical use as well as the patient acceptance of this type of technology increases.

Sensitivity is the number-one patient complaint with power-driven scalers; therefore, many hygienists avoid using them. AcquaMed Technologies in Batavia, Ill., (www.acquamedtech.com) has recently developed AcquaSeal Benz, which is designed to treat cervical sensitivity and has shown to have remarkable consistent results. The benzalkonium (Benz) chloride formula is tissue friendly and is easy to dispense in a single use swab applicator. It works through effective occlusion of the dentinal tubules therefore inhibiting fluid movement within the tubules and eliminating sensitivity. One swab will cover approximately one quadrant, and most importantly, it will stop sensitivity for six to nine months after application!

The AcquaSeal Benz swabs are a must for every dental hygiene treatment room and they should be kept on the bracket tray beside our instrument selection and polishing paste. AcquaMed Technologies will feature a complete line of products to stop sensitivity including prophy paste, whitening products, and bonding systems.

Polishing all porcelain restorations and veneers is a critical component to helping our patients maintain their beautifully enhanced smiles. To support our patients’ periodontal health, The JP Institute suggests that polishing be done prior to ultrasonic instrumentation. This allows the clinician an opportunity to flush the subgingival areas leaving them free of polishing paste residue.

One of the nation’s leading dental laboratories, MicroDental, has approved the use of Proxyt RDA7 Fine Porcelain Polishing Paste by Ivoclar/Vivadent for use on all porcelain restorations. Even though most patients’ re-care intervals are customized to prevent disease and/or maintain periodontal health, polishing with Proxyt to restore luster, to veneers in particular, is highly recommended at least every six months.

For the patients who have both porcelain restorations and natural detention, the clinician should always polish the porcelain surfaces first, followed by the natural dentition. If the clinician chooses a more abrasive prophy paste for the natural dentition, extreme caution must be taken to avoid the porcelain restorations. Following this recommendation will guarantee the porcelain surfaces remain free of scratches caused by abrasive prophy paste.

To help the patient keep their smile stain-free and support them in their home care, the addition of power brushing has proven to be a great benefit. Adding power brushing to a patients’ daily routine has been shown to significantly reduce staining between dental hygiene visits.

Additionally the vibrations of the Sonicare by Phillips Oral Healthcare, for example, also create “fluid dynamics,” which assist in the reduction of the planktonic bacteria, the precursors to biofilm. Given these benefits, a power brush should be recommended as part of a patient’s veneer recare system.

As dental professionals we are responsible for patient education regarding periodontal maintenance, which supports the longevity of our patients’ enhanced smiles. Implementing the techniques and products we have discussed in this two-part article will result in improved patient compliance while adding increased value to your hygiene procedures.

To find out more about continuing education courses and products to enhance your clinical expertise, or to become a JP-certified hygienist, visit our Web site at www.jpconsultants.com or call (800) 946-4944. The JP Institute has taught the most advanced clinical protocols, technology, and evidence based science since 1979. The JP curriculum emphasizes team support for comprehensive dentistry.

JP specializes in analyzing and refining practice philosophies, strategies and business systems, hands-on implementation of clinical skills, and technology and product integration. Call The JP Institute for a complementary practice or career profile to analyze your professional development, clinical protocols, technology and product integration, management systems, and profit potential.

Kim Miller, RDH, BS, has been an instructor, senior consultant, and author with The JP Institute since 1992. She is also the director of and featured instructor for The JP Institute’s Evolutionary Hygiene in Support of Aesthetic Dentistry course (taught at the Las Vegas Institute for Advanced Dental Studies since 1995). Kim has coached more than 300 individual practices for The JP Institute, teaching a hands-on curriculum, as well as providing workshops, seminars, and lectures throughout the United States and Canada.

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