Have you ever taken a radiograph and seen an overhang? It could be cement, composite, or amalgam. Whatever the material, don’t leave them hanging out. Just like calculus, they can harbor bacteria, causing recurrent caries and periodontal diseases. Sometimes they are a piece of the restoration and can only be removed by redoing the restoration. Other times, it is more of a flash situation where the overhanging material is just barely hanging on. When this is the case, a hygienist can safely remove it.
I can remember a case where the dentist walked in and asked if I had removed an overhang visible on the radiograph. I had scaled it but was unsure, as a newbie, if I should even touch the thing. The dentist could still feel it and asked if I would try again to remove it and then take a post-op radiograph. So I pulled out my ultrasonic and my hand instruments and scaled it from multi directions on the buccal and lingual.
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When exploring, I couldn't feel it anymore, so I took a post-op radiograph as requested by the dentist. On the radiograph I could see that the overhang was detached from the tooth, but it was just floating in the embrasure space. I needed to go one step further to get it out of the tissues. I tried to use my instruments with a scoop technique and then a push technique but didn’t see anything come out. I tried tying a few knots in a piece of floss to see if that would pull it out as I moved it up down and right to left, but nothing was working.
Hearing my frustrations from the next room, my fellow hygienist Cheryl, who had been practicing for 25 years, said, “Use an interproximal brush and it will pop right out.” Hallelujah, it worked! There on the tip of the interproximal brush was a small piece of cement that I pulled off the tip before pulling the interproximal brush back through the interproximal space. The dentist requested one more post-op radiograph, and it showed a clean margin.
One thing to note when doing this procedure is that you may have numb the patient. I usually try without doing that first, but if they're experiencing any pain, it is best to just get them comfortable so that you can complete the job. Take a look at the removal technique in action.
Hygiene Edge was created by three dental hygiene educators who love both dentistry and education. With over 40 years of experience both in the education space and in the dental field, Melia Lewis, Jessica Atkinson, and Shelley Brown love sharing their knowledge through helpful, short videos online, speaking, and working with amazing companies. You can find more information at Hygiene Edge, on YouTube (www.youtube.com/hygieneedge), and Instagram (@hygieneedge). Have a question or a tricky area? Let us know! We’d love to help.