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Maintenance of Restorations

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sushantpatel_doc's picture
Joined: 30 Nov 2009

Ceramic restorations are bonded in place using an adhesive, usually a resin cement or a glass ionomer cement. The glass ionomer cement definitely has better adhesion to dentin and roots, which can be a problem because excess glass ionomer can be extremely difficult to remove if there is excess. Sometimes the scaler can go right over glass ionomer and it seems as if it is the root. Hygienists should look at the radiograph to see if there is a small protrusion or anything that looks like the root is not perfectly straight. The protrusion could be calculus also, but glass ionomer shows up differently. It is more radiolucent.
Being careful with ceramic restorations means exercising caution with the prophy jet or air abrasion unit. Over time, prophy jets can affect the porcelain surface of any ceramic restoration. A class four restoration that restores the area from incisal angle to the gingival area is not a problem, but if it is a class five restoration that goes under the gingiva, the scaling direction is absolutely essential. In this situation, scaling must be done laterally—not vertically. If there is a small ledge or something is irregular, alert the dentist. The dentist can then finish it down better. Not only can the ledge hold plaque, it can also irritate the tissue. The smartest approach is to use the explorer to go around the cervical edges to make sure that overhangs are not present. If overhangs are there, avoid them and alert the dentist so they can be corrected.
Ultrasonic vibrations are potentially damaging to any resin or ceramic restoration because it can break the adhesive bond. If it is bonded to enamel, it is very strong. But most restorations, especially at the gingival area, involve dentin and the bond is not as strong—not nearly as strong as to enamel. Ultrasonic vibrations can result in loosening that bond. The restoration may not come out, but microleakage at the margin can occur.

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