FINISHING, POLISHING & FINISHING, POLISHING & CLEANSING MATERIALSCLEANSING MATERIALS

Finishing & polishing techniques are meant to Finishing & polishing techniques are meant to remove excess material & to smooth remove excess material & to smooth roughened surfaces.roughened surfaces.

Cleansing techniques are meant to remove Cleansing techniques are meant to remove food & other debris from a surface without food & other debris from a surface without damaging it.damaging it.

Polishing & cleaning are routine procedures Polishing & cleaning are routine procedures for maintaining the health of the natural for maintaining the health of the natural dentition.dentition.

ABRASIONABRASION

Results when a hard, rough surface, such as a Results when a hard, rough surface, such as a sandpaper disk, or hard, irregularly shaped sandpaper disk, or hard, irregularly shaped particles, plow grooves into a softer material & particles, plow grooves into a softer material & cause material from such grooves to be cause material from such grooves to be removed from the surface.removed from the surface.

Abrasive action – cuttingAbrasive action – cutting The process of abrasion is affected by the The process of abrasion is affected by the

physical & mechanical properties of the physical & mechanical properties of the material being abraded.material being abraded.

Rate of abrasionRate of abrasion

Determined primarily by 3 factors:Determined primarily by 3 factors: The size of the abrasive particle The size of the abrasive particle

Larger particles cause deeper scratches & wear away the surface at a Larger particles cause deeper scratches & wear away the surface at a faster rate.faster rate.

The pressure of the abrasive against the material being The pressure of the abrasive against the material being abradedabraded

Heavy pressure applied by the abrasive causes deeper scratches & Heavy pressure applied by the abrasive causes deeper scratches & more rapid removal of material.more rapid removal of material.

The speed at which the abrasive particle moves across the The speed at which the abrasive particle moves across the surface being abradedsurface being abraded

Increasing the speed increases the rate of abrasionIncreasing the speed increases the rate of abrasion

* All these factors can be clinically controlled* All these factors can be clinically controlled

Types of abrasivesTypes of abrasives Finishing Finishing

Generally hard, coarse abrasives that are used primarily for developing Generally hard, coarse abrasives that are used primarily for developing desired contours of a restoration or tooth preparation & for removing desired contours of a restoration or tooth preparation & for removing gross irregularities on the surface.gross irregularities on the surface.

PolishingPolishing Have finer particle sizes & generally less hard than finishing abrasivesHave finer particle sizes & generally less hard than finishing abrasives Used to smooth surfaces that have been roughened typically by Used to smooth surfaces that have been roughened typically by

finishing abrasives or wear particles encountered in the mouth.finishing abrasives or wear particles encountered in the mouth. CleansingCleansing

Generally soft materials with small particle sizesGenerally soft materials with small particle sizes Intended to remove softer materials that adhere to enamel or restorative Intended to remove softer materials that adhere to enamel or restorative

material substratesmaterial substrates

Abrasive toolsAbrasive tools

FinishingFinishing Plastic or paper disksPlastic or paper disks

Attached to dental handpiece or strips for finishing of Attached to dental handpiece or strips for finishing of interproximal areasinterproximal areas

Paper disks – for finishing contoured surfaces because they are Paper disks – for finishing contoured surfaces because they are more flexible than plastic disksmore flexible than plastic disks

Diamond rotary instrumentsDiamond rotary instruments Diamond chips are attached to steel wheels, disks, & cylindersDiamond chips are attached to steel wheels, disks, & cylinders

Grinding wheels & dental stonesGrinding wheels & dental stones Abrasive particles are bonded by a matrix material that is molded Abrasive particles are bonded by a matrix material that is molded

to form tools of desired sizes & shapes.to form tools of desired sizes & shapes.

Polishing & cleaningPolishing & cleaning Mixed with water, glycerin or some other medium Mixed with water, glycerin or some other medium

to produce slurries or pastesto produce slurries or pastes Glycerin – prevents the change in consistency that Glycerin – prevents the change in consistency that

occurs when water, which evaporates, is used to occurs when water, which evaporates, is used to mix a slurry.mix a slurry.

Abrasive agentsAbrasive agents

FinishingFinishing Aluminum oxide – most commonly applied to Aluminum oxide – most commonly applied to

paper/plastic disks in coarse, medium, & fine grits; paper/plastic disks in coarse, medium, & fine grits; reddish brown; powders are used in air-abrasion reddish brown; powders are used in air-abrasion unitsunits

Cuttle – from bones of fish; refers to fine grade Cuttle – from bones of fish; refers to fine grade quartz; applied to paper disk in coarse, medium, & quartz; applied to paper disk in coarse, medium, & fine grits; beigefine grits; beige

Diamond – hardest known substance; chips are Diamond – hardest known substance; chips are impregnated in a binder to form diamond “stones” impregnated in a binder to form diamond “stones” & disks& disks

Garnet – mined; paper/plastic disks in extra-coarse, Garnet – mined; paper/plastic disks in extra-coarse, coarse, medium, fine, & extra-fine grits; redcoarse, medium, fine, & extra-fine grits; red

Sand – form of quartz; plastic/paper disks in coarse, Sand – form of quartz; plastic/paper disks in coarse, medium, & fine grits; beige; should not be used medium, & fine grits; beige; should not be used interchangeably with cuttle disks because particle interchangeably with cuttle disks because particle sizes are not the samesizes are not the same

Silicon carbide (SiC) – second hardest; paper/plastic Silicon carbide (SiC) – second hardest; paper/plastic disks in fine, extra-fine & double extra-fine grits; disks in fine, extra-fine & double extra-fine grits; blackblack

Polishing & cleaningPolishing & cleaning Calcite & chalk – form of calcium carbonate; Calcite & chalk – form of calcium carbonate;

prophylactic pastes & dentrifices as polishing prophylactic pastes & dentrifices as polishing agentagent

Kieselguhr – polishing agent composed of the Kieselguhr – polishing agent composed of the siliceous remains of minute aquatic plants known siliceous remains of minute aquatic plants known as diatomsas diatoms

Pumice – highly siliceous volcanic glass when Pumice – highly siliceous volcanic glass when ground is useful as a polishing agent in ground is useful as a polishing agent in prophylactic pastes & for finishing acrylic denture prophylactic pastes & for finishing acrylic denture basesbases

Rouge – fine red powder composed of iron oxide; Rouge – fine red powder composed of iron oxide; cake form; may be impregnated in paper or fabric cake form; may be impregnated in paper or fabric known as crocus cloth; excellent laboratory polishing known as crocus cloth; excellent laboratory polishing agent for gold & other precious metal alloysagent for gold & other precious metal alloys

Silex – siliceous materials such as quartz or tripoli; Silex – siliceous materials such as quartz or tripoli; polishing abrasives in the mouthpolishing abrasives in the mouth

Tin oxide – pure white powder; final polishing agent Tin oxide – pure white powder; final polishing agent for teeth & metallic restorations in the mouth; mixed for teeth & metallic restorations in the mouth; mixed with water, alcohol, or glycerin; used as pastewith water, alcohol, or glycerin; used as paste

Tripoli – originates from certain porous rocks found Tripoli – originates from certain porous rocks found in North Africa; often used with Kieselguhrin North Africa; often used with Kieselguhr

Zirconium silicate – hard abrasive; in small particlesZirconium silicate – hard abrasive; in small particles

Abrasive agents in prophylactic pastesAbrasive agents in prophylactic pastes Quartz; anatase; feldspar; montmorillonite; Quartz; anatase; feldspar; montmorillonite;

aluminum hydroxide; kaolinite; talcaluminum hydroxide; kaolinite; talc Abrasives in dentrificesAbrasives in dentrifices

Calcium carbonate; dibasic calcium phosphate Calcium carbonate; dibasic calcium phosphate dihydrate; anhydrous dibasic calcium phosphate; dihydrate; anhydrous dibasic calcium phosphate; tricalcium phosphate; calcium pyrophosphate; tricalcium phosphate; calcium pyrophosphate; sodium metaphosphate; hydrated alumina; silicasodium metaphosphate; hydrated alumina; silica

Mainly cleansing & polishing abrasives not meant Mainly cleansing & polishing abrasives not meant to abrade enamel severelyto abrade enamel severely

Finishing & polishing techniquesFinishing & polishing techniques

The key to successful finishing & polishing is The key to successful finishing & polishing is strict adherence to a recommended abrasive strict adherence to a recommended abrasive sequencesequence Initial contouring & smoothing of the surface done Initial contouring & smoothing of the surface done

with a coarse abrasive or bur.with a coarse abrasive or bur. Successively finer abrasives then remove the large Successively finer abrasives then remove the large

scratches producedscratches produced With each change in abrasive, rinse the area being With each change in abrasive, rinse the area being

finished & polished to remove the previously used finished & polished to remove the previously used abrasive particles.abrasive particles.

Take care not to allow the abrasive tool or slurry to Take care not to allow the abrasive tool or slurry to be used in a dry condition.be used in a dry condition.

Dry polishing may dramatically reduce the efficiency of Dry polishing may dramatically reduce the efficiency of the abrasive & increase the danger of overheating the the abrasive & increase the danger of overheating the surface.surface.

Denture baseDenture base Ready for finishing & polishing once it has been processed & Ready for finishing & polishing once it has been processed &

deflasked.deflasked. Any remaining gypsum can be removed by light scraping or Any remaining gypsum can be removed by light scraping or

with a shell blasterwith a shell blaster Feathered edges of acrylic can be smoothed & rounded with Feathered edges of acrylic can be smoothed & rounded with

an acrylic finishing buran acrylic finishing bur A rag wheel & felt cone with a pumice slurry are used to A rag wheel & felt cone with a pumice slurry are used to

finish the tongue side of the maxillary basefinish the tongue side of the maxillary base A single-row brush wheel & a rag wheel about 6mm in width A single-row brush wheel & a rag wheel about 6mm in width

are used with a pumice slurry to smooth the labial & buccal are used with a pumice slurry to smooth the labial & buccal surfaces on the tongue side of a mandibular denture without surfaces on the tongue side of a mandibular denture without destroying the contour.destroying the contour.

A final high polish is given to all non-tissue bearing surfaces A final high polish is given to all non-tissue bearing surfaces by a rag wheel with tripoli, Bendick, or a paste of tin oxide & by a rag wheel with tripoli, Bendick, or a paste of tin oxide & water.water.

Overheating affects the appearance of the Overheating affects the appearance of the denture & may cause warpage to occur.denture & may cause warpage to occur.

Acrylic denture teeth must be protected from Acrylic denture teeth must be protected from the pumice because they are easily abraded.the pumice because they are easily abraded.

After polishing, the denture should be washed After polishing, the denture should be washed with soap & water & stored in water until with soap & water & stored in water until delivery to the patient.delivery to the patient.

To maintain infection control, separate polishing To maintain infection control, separate polishing burs, rag wheels, & pumice pans should be used for burs, rag wheels, & pumice pans should be used for each prosthesis.each prosthesis.

Pumice can be mixed with a liquid disinfectant (5 Pumice can be mixed with a liquid disinfectant (5 parts sodium hypochlorite to 100 parts distilled parts sodium hypochlorite to 100 parts distilled water) and green soap (3 parts) to keep the pumice water) and green soap (3 parts) to keep the pumice suspended.suspended.

Pumice should be changed daily.Pumice should be changed daily. Rag wheels can be sterilized in a steam autoclave or Rag wheels can be sterilized in a steam autoclave or

by ethylene oxide.by ethylene oxide.

Composites Composites

Allowing polymerization of the freshly inserted resin Allowing polymerization of the freshly inserted resin to occur against a Mylar (polyester film) matrix to occur against a Mylar (polyester film) matrix produces the smoothest surface on a composite.produces the smoothest surface on a composite.

Finishing procedureFinishing procedure Use of diamond stones or 12-blade carbide burs for Use of diamond stones or 12-blade carbide burs for

removal of gross excesses that are not near enamel removal of gross excesses that are not near enamel margins.margins.

Use of abrasive disks for the finishing of accessible areasUse of abrasive disks for the finishing of accessible areas Use white stones of suitable shape for the finishing of more Use white stones of suitable shape for the finishing of more

inaccessible areas.inaccessible areas. Fine & microfine diamonds & diamond polishing pastes Fine & microfine diamonds & diamond polishing pastes

are suitable for the final finishing of compositesare suitable for the final finishing of composites

Compomers – same as compositesCompomers – same as composites Hybrid ionomers Hybrid ionomers

do not finish as smoothly as microhybrid compositesdo not finish as smoothly as microhybrid composites best finish is achieved with the use of Mylar matrixbest finish is achieved with the use of Mylar matrix unfilled resin glaze can be applied to smooth the surface unfilled resin glaze can be applied to smooth the surface

after finishing but the glaze may wear away in the mouthafter finishing but the glaze may wear away in the mouth Glass ionomers – same as composites; some products Glass ionomers – same as composites; some products

may require a delay of 24 hrs to allow further settingmay require a delay of 24 hrs to allow further setting Gold alloy – dependent on fabrication techniqueGold alloy – dependent on fabrication technique

Indirect technique – finishing & polishing on the die after Indirect technique – finishing & polishing on the die after the occlusion & margins have been properly adjustedthe occlusion & margins have been properly adjusted

Direct technique – polished on the tooth when surfaces are Direct technique – polished on the tooth when surfaces are accessible; finishing of the pickled casting & polishing of accessible; finishing of the pickled casting & polishing of proximal surfaces are done in the lab; the casting is generally proximal surfaces are done in the lab; the casting is generally rubbed with alcohol to prepare its surface for cementation.rubbed with alcohol to prepare its surface for cementation.

Amalgam Amalgam

Steps involved in the manipulation of Steps involved in the manipulation of amalgamamalgamMixing (trituration) Mixing (trituration)

condensation condensation

carving carving

finishingfinishing

Steps in the polishing of dental amalgamSteps in the polishing of dental amalgamContour Contour

( greenstones, abrasive disks, burs)( greenstones, abrasive disks, burs)

Finish margins Finish margins ( greenstones, abrasive disks, burs)( greenstones, abrasive disks, burs)

Smooth alloy surface Smooth alloy surface

( rubber abrasive points, pumice, Silux)( rubber abrasive points, pumice, Silux)

Add lusterAdd luster( rubber abrasive points, fine abrasive paste)( rubber abrasive points, fine abrasive paste)

Polishing is done through application of a Polishing is done through application of a sequence of operations that includes the use of sequence of operations that includes the use of fine stones & abrasive disks or strips.fine stones & abrasive disks or strips.

The final polish is developed by The final polish is developed by the application of extra-fine silexthe application of extra-fine silex Followed by the application of a thin slurry of tin Followed by the application of a thin slurry of tin

oxide, with a rotating soft brushoxide, with a rotating soft brush The restoration should be kept moist to avoid The restoration should be kept moist to avoid

overheatingoverheating

Fast-setting high-copper amalgams can be Fast-setting high-copper amalgams can be polished 8-12 minutes after placement.polished 8-12 minutes after placement. Polishing is done with a creamy paste of extra-fine Polishing is done with a creamy paste of extra-fine

silex & water that is gently applied in an silex & water that is gently applied in an unwebbed rubber cup with a slow-speed handpiece unwebbed rubber cup with a slow-speed handpiece for 30 seconds per surface.for 30 seconds per surface.

Prophylactic pastesProphylactic pastes

Dental prophylaxis – widely used procedure in Dental prophylaxis – widely used procedure in the dental office for removal of exogenous the dental office for removal of exogenous stains, materia alba, & oral debris.stains, materia alba, & oral debris.

CharacteristicsCharacteristics should be sufficiently abrasive to remove should be sufficiently abrasive to remove

effectively all types of accumulation from the effectively all types of accumulation from the tooth surface without imparting undue abrasion to tooth surface without imparting undue abrasion to the enamel, dentin or cementum; cleansing agentthe enamel, dentin or cementum; cleansing agent

Should have the quality of endowing the hard Should have the quality of endowing the hard tissue with a highly polished, esthetic appearance.tissue with a highly polished, esthetic appearance.

compositioncomposition

Sodium fluoride or stannous fluoride either mixed Sodium fluoride or stannous fluoride either mixed with the abrasive or in a more complex, buffered with the abrasive or in a more complex, buffered systemsystem

AbrasivesAbrasives Recrystallized kaoliniteRecrystallized kaolinite Silicon dioxideSilicon dioxide Diatomaceous silicon dioxideDiatomaceous silicon dioxide PumicePumice Sodium-potassium-aluminum silicateSodium-potassium-aluminum silicate Zirconium silicateZirconium silicate

Properties Properties

Predominantly pumice & quartzPredominantly pumice & quartz Higher cleansing values but generally result in greater Higher cleansing values but generally result in greater

abrasion to both enamel & dentin abrasion to both enamel & dentin Coarse pumiceCoarse pumice

Generally the most abrasiveGenerally the most abrasive Silicate abrasivesSilicate abrasives

Zirconium silicate is a particularly effective cleansing & Zirconium silicate is a particularly effective cleansing & polishing agentpolishing agent

Produced higher polishing scores for enamel with lower Produced higher polishing scores for enamel with lower abrasion of enamel abrasion of enamel

Fluoride containingFluoride containing

Abrasion of dentin has been measured to be 5 to 6 Abrasion of dentin has been measured to be 5 to 6 times greater than abrasion of enamel, regardless of times greater than abrasion of enamel, regardless of the product used.the product used.

During a prophylactic procedure, take care to avoid During a prophylactic procedure, take care to avoid excessive abrasion of any restorative material present.excessive abrasion of any restorative material present.

Polymeric materials such as denture base & artificial Polymeric materials such as denture base & artificial tooth resins, laboratory composites, & direct tooth resins, laboratory composites, & direct composites are particularly susceptible to wear composites are particularly susceptible to wear because of their low hardness.because of their low hardness. Result of wear – possible reduction in contours & increased Result of wear – possible reduction in contours & increased

surface roughness, both of which are undesirable.surface roughness, both of which are undesirable.

Dentrifices Dentrifices

Advantages of brushing with a dentrificeAdvantages of brushing with a dentrifice Enhances personal appearance by maintaining Enhances personal appearance by maintaining

cleaner teethcleaner teeth May reduce the incidence of dental cariesMay reduce the incidence of dental caries Help maintain a healthy gingivaHelp maintain a healthy gingiva Reduce the intensity of mouth odorsReduce the intensity of mouth odors

Primary functionPrimary function to clean and polish the surfaces of the teeth to clean and polish the surfaces of the teeth

accessible to a toothbrush.accessible to a toothbrush.

Composition & role of ingredientsComposition & role of ingredients

Primarily in paste & powder formsPrimarily in paste & powder forms Tooth powdersTooth powders

AbrasiveAbrasive A surface-active detergent A surface-active detergent Flavoring oilsFlavoring oils Sweetening agentsSweetening agents WaterWater A humectant (to prevent dehydration)A humectant (to prevent dehydration) A binderA binder A preservativeA preservative fluoridefluoride

Forms of Fluoride – sodium fluoride, sodium Forms of Fluoride – sodium fluoride, sodium monofluorophosphate, stannous fluoridemonofluorophosphate, stannous fluoride Help prevent dental cariesHelp prevent dental caries

Soluble tetrasodium or tetrapotassium Soluble tetrasodium or tetrapotassium pyrophosphates (3.3%)pyrophosphates (3.3%) Reduce the rate of formation of supragingival Reduce the rate of formation of supragingival

calculuscalculus Triclosan (0.3%) & sodium fluoride (0.24%)Triclosan (0.3%) & sodium fluoride (0.24%)

Antiplaque-antigingivitisAntiplaque-antigingivitis

Abrasives Abrasives

Should exhibit a maximum cleansing efficiency with Should exhibit a maximum cleansing efficiency with minimum tooth abrasionminimum tooth abrasion

Should be present to polish the teethShould be present to polish the teeth Silica, calcium carbonate, or anhydrous dibasic Silica, calcium carbonate, or anhydrous dibasic

calcium phosphatecalcium phosphate Whiten / brighten teeth but are harsher agentsWhiten / brighten teeth but are harsher agents

Patients having exposed cementum or dentin should Patients having exposed cementum or dentin should avoid regular use of dentrifice powders or highly avoid regular use of dentrifice powders or highly abrasive pastesabrasive pastes

Polymeric restorative materials are also susceptible to Polymeric restorative materials are also susceptible to abrasion from toothbrush & dentrifice use.abrasion from toothbrush & dentrifice use.

Ingredients that serve to increase the Ingredients that serve to increase the effectiveness of the cleasing & polishing effectiveness of the cleasing & polishing agents / to make the dentrifice more appealing agents / to make the dentrifice more appealing to useto use Surface-active agent ( detergent) – to improve the Surface-active agent ( detergent) – to improve the

wettability of enamel by the dentrifice thereby wettability of enamel by the dentrifice thereby improving contact with enamel by the abrasivesimproving contact with enamel by the abrasives

Flavoring oils & sweetening agents (saccharin) – Flavoring oils & sweetening agents (saccharin) – makes the dentrifice more appealingmakes the dentrifice more appealing

Humectant (sorbitol, propylene glycol, glycerin) – Humectant (sorbitol, propylene glycol, glycerin) – keeps the paste from drying outkeeps the paste from drying out

Binder (sodium alginate) – aids in controlling Binder (sodium alginate) – aids in controlling consistency & keeps the abrasives in suspensionconsistency & keeps the abrasives in suspension

Stabilizer (sodium carboxymethyl cellulose) – Stabilizer (sodium carboxymethyl cellulose) – stabilizes alginate binderstabilizes alginate binder

Foaming agent – added to favor the formation Foaming agent – added to favor the formation of a stable foam when the paste is usedof a stable foam when the paste is used

Effect of toothbrushEffect of toothbrush

When compared with the abrasion of common When compared with the abrasion of common dentrifices, the bristles have little abrasive dentrifices, the bristles have little abrasive power.power.

Properties of bristles such as configuration, Properties of bristles such as configuration, hardness, stiffness & number, generally do not hardness, stiffness & number, generally do not influence abrasion by themselves, though they influence abrasion by themselves, though they do affect the abrasion caused by the dentrifice.do affect the abrasion caused by the dentrifice.

Selection of toothbrush & dentrificeSelection of toothbrush & dentrifice

GuidelinesGuidelines Degree of staining of the dentitionDegree of staining of the dentition Force exerted on the brushForce exerted on the brush Method of brushingMethod of brushing Amount of exposed dentin or cementumAmount of exposed dentin or cementum

Denture cleansersDenture cleansers

2 methods commonly used to remove both 2 methods commonly used to remove both stains & calculusstains & calculus Professional repolishing of the dentureProfessional repolishing of the denture Soaking or brushing of the denture on a daily basis Soaking or brushing of the denture on a daily basis

at homeat home

Requirements Requirements

Non-toxic & easy to remove, leaving no traces Non-toxic & easy to remove, leaving no traces of irritant materialof irritant material

Able to attack or dissolve both the organic & Able to attack or dissolve both the organic & inorganic portions of denture depositsinorganic portions of denture deposits

Harmless to all materials used in the Harmless to all materials used in the construction of dentures construction of dentures

Not harmful to eyes, skin, or clothingNot harmful to eyes, skin, or clothing Stable during storageStable during storage Preferably bactericidal & fungicidalPreferably bactericidal & fungicidal

Types Types

Abrasive creamsAbrasive creams Alkaline hypochloritesAlkaline hypochlorites Alkaline perboratesAlkaline perborates Dilute acidsDilute acids Enzymes Enzymes

Effectiveness Effectiveness

Brushing of a denture surface is an effective Brushing of a denture surface is an effective means of improving denture cleanliness & means of improving denture cleanliness & maintaining a healthy mucosa beneath a maintaining a healthy mucosa beneath a removable denture.removable denture.

Daily overnight immersion of dentures in an Daily overnight immersion of dentures in an alkaline peroxide solution provides a safe & alkaline peroxide solution provides a safe & relatively effective means of cleansingrelatively effective means of cleansing

Recommended techniques & precautionsRecommended techniques & precautions

ImmersionImmersion Solution of 1 part 5% sodium hypochlorite in 3 Solution of 1 part 5% sodium hypochlorite in 3

parts water followed by brushingparts water followed by brushing Solution containing 1 tsp hypochlorite & 2 tsps Solution containing 1 tsp hypochlorite & 2 tsps

glassy phosphate (calgon) in ½ glass waterglassy phosphate (calgon) in ½ glass water Not recommended on prosthetic appliances fabricated Not recommended on prosthetic appliances fabricated

from base metals (Co-Cr) because chlorine solutions from base metals (Co-Cr) because chlorine solutions tend to darken these metalstend to darken these metals

* Never soak dentures in hot water because heat * Never soak dentures in hot water because heat may cause acrylic to become distorted.may cause acrylic to become distorted.

Light brushingLight brushing Avoid brushing with hard, stiff bristlesAvoid brushing with hard, stiff bristles Don’t use dentrifices except those with gentle Don’t use dentrifices except those with gentle

abrasives (acrylic resin, sodium bicarbonate)abrasives (acrylic resin, sodium bicarbonate) Avoid organic solvents (chloroform)Avoid organic solvents (chloroform)

May dissolve or craze an acrylic dentureMay dissolve or craze an acrylic denture

Bleaching Bleaching

19891989 Effective for lightening teeth stained by:Effective for lightening teeth stained by:

FluorosisFluorosis TetracyclineTetracycline Acquired superficial discolorationAcquired superficial discoloration

Composition Composition

Commonly contain 30%-35% hydrogen peroxide that Commonly contain 30%-35% hydrogen peroxide that may be mixed with may be mixed with silica to form a gel silica to form a gel Calcium, phosphate, & fluoride ions to allow Calcium, phosphate, & fluoride ions to allow

remineralization during treatmentremineralization during treatment Home bleachingHome bleaching

10%-22% carbamide peroxide or 1.5% to 6% hydrogen 10%-22% carbamide peroxide or 1.5% to 6% hydrogen peroxideperoxide

pH ranges from 4.6 – 6.7 when diluted; 4.3 – 6.6 when pH ranges from 4.6 – 6.7 when diluted; 4.3 – 6.6 when diluted 1:2 with waterdiluted 1:2 with water

Properties Properties

Primary treatment to improve estheticsPrimary treatment to improve esthetics Effect may last a year & retreatment is simpleEffect may last a year & retreatment is simple Yellow, orange or light brown stains, often Yellow, orange or light brown stains, often

associated with aging, are treated most associated with aging, are treated most successfullysuccessfully

Bonding or veneering should be consideredBonding or veneering should be considered Does not adversely affect gold alloys, Does not adversely affect gold alloys,

amalgam, microfilled composites or porcelainamalgam, microfilled composites or porcelain Should not come into contact with dentinShould not come into contact with dentin

Side effectsSide effects

Tooth hypersensitivityTooth hypersensitivity Soft – tissue lesions / sloughingSoft – tissue lesions / sloughing NauseaNausea Tmj syndrome from the trayTmj syndrome from the tray Sore throats from swallowing the bleachSore throats from swallowing the bleach

Techniques Techniques Home bleachingHome bleaching

Require plaque removal followed by use of a tray of gel for Require plaque removal followed by use of a tray of gel for 3-4 hours once or several times a day3-4 hours once or several times a day

Replenish gel each hourReplenish gel each hour Effectiveness related to the number of hours the tray is Effectiveness related to the number of hours the tray is

wornworn 3 major methods3 major methods

Gels – more conservative; works faster if combined with Gels – more conservative; works faster if combined with light-curing for 10 minuteslight-curing for 10 minutes

Heat & lightHeat & light Typically used as a powerful bleaching light or wand calibrated to Typically used as a powerful bleaching light or wand calibrated to

control bleaching temperaturecontrol bleaching temperature

Universal bleaching guidelinesUniversal bleaching guidelines

Comprehensive clinical examinationComprehensive clinical examination Full-mouth radiographFull-mouth radiograph PhotographsPhotographs Evaluation of existing restorations & pathologic Evaluation of existing restorations & pathologic

conditionsconditions ProphylaxisProphylaxis Rubber damRubber dam Eyewear & glove protectionEyewear & glove protection No anesthesiaNo anesthesia Constant patient monitoringConstant patient monitoring

Additional guidelines for gelsAdditional guidelines for gels

Refrigerate stored 35% hydrogen peroxide Refrigerate stored 35% hydrogen peroxide activatoractivator

Never use anesthesiaNever use anesthesia Never leave patient unattendedNever leave patient unattended Protect patient’s eyesProtect patient’s eyes