Transcript air-powder polishing

AIR-POWDER
POLISHING
Darby pages: 447-451
Fundamentals of Periodontal
Instrumentation pages: 610-611
USE OF AIR-POWDER
POLISHING
A. Requires less time and ergonomically favorable to the
clinician and generates no heat
B. Sodium bicarbonate is less abrasive than traditional
prophylaxis pastes, which makes the air-powder polisher
ideal for stain and biofilm removal.
C. Removal of heavy, tenacious tobacco stain and
chlorhexidine-induced staining
D. Stain and biofilm removal from orthodontically banded
and bracketed teeth and dental implants
E. Prior to bonding procedures
F. Root detoxification for periodontally diseased roots
Chlorhexidine Stain
Tobacco stain
Air Polishing
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A method of stain removal that uses a
specially designed device with a handpiece
that delivers a spray of warm water and
sodium bicarbonate under pressure
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Requires less time and less operator fatigue
Effects on enamel, cementum and dentin
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Enamel is not damaged – air polishing may
be the least damaging and most efficient
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Prolonged use on cementum and dentin can
remove significant tooth structure and should
be avoided
Effects on soft tissues
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Gingival bleeding and abrasion are most
common effects
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Temporary, healing occurs quickly
Not clinically significant
Salty taste
Restorations
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Clinicians should avoid extended use of air
polishing on all restorative dental materials
Implants
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Research not in- avoid at this time
Safety Issues
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Patient: absorption of the sodium bicarbonate
Respiratory difficulties from inhaling aerosols
Stinging of lips
Eye problems
DHCP: PPE’s, high-volume evacuator,
aerosol reduction device, pre-procedural
rinse
Medical Contraindications
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Low-sodium diet or history of hypertension
Respiratory illness
Infectious disease
Renal insufficiency
Addison’s disease
Cushing’s disease
Metabolic aldalosis
Medications such as mineralocorticoid steroids,
antidiuretics, or potassium supplements
Technique
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Dangers of Incorrect Nozzle Angulation
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Never direct at the soft tissues of the cheeks, lips,
gingival margin, or tongue.
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Could result in severe tissue sloughing
Never angle the powder spray directly into the
sulcus or pocket
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Could result in subcutaneous facial emphysema = a
sudden unilateral swelling of the face, head, or neck
because of the presence of air in the connective tissue.
Technique
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Distance from tooth: 3-4 mm
Adaptation for anterior teeth: 60 degree angle
Adaptation for Posterior Teeth: 80 degree
angle
Adaptation of occlusal surfaces: 90 degree
angle to the occlusal surfaces
TECHNIQUE
For Posterior Teeth
For Anterior Teeth
For Occlusal Surfaces
Aerosol Control
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Aerosol reduction can be significantly
reduced by:
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Correct positioning of the nozzle tip
Use of high-velocity evacuation
Correct patient positioning
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45 degree recline for most tooth surfaces
Supine for lingual surfaces on the maxillary arch
Correct patient head position
Tissue cupping
Stain Management Procedures
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Human Need for a wholesome facial image
Identify the cause of the stain
When stains are intrinsic bleaching is a viable
alternative
OTC products
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Whitening toothpastes
may have peroxide or titanium
dioxide
Commercial bleaching kits
Contraindications to Tooth Bleaching
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Pregnancy
Breastfeeding
Allergy to any of the ingredients
Cervical erosion
Large, defective restorations
Gingival periodontal or mucosal conditions that could be irritated
by use of a bleaching tray or rubberdam
Recession
Enamel cracks
Toothsensitivity
Caries
Home bleaching with professionally
supplied products
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Custom-fitted tray and bleaching agent
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Nightguard vital bleaching
Oxidizing agent – 10 - 22% carbamide peroxide
Yellow – brown responds better than blue – gray
Tetracycline – stained may become worse
Restorations don’t change color
Most common side effects are mild thermal toothe
sensitivity and gingival irritation
In-Office Bleaching
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Vital tooth bleaching is bleaching of a tooth
with a vital pulp
Nonvital tooth bleaching is bleaching of an
endodontically treated tooth
Rubber dam, etching, heat source
ADA approved: Starbrite In-Office Bleaching
Gel and Superoxyl (both 35% hydrogen
peroxide)
DH role
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Provide education
Determine etiology of stains, allergies to products
Assess for contraindications
Assess for tooth sensitivity
Evaluate the translucency of the teeth
Assess gingival recession
Assist in setting realistic expectations with shade guide, IOC
Assess the presence of cracks
Remove calculus and extrinsic stains
Take impressions and fabricate custom trays
Provide in-office bleaching