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Polishing Amalgam Restorations

Polishing Amalgam Restorations

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Published by: tristiarina on Oct 31, 2013
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Polishing Amalgam Restorations

 A properly contoured, polished restoration will contribute to the longevity of the restoration and the health of the surrounding periodontium.

 Whether or not it is necessary to finish and polish an amalgam restoration remains to some a controversial subject. Some dentists will argue that correctly carved amalgam does not require any more manipulation. Despite the argument, there remain some very valid reasons to carefully finish the margins, smooth the surfaces, and polish the restoration. An amalgam restoration that will contribute to the longterm dental health of a patient requires proper finishing and polishing procedures.

 Finishing amalgam restorations involves removing marginal irregularities, defining anatomical contours, and smoothing the surface roughness of the restoration.  Polishing is performed to obtain a smooth, shiny luster on the surface of the amalgam.

Why amalgam restorations should be polished:  Prevention of recurrent decay  Prevention of deterioration of the amalgam surface  Maintenance of periodontal health  Prevention of occlusal problems .

and the restoration is easier to clean.Prevention of recurrent decay  After carving is completed. Finishing and polishing amalgam restorations result in a smooth. Plaque and debris collection are reduced. the surface of the amalgam is still somewhat rough and the margins are not as smooth as they could be. lustrous finish and margins. .

and thus is less likely to develop a tarnished appearance. which may encourage galvanic action on the surface.  Corrosion is a destructive attack on both the surface and subsurface of the restoration. .  A smooth. polished surface is less likely to accumulate acids. and debris. plaque.Prevention of amalgam deterioration  Tarnish is a discoloration on the surface of the amalgam.

A slightly under contoured restoration is less of a potential problem because it is less likely to interfere with the patient’s ability to clean the area. . The bulky contour may interfere with the patient’s ability to cleanse the area. An over contoured surface presents an area that quickly collects and harbors plaque. resulting in irritation.Maintenance of periodontal health  Restorations that are improperly contoured contribute to periodontal breakdown.

With the use of specific instruments. Recontouring. finishing. and polishing provide an opportunity to correct discrepancies in the anatomical contours of the restoration. the contours of the amalgam can be altered. and the health of the adjacent tissues can be preserved if recontouring and finishing procedures are accomplished within a reasonable timeframe. .

. which can lead to several problems. The tooth may exhibit pain or sensitivity. In more severe cases. a restoration may be left in premature occlusion.Prevention of occlusal problems  Occasionally. the restoration or the opposing tooth may fracture. This problem can be corrected during the recontouring process. especially during mastication.

. All of the previous reasons for performing finishing and polishing procedures lead to an increased serviceable lifetime of the restoration.

 An amalgam restoration is not considered complete until it is polished . The finishing and polishing procedures should not be initiated on an amalgam restoration until the amalgam has reached its final set. at least 24 hours after it has been placed and carved.

.  All margins can be contoured to be flush with the cavosurface margin of the cavity preparation.The criteria for serviceable amalgams that indicate polishing include:  No fractures in the restoration  Proximal contact is present in Class II restorations when tooth position makes it possible.  The anatomy can be maintained or improved.  The occlusion can be maintained or improved.

Restorations that are contraindicated for polishing include:  Restorations with gross overhangs that need to be replaced  Restorations in teeth to be extracted or crowned  Restorations with recurrent decay that need to be replaced .

it indicates there is an excess of amalgam which needs to be removed.Flashing  An excess of amalgam which extends over the cavosurface margin of the cavity preparation.  If the tip of the explorer catches when moving from tooth structure to amalgam but not from amalgam to tooth. .

 If the explorer tip catches going from amalgam to tooth structure. but not from tooth to amalgam. it indicates there is inadequate amalgam at the margin. preventing the margin of the cavity preparation from being flush. .Ditching  A deficiency of amalgam along the margin.

Open Margin  If the tip of the explorer catches in both directions across the margin. it indicates there is an open margin and the amalgam should probably be replaced. .

and smoothing the amalgam surface. .  Finishing procedures are completed prior to polishing and require abrasive agents that are coarse enough to remove the bulk from the surface. defining the anatomy. removal of marginal discrepancies.Finishing  Finishing the restoration involves contouring.

Polishing  Polishing enhances the quality of the restoration by producing the smoothest and shiniest surface possible.  Polishing procedures require more mildly abrasive materials for smoothing and shining the amalgam surface. . One which will offer better resistance to corrosion and tarnish.

the surface of the restoration passes through various stages.Abrasive changes  An abrasive changes the surface of the tooth by frictional grinding. etc. scraping. to remove irregularities. As this process proceeds from coarse abrasion (finishing) to very fine abrasion (polishing). scratching. . rubbing.

which is regarded as the polished surface and. 4. will appear as a high shine. To a finely scratched surface which is much smoother and better reflects light. . And finally a finely scratched surface.Stages: 1. From an irregular surface. to the human eye. To a grooved surface. 3. 2.

 It is extremely important to use abrasive agents in the order of decreasing coarseness. . The fine abrasive agents will not remove the large. The likelihood of achieving a high shine with a mirror-like finish is decreased if very coarse abrasive agents are immediately followed by fine abrasive agents. concluding with the least abrasive material. deep scratches left by the coarse abrasive agents.

Different abrasives vary considerably in their hardness and shape. of rougher shape. shape. size. and concentration of abrasive material. Factors determining the abrasiveness or polishing potential of an agent include its hardness. Within the same abrasive sizes are graded from coarse to fine. increased particle size. With abrasive compounds that are harder. . or high concentration. abrasiveness is increased.

As such. and extra fine varieties. fine. size and shape. both garnet disks and cuttle disks are available in coarse. . However. garnet is more abrasive than cuttle because of its hardness. a coarse garnet disk will remove many more irregularities than will the coarse cuttle disk. medium. For example.

the greater the friction which results in the production of heat. Additional factors which relate to abrasiveness must also be considered. . The greater the pressure or speed used while applying the abrasive. These include the pressure and speed used to apply the abrasive material.

The creation of heat during the polishing procedure is potentially dangerous. 1. cloudy surface. Heat can cause thermal damage to the pulp (and pain to the patient!). and a surface that is more susceptible to corrosion . 2. Heat brings the mercury to the surface of the restoration which results in a dull.

High speeds increase friction and thus generate more heat. Heavy or prolonged pressure generates heat.  Use slow to moderate speed with rotary instruments. intermittent pressure with rotary instruments lifting the instrument off of the restoration frequently. .To minimize heat production:  Use light. Increase speed only to produce the final high shine.

. Some abrasive materials (pumice and tin oxide) can be mixed with water or alcohol to help lubricate and cool the agents.  Use compressed air directed at the amalgam surface during polishing. Use abrasive agents that are wet rather than dry.

.Precautions 1. 3. Prevent damage to the patient’s soft tissues. Protect the patient from polishing debris. 2. Do not weaken the restoration by improper contouring. 4. Maintain functional anatomy by using polishing instruments in the prescribed manner.

2.Maintain functional anatomy  To prevent loss of anatomy: 1. Use short overlapping strokes 4. 3. Start all rotary instruments just prior to touching the restoration. or by ditching or grooving the restoration. by removing the contact. .  Do not destroy functional anatomy by flattening cusps or marginal ridges. Use each polishing instrument on the surface it was designed for. Keep instruments moving over the surface.

Prevent damage to patient’s soft tissue  To avoid accidentally “slipping” off the tooth always: 1. cheek. and lips during the procedure. Position instruments so they will not abrade or lacerate gingival tissues while polishing. 4. . 3. 2. Retract the tongue. Use a secure grasp and stable fulcrum with all instruments. Rinse all abrasive agents out of sulcus area and mouth after polishing.

 Prevent potential damage always: 1. . 3. 2. Offer the patient safety glasses or have the patient close their eyes. Do not carry or pass instruments and materials over the patient’s face. Vacuum up all the materials as they accumulate.Protect patient from debris.

Limiting the number of instruments will keep the technique simple and will contribute to speed and efficiency in performing the procedure.Instruments  There is a wide variety of instruments available for recontouring. finishing. . and polishing amalgam restorations.

disks. The choice of abrasive stones. the adaptability to the tooth surface. disks. and the amount of amalgam to be removed. and burs is dependent upon the size of the restoration. and finishing burs.Rotary Instruments  The most commonly used rotary instruments are abrasive stone. .

. round or a variety of other shapes.  Since the green stone is harder than enamel. care must be taken not to scratch the tooth surface.Green stones  Available as tapered points pear shape.  They are fast cutting and produce a moderately rough surface.

 Finishing burs should be operated in the burnishing direction rather than cutting direction. . and their number of blades greater. If it grabs or catches it is in the cutting direction. their sizes smaller.Finishing burs  Differ from cutting burs in that their blades are finer.

or lingual surfaces.  Use of a medium grit disk is always followed by the application of a finer grit disk which cuts less.  Available in a variety of sizes and grits.Finishing disks  Disks are used primarily on the proximal. buccal. .

 Finishing strips are used to smooth the gingival margin and interproximal surfaces below the contact area of a Class II restoration. .Hand Instruments  The cleoid end of a discoid-cleoid hand instrument is often used to smooth the base of the grooves and/or fossae when a smaller bur cannot reach the depth of them.

Polishing Agents  Pumice and tin oxide are two commonly used polishing agents. . Greenies.  Other polishing agents are available in the form of abrasive-impregnated rubber points and cups. and Super Greenies. They are to be used in the following order: Brownies.

Review the Procedure with the Patient. how you are going to do it. what it will do for them. . and when you are finished.  Patients should be carefully educated about the value of the polish procedure. show them the polished restoration. Explain to your patients why you are doing this.

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