The care and maintenance of direct resin restorations: what your patients and hygienists need to know

June 26, 2011
Dr. Ron Jackson shares the letter he gives to his patients when they receive new composite resin restorations or veneers, plus some maintenance tips to share with their hygienists to ensure maximum beauty and longevity of the cosmetic dentistry.
By Ron Jackson, DDSPatient instructions for the care of direct resin restorations/veneersFrom the office of Dr. Ron JacksonDear Patient:Congratulations! You have just received the most up-to-date, state-of-the-art composite resin restoration or veneer dentistry has to offer.Your cosmetic enhancement has been accomplished with the following materials: ___________________To ensure maximum beauty and longevity, a few points should be mentioned:1. Brush with an ultra-soft toothbrush at least two times a day. Floss at least once a day, preferably before bedtime. 2. Although it is possible for direct composite resin materials to pick up surface stains from foods, it is usually less than that seen on natural teeth. As with natural teeth, staining will be less if you avoid or reduce exposure to tobacco, coffee, tea, soy sauce, curry, colas, grape juice, blueberries, or red wine. Brush and floss normally. Do not use baking soda or any abrasive toothpaste. NOTE: Composite resin restorations or veneers rarely need polishing at appointments with your hygienist. If you see a hygienist other than ours, you have been given special instructions to give the hygienist. You may need to remind her of where your restorations/veneers are and that she should follow the special instructions regarding maintenance.3. Do not rinse routinely with mouthwashes that contain alcohol. Alcohol can soften bonded composite resin. If mouthwash is desired, select a non-alcohol-containing mouthwash such as Breath Rx or Rembrandt.4. Sodium fluoride is the only home fluoride that should be used. Stannous fluoride or acidulated phosphate fluoride are not recommended for composite resin bonding or porcelain. ACT is a sodium fluoride rinse and can be recommended for home use.5. Habits such as opening packages with your teeth, biting thread, chewing ice, nail biting, or pipe smoking should be avoided. Avoid direct biting into ribs, bones, hard candy, nuts, or hard bread and rolls. This puts stress on the material and could result in a fracture. Be aware that certain foods such as spare ribs, corn on the cob, carrots, and apples can also put added stress on bonded teeth. Eat with care in order to avoid chipping. Most kinds of sandwiches are not a problem.6. If a chip or a fracture does occur, the veneer can usually be renewed using the same material. It is a short appointment and the fee is similar to that of a restoration for a front tooth.7. How long bonding lasts depends on many things. It's a lot like getting a new set of tires. How long they last depends on the quality of the tire, how well it was made, the type of road surfaces traveled, the way you drive, and how many miles you drive in a year. In the same manner, longevity of your veneers depends on your habits and how much stress is placed on the front teeth. With prudence and proper care, current composite materials last a long time.8. Since your cosmetic bonding is accomplished in a single office visit, your teeth will feel different to your lips and tongue when you first close your mouth. This is normal and to be expected when changes have been made to the shape and size of the teeth. Sometimes your speech may change or be affected in the beginning until your tongue adapts to the changes. Even though the changes are slight, (measurable only in millimeters), your mouth is extremely sensitive and will exaggerate those feelings at first. Usually after a couple of days, the feelings lessen and your mouth will feel normal again. Maintenance instructions for direct resin restorations for the hygienistFrom the office of Dr. Ron JacksonDear Hygienist:The following are suggestions to maintain these restorations for maximum longevity and appearance.1. Do not use sonic scalers around margins of esthetic restorations — composite or ceramic.2. Current composite and ceramic materials stain very rarely; in fact, less than natural teeth. If there is no stain present on the restoration or veneers, leave them alone. Do not use any prophy paste.3. If stain is present, the doctor should see it and advise if one of the following pastes may be used:
  • Proxyt Fine by Ivoclar
  • Prisma Gloss Extra Fine by Dentsply Caulk

Polish with very light pressure.

4. If one of the above pastes is used to remove stain, repolish the surface to an enamel luster using the Astropol (Ivoclar/Vivadent) High Polish (Pink) Cup or Disc with copious water, rotating from tooth structure to material at medium/high speed. Use a feather light touch. Follow this step with a silicone carbide impregnated brush such as the Astrobrush (Ivoclar) or Jiffy Brush (Ultradent). Use dry with feather light touch at medium/high speed.

5. If no stain present but the composite surface is matte in finish, regain the enamel luster by using the Astropol High Polish (Pink) Cup or Disc with copious water, rotating from tooth structure to material at medium/high speed. Use a feather light touch. Follow this step with a silicone carbide impregnated brush such as the Astrobrush or Jiffy Brush. Use dry with feather light touch at medium/high speed.

6. If fluoride is to be applied, do not use acidulated phosphate fluoride (APF) or stannous fluoride. Only neutral sodium fluoride (NSF) should be used.

Author bio
Dr. Ron Jackson is a 1972 graduate of West Virginia University School of Dentistry. He is a fellow in the American Academy of Cosmetic Dentistry, a fellow in the Academy of General Dentistry, and director of the Mastering Dynamic Adhesion and Composite Artistry programs at the Las Vegas Institute for Advanced Dental Studies. Dr. Jackson practices comprehensive restorative and cosmetic dentistry in Middleburg, Va. He can be reached at (540) 687-8075 or by email at [email protected].