Air Polishing Around Restorations

For clinicians who prefer to use air-powder polishing systems, some studies show that air polishing may be more effective at plaque and stain removal than polishing with rotating cups and abrasive pastes.^28,29 In comparison, Chowdhary and Mohan found that polishing with a rubber cup was more effective than air polishing for smoothing and debris removal.³³ Air polishing is also effective when preparing teeth for sealants. However, air polishing should be avoided once sealants have been placed.³¹ Care should be taken when using air polishers near restorations. An in vitro study using bovine mandibular incisors found that air-powder polishing devices created larger marginal gaps in Class V restorations than when prophylaxis was performed with a rubber cup and pumice powder.³⁰

Traditionally, sodium bicarbonate powders have been used for air-powder polishing devices.³¹ However, there are additional powders available for use with air polishers. These include glycine, calcium sodium phosphosilicate, calcium carbonate and aluminum trihyrdoxide powders.^19,31 These new powders have the added benefit of containing very little or no sodium, which is beneficial for patients on sodium-restricted diets.³¹ Clinicians should be familiar with the properties of each agent and understand the manufacturers’ respective recommendations.³¹ For example, due to the surface alterations that were observed visually and with a Scanning Electron Microscope, aluminum trihydroxide powder should be avoided on resin composites, resin-modified composites and around the margins of cemented restorations.⁴ In general, dental clinicians should avoid the use of air polishers on composite restorations.¹ However, glycine-based powders were found to create fewer defects on restorative material and tooth structures³¹ and may be preferable for that reason.