Years ago the majority of our porcelain restorations were completed with layered powder liquid ceramics to create the esthetics. Today because of our new monolithic materials with improved esthetic and strength, a large portion of restorations are simply stained and glazed. This stain is used to create the incisal and interproximal appearance of translucency and cervical chroma gradient.
A question to ask is how this external layer of stain and glaze will endure in the mouth. Restorations are subjected to abrasion from food and toothpastes. Many of our patients eat a highly acidic diet. We add to this by using prophy paste, prophy jet’s and ultrasonic scalers at their hygiene visits. So what do we need to know and tell our patients about the longevity of the esthetics of their restorations?
This surface layer will change over time, it is a fact. How quickly the change will occur and will it be clinically visible is the challenge to predict. The answer will be different for every patient, but generally dental ceramics have been shown to be very stable over time. Normal toothbrushing and the use of OTC toothpaste has not been shown to have a significant impact on the extrinsic stain or surface glaze of the porcelain over an extended period of years (1). I routinely recommend prescription toothpaste for our post restorative patients so they get the benefit of high fluoride to prevent recurrent decay and it also has the advantage of low abrasiveness. During routine hygiene visits we utilize a low abrasive polishing paste, Proxyt from Ivoclar, on our patients with ceramic restorations to reduce the wear and tear on the surface integrity.
A high concentration of acid in the mouth can have a negative impact on the surface of the ceramics. Be cautious that you are using neutral sodium fluoride products in your office and as home prescriptions, if this is part of your caries protocol, the acidulated versions are proven to be hard on the surface of porcelain. If you are concerned about the amount of acid in a patient’s mouth from diet, GERD or vomiting discuss this with them. We follow the same recommendations we give patients who show evidence of erosion on their natural teeth
Lastly, be realistic with your patients about the lifespan of their dentistry. It does not serve our patients, the relationship or us if unrealistic expectations are set. Nothing we do lasts forever, it all has a lifespan and will need maintenance or replacement at that time. Given the information currently available I am not overly concerned about the loss of surface glaze and stain in my practice.
1) K. J. ANUSAVICE, DEGRADABILITY OF DENTAL CERAMICS, Adv Dent Res 6:82-89, September, 1992,