8 September, 2026After dental restoration with crowns, many people believe that their teeth are now “immune” to oral diseases and will remain durable and aesthetically pleasing for a long time. In reality, the longevity of dental restorations depends not only on the quality of the materials and the dentist’s expertise, but also on how they are cared for and cleaned throughout their use.
Undergoing dental restoration does not make you immune to oral diseases. – Photo: Courtesy of the doctor.
It is important to note that although the ceramic material itself can be highly durable, the gingival tissue and the finishing line between the crown and the natural tooth remain areas that are prone to plaque accumulation. When biofilm (a bacterial film) is not properly controlled, patients may develop gingivitis, bleeding gums, bad breath, gingival recession, caries at the restoration margin, or periodontal disease.
Therefore, biofilm can affect the health of the tissues surrounding the teeth as well as the longevity of the restoration.
In modern dentistry, particularly when cleaning around dental crowns or implants, glycine, erythritol, or sodium bicarbonate powders are preferred because their particle sizes are much smaller, making them less abrasive and safer for tooth surfaces, restorations, and gingival tissues.
Although ultrasonic tips can also partially disrupt biofilm through vibration and the cavitation effect created by the water flow, this is not the optimal method for completely removing the thin layer of biofilm covering restoration surfaces, especially in areas with complex contours such as crown margins, occlusal surfaces, or around implants (artificial tooth roots).
Bacterial biofilm – the primary causative factor of inflammation in gingival tissues around restorations
Biofilm is a bacterial film that can firmly adhere to the surfaces of teeth, ceramic restorations, or implants. Numerous studies in modern periodontology have shown that biofilm is the causative factor of inflammation, while dental calculus is a retention factor that promotes biofilm accumulation. This is also the current perspective of the European Federation of Periodontology as well as the American Academy of Periodontology.
If biofilm is removed regularly, the risk of gingival inflammation is significantly reduced. Conversely, even when dental calculus has been completely removed, if biofilm remains on the restoration surface, inflammation may continue. If this persists, it may progress to periodontitis or peri-implant inflammation.
It is important to note that plaque begins to reform shortly after cleaning and continues to mature if it is not properly controlled. Therefore, if patients do not control plaque daily, or if professional cleaning does not effectively remove biofilm from restoration surfaces, inflammation can quickly recur even after dental calculus has been removed.
Why should you not rely solely on ultrasonic tips for routine dental calculus removal?
The rough surface of dental calculus creates favorable conditions for bacterial adhesion and makes daily oral hygiene more difficult. Therefore, dental calculus is not the direct cause of inflammation but acts as a retention factor for biofilm.
For this reason, professional dental cleaning is still essential, but the ultimate goal is not merely to remove calcified deposits; it is to reduce the amount of disease-causing biofilm. Consequently, the modern approach to periodontal care and restoration maintenance no longer focuses solely on “scaling,” but instead emphasizes regular, effective, and minimally invasive biofilm control.
Ultrasonic scaling devices operate at high-frequency vibrations to break up hard, calcified deposits. This method is highly effective for firmly attached dental calculus.
The greater the surface roughness, the greater the ability of bacteria to adhere, making restorations more susceptible to discoloration, plaque accumulation, and gingival inflammation.
Air Flow (air-polishing technology) combined with ultrasonic scaling – a comprehensive cleaning technology prioritized for ceramic restorations.
However, this does not mean that ultrasonic tips should be eliminated. Ultrasonic instruments remain an important tool for removing hard dental calculus when indicated. Dentists need to select the appropriate tip, adjust the power level accordingly, and combine it with less invasive cleaning methods.
Air Flow is a system that uses a mixture of compressed air, water, and very fine powder particles to clean biofilm, soft plaque, and stains from tooth surfaces. When this mixture is sprayed onto the tooth surface at an appropriate angle and distance, millions of very small powder particles collide with the biofilm layer.
The energy generated by these powder particles is sufficient to disrupt the structure of the extracellular matrix, weakening the adhesion between the biofilm and the tooth surface as well as between the bacteria themselves. At the same time, the continuous flow of water washes away the disrupted biofilm fragments from the restoration surface.
An ultrasonic scaler operates using high-frequency vibrations to break down hardened tartar deposits – Illustrative image.
If the patient has a significant amount of hard subgingival calculus, the dentist still needs to use ultrasonic instruments or hand instruments to remove these calcified deposits. This approach enables effective cleaning while minimizing the risk of damaging the restoration surface.
Therefore, modern maintenance protocols generally involve a combination of methods. Proper care of ceramic restorations is not only intended to maintain aesthetics, but more importantly, to protect the gingival tissues, abutment teeth, and restoration margins. Biofilm control should be performed daily at home and combined with regular professional cleaning according to each patient’s individual risk level.
Air Flow with an appropriate powder can help remove biofilm and stains. Ultrasonic instruments or hand instruments remain necessary in areas with hard dental calculus. Using the appropriate combination of methods enables effective cleaning, minimizes unnecessary effects on restoration surfaces, and contributes to maintaining treatment outcomes over the long term.
Prof. Dr. Võ Trương Như Ngọc
Source: Tuổi Trẻ Newspaper: https://tuoitre.vn/ve-sinh-rang-su-dung-cach-de-sau-phuc-hinh-rang-dam-bao-ben-dep-lau-dai-100260831145917403.htm?gidzl=-Dte6Oie417nmEiSYZuP4_p8v1cHFHP1vfwuJvO-GaUtox5Bp3rCHEdDvHkORXqMxCwnIJX3niewYICK5m#content-1
