Featured Article

The first two articles in this series, “Introduction to Oral Oxidative Stress,” and “Oral Oxidative Stress, Antioxidants and Wound Healing,” described the basic science of oxidative stress, antioxidants, and their influence on wound healing. Here, the focus will be on the use of antioxidants in restorative dentistry.

The use of metal in fillings, braces, implants, bridges, and other prosthodontic restorations is common in practice1. Zinc and copper released from gold alloys and nickel released from nickel-chromium alloys can have a highly cytotoxic effect on fibroblast cell cultures. The use of pure antioxidants can counteract the detrimental effects by increasing cell viability and DNA synthesis and decreasing reactive oxygen species (ROS).

I recommend the use of PerioSciences AO products in restorative dentistry for the following:

  • Pre-treatment
  • During treatment
  • Post-treatment


Pre-treatment use of antioxidants assists in establishing ideal gingival health before beginning restorative treatment. I recommend the following regime:

  • Brush with AO ProToothpaste – Sensitive, 2-3 times per day
  • Floss daily
  • AO ProRinse Natural mouthwash, two times per day
  • Apply AO ProVantage Gel to the area to be treated, three times per day for 4-8 weeks

This regime optimizes periodontal health because the essential oils in the mouthwash (menthol and thymol) have an anti-plaque and anti-gingivitis effect without damaging tissue cells and the antioxidants (phloretin and ferulic acid) have beneficial effects on the functional mechanisms that regulate fibroblast migration and proliferation during gingival healing or periodontic repair.

Establishing ideal gingival health before beginning the restorative process decreases gingival inflammation. It promotes a decrease in gingival bleeding during clinical restorative procedures that manipulate the tissue.

During treatment

During treatment I recommend the following:

  • Brush with AO Pro Toothpaste – Sensitive, 2-3 times per day
  • AO ProRinse Natural mouthwash, two times per day
  • Apply AO ProVantage Gel to the tissue around the prepared and impressed teeth, 3-5 times per day while provisional restorations are on the teeth.

This regime can help return irritated tissue to a healthy state by reducing inflammation. Chlorhexidine is often used for its antibacterial effect, but its poor taste and staining of the provisionals may decrease patient compliance.

As described in my previous article, chlorhexidine can have a detrimental effect on cell migration and long-term cell survival, even in diluted concentrations.

Immediate post-treatment and maintenance

After treatment, I encourage patients to use the following regime:

  • Brush 2-3 times per day with AO ProToothpaste – Sensitive
  • AO ProRinse Natural once daily
  • AO ProVantage Gel applied to the area around the restorations 3-5 times per day for 1-2 weeks, then continue by applying at bedtime for maintenance.

All these products can be purchased by the patient online at Amazon.com, Dermstore.com, or dentists can purchase and resell to their patients from PerioSciences.

By following this regime, I have found significant improvement in patient oral health in restorative procedures, which may influence oral soft tissue and make treatment more predictable.

Robert Winter, D.D.S., is a member of Spear Resident Faculty.


  1. San Miguel SM, Opperman LA, Allen EP, Zielinski JE, Svoboda KK. Antioxidant combinations protect oral fibroblasts against metal-induced toxicity. Archives of Oral Biology. 2012;58(3):299-310.