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He's having post-op sensitivity. Thoughts?

 
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Tue Nov 11, 2008 8:52 am    Post subject: He's having post-op sensitivity. Thoughts? Reply with quote

After finish prepping, rinse prep to get "gunk" out
etch enamel outline only, leave on for 10 sec
rinse off for 5 sec
lightly air dry
apply ibond, agitate for 20 sec w/microbrush
blow off excess w/air, leave shiny film
cure 20 sec
pack heated tetric ceram composite in increments- always less than 2mm
filling prox box first if a class II (fill it in increments)
covering floor in small increments if a class I
cure each increment for 10 sec
adjust occlusion w/carbide football bur
polish w/enhance cup
cure for another 10 sec.

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Ekrause



Joined: 11 May 2005
Posts: 782
Location: I'm here now.

PostPosted: Tue Nov 11, 2008 1:32 pm    Post subject: Reply with quote

Blow off excess I(can't)Bond leaving a light shiny film.


a 2mm layer of heated hybrid in the proximal box as a first layer is a recipe for disaster.
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Tue Nov 11, 2008 4:16 pm    Post subject: Re: He's having post-op sensitivity. Thoughts? Reply with quote

john kanca wrote:
After finish prepping, rinse prep to get "gunk" out
[i]etch enamel outline only, leave on for 10 sec
Unless you do something to "condition"/etch the dentin how can you get a good bond to dentin? Then whenever the pt chews the composite will "move" vis a vis hurt.rinse off for 5 sec
lightly air dry Another sensitivity creater - drying at the wrong time
apply ibond, agitate for 20 sec w/microbrush
blow off excess w/air, leave shiny film
cure 20 sec
pack heated tetric ceram composite That oughta help too in increments- always less than 2mm
filling prox box first if a class II (fill it in increments)
covering floor in small increments if a class I
cure each increment for 10 sec
adjust occlusion w/carbide football bur
polish w/enhance cup
cure for another 10 sec.[/i]



Tom
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scottie



Joined: 21 May 2005
Posts: 360
Location: Albuquerque NM

PostPosted: Wed Nov 12, 2008 8:35 pm    Post subject: Reply with quote

I'm not sure what he did wrong.
The instructions with iBond say that it will etch enamel and dentin, so etching the enamel with phosphoric acid may not have been necessary. But he only did it for 10 seconds so how would that harm anything?
He didn't use flowable but he used warmed composite, so presumably that would flow better. He also did not seal the finished restoration.
I think if he is having sensitivity then he has got some gaps between the comp and the tooth.
Never have this problem using the Apex products the way we do.
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Wed Nov 12, 2008 10:23 pm    Post subject: Reply with quote

scottie wrote:
I'm not sure what he did wrong.
The instructions with iBond say that it will etch enamel and dentin, so etching the enamel with phosphoric acid may not have been necessary. But he only did it for 10 seconds so how would that harm anything?
He didn't use flowable but he used warmed composite, so presumably that would flow better. He also did not seal the finished restoration.
I think if he is having sensitivity then he has got some gaps between the comp and the tooth.
Never have this problem using the Apex products the way we do.


Honestly, the real problem is the adhesive.

Somewhere along the way these materials have to be dried well, and this just allow for that. Etching the enamel was the right thing to do here.
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