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Let's discuss this! III.

 
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Sun May 29, 2005 9:35 am    Post subject: Let's discuss this! III. Reply with quote

"Over the years, I recall that patients are more likely to have post -op symptoms on teeth that have had a restoration missing for weeks or months.With that in mind what is recommended to cleanse a tooth that is caries free, but has had a considerable amount of dentin exposed to the oral environment. Would you remove additional tooth structure prior to restoring with composite?"


Accurate observation!

Who knows why? Question
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bj



Joined: 15 May 2005
Posts: 320

PostPosted: Sun May 29, 2005 11:25 pm    Post subject: Reply with quote

Over the years, I recall that patients are more likely to have post -op symptoms on teeth that have had a restoration missing for weeks or months.
I NEVER FOUND THAT. SEVERAL MONTHS PERHAPS BUT NOT WEEKS. SEVERAL MONTHS MOST LIKELY BECAUSE ANYONE WHO DOESN'T GET A LOST FILLING FIXED WILL LIKELY WAIT TILL IT HURTS ANYWAYS (HURTS FROM THE ADVANCED DECAY, NOT YOUR COMPOSITE, OR ELSE ALL OF THEM WOULD HURT ) & IS ALSO LIKELY TO TELL YOU THERE IS NO PREOP PAIN BECAUSE THEY WISH THERE WASN'T ( SO WHY NOW, 5MONTHS LATER ARE YOU ALL THE SUDDEN INSPIRED TO SEEK CARE- BECAUSE ITS STARTING TO HURT)
With that in mind what is recommended to cleanse a tooth that is caries free, but has had a considerable amount of dentin exposed to the oral environment.
NOW THAT I AM A SIM USER, ISOPROPYL ALCOHOL. PRIOR TO SIM I USED BLEACH PRIOR TO ALL BONDING & THE ONLY TEETH THAT WERE SENS NEEDED ENDO FROM GROSS PULPAL INVOLVEMENT. BTW JK, ALCOHOL IS PRETTY COMPATIBLE W THE SIM. DID YOU TRY BLEACH? HECK, I AM ALL FOR ALCOHOL OVER BLEACH SINCE BLEACH RUNS THE RISK OF MAKING A MESS SO WE ALL HANDLE IT LIKE NUCLEAR WASTE. I CAN'T BELIEVE ALCOHOL DOES A SUPERIOR JOB THAN BLEACH BUT CLEARLY ALCOHOL IS ADEQUET. I KIND BASE MY LOVE OF BLEACH W GOOD SUCCESS RECORD & THAT ENDOD DON'T USE IT ( BUT I KNOW THE OTHER GOOD PROPERTIES THAT MAKE BLEACH DESIRABLE IN ENDO). BUT IF YOU BEEN DIRECT ULP CAPPING W ALCOHOL & SIM, I'M GLAD TO DITCH THE BLEACH
Would you remove additional tooth structure prior to restoring with composite?"
YES, GET FRESH DENTIN FOR IDEAL BONDING, THE SAME REASON YOU FRESHEN A NONCARIOUS CLASS V.
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Mon May 30, 2005 8:43 am    Post subject: Reply with quote

Over the years, I recall that patients are more likely to have post -op symptoms on teeth that have had a restoration missing for weeks or months.
I NEVER FOUND THAT. SEVERAL MONTHS PERHAPS BUT NOT WEEKS. SEVERAL MONTHS MOST LIKELY BECAUSE ANYONE WHO DOESN'T GET A LOST FILLING FIXED WILL LIKELY WAIT TILL IT HURTS ANYWAYS (HURTS FROM THE ADVANCED DECAY, NOT YOUR COMPOSITE, OR ELSE ALL OF THEM WOULD HURT ) & IS ALSO LIKELY TO TELL YOU THERE IS NO PREOP PAIN BECAUSE THEY WISH THERE WASN'T ( SO WHY NOW, 5MONTHS LATER ARE YOU ALL THE SUDDEN INSPIRED TO SEEK CARE- BECAUSE ITS STARTING TO HURT)
With that in mind what is recommended to cleanse a tooth that is caries free, but has had a considerable amount of dentin exposed to the oral environment.
NOW THAT I AM A SIM USER, ISOPROPYL ALCOHOL. PRIOR TO SIM I USED BLEACH PRIOR TO ALL BONDING & THE ONLY TEETH THAT WERE SENS NEEDED ENDO FROM GROSS PULPAL INVOLVEMENT. BTW JK, ALCOHOL IS PRETTY COMPATIBLE W THE SIM. DID YOU TRY BLEACH? HECK, I AM ALL FOR ALCOHOL OVER BLEACH SINCE BLEACH RUNS THE RISK OF MAKING A MESS SO WE ALL HANDLE IT LIKE NUCLEAR WASTE. I CAN'T BELIEVE ALCOHOL DOES A SUPERIOR JOB THAN BLEACH BUT CLEARLY ALCOHOL IS ADEQUET. I KIND BASE MY LOVE OF BLEACH W GOOD SUCCESS RECORD & THAT ENDOD DON'T USE IT ( BUT I KNOW THE OTHER GOOD PROPERTIES THAT MAKE BLEACH DESIRABLE IN ENDO). BUT IF YOU BEEN DIRECT ULP CAPPING W ALCOHOL & SIM, I'M GLAD TO DITCH THE BLEACH

WE'RE ALL FRIENDS HERE, BJ, NO NEED TO YELL! Wink

Would you remove additional tooth structure prior to restoring with composite?"

I sure would.


YES, GET FRESH DENTIN FOR IDEAL BONDING, THE SAME REASON YOU FRESHEN A NONCARIOUS CLASS V.

It's not just that. The dentin under an old amalgam is very different from that in class V type areas. Dentin in unrestored class V areas is awful to try to bond. Dentin under old amalgams is easy. I tried an experiment to reproduce the surface seen in "abfraction/abrasion" areas and bond strengths go WAY down.
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pablo



Joined: 19 May 2005
Posts: 64

PostPosted: Mon May 30, 2005 11:05 am    Post subject: Reply with quote

I have seen patients with fractured cusps and exposed dentin that has been that way for months without sensitivity. When I restore these teeth I always remove some dentin, clean with isopropyl alcohol and restore. I don't recall any post op sensitivity.

rEGARDS,

pAUL
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DrDan



Joined: 11 May 2005
Posts: 160
Location: Longwood, FL

PostPosted: Mon May 30, 2005 11:31 am    Post subject: Re: Let's discuss this! III. Reply with quote

john kanca wrote:
"Over the years, I recall that patients are more likely to have post -op symptoms on teeth that have had a restoration missing for weeks or months.With that in mind what is recommended to cleanse a tooth that is caries free, but has had a considerable amount of dentin exposed to the oral environment. Would you remove additional tooth structure prior to restoring with composite?"


Accurate observation!

Who knows why? Question


No one else will bite so I'll take a stab at it. I would suppose that if the dentinal tubules were to be exposed for a lengthy amount of time that it would be very likely for quite a colony of bacteria to enter these tubules...and over time could migrate into the pulp chamber.....causing inflammation to begin with....putting the tooth at risk. By prepping away some of the exposed dentin you're hopefully removing the largest portion of these bacteria as well as providing a better surface on which to bond.

Pure speculation on my part...

Dan Smile
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Mon May 30, 2005 1:14 pm    Post subject: Reply with quote

Right, Dan. Anything left open can become bacterially-involved. The symptoms can remain hidden until the tooth is sealed up. It is fortuitous when teeth in these conditions do not blow up but the risk of that happening is real.
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bj



Joined: 15 May 2005
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PostPosted: Mon May 30, 2005 7:50 pm    Post subject: Reply with quote

No yelling intended. Sorry if it came across that way. Just used all caps to distinguish authors. I'll use bold hereafter[/b]
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john kanca



Joined: 14 May 2005
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PostPosted: Mon May 30, 2005 8:18 pm    Post subject: Reply with quote

bj wrote:
No yelling intended. Sorry if it came across that way. Just used all caps to distinguish authors. I'll use bold hereafter[/b]


NO PROBLEM! Wink Laughing
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rajeev2003



Joined: 14 May 2005
Posts: 57
Location: WETHERSFIELD, CT

PostPosted: Tue May 31, 2005 12:41 am    Post subject: Reply with quote

John, your question reminded me of the time i kept myself from getting screwed royally.
Pt wanted multiple incisal composites for severe dentinal exposure at incisal edges of lower ants....the kind that look very,very hollowed out with a rim of tall chipped enamel .
You could literally see a dot of pulpal tissue thru the thinned dentine...dead center of the hollowed incisal .....like a small red blotch.
Patient had long term cold sensitivity and newly developing heat sensitivity.
Informed pt that rct was a better choice before the fill as post restorative inflamation exacerbation was a distinct possibility.
Patient did not want the rct's and did not want to sign consent form stating rct was discussed before any attempted composite restorations.
So i refused treating sans consent and he went elsewhere.
Three days after getting his incisal composites,he came back in severe pain in 2 of 5 ants restored.He now had diffuse pain on biting,heat,an acute continuous throb relieved with motrin 600mg for decreasing time periods,excruciating sensitivity to cold air/touch.
He was happy after the rct's.
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DrDan



Joined: 11 May 2005
Posts: 160
Location: Longwood, FL

PostPosted: Tue May 31, 2005 5:47 am    Post subject: Reply with quote

Rajeev,
He should have listened to you to begin with!

Dan Smile
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Tue May 31, 2005 8:02 am    Post subject: Reply with quote

John, your question reminded me of the time i kept myself from getting screwed royally.
Pt wanted multiple incisal composites for severe dentinal exposure at incisal edges of lower ants....the kind that look very,very hollowed out with a rim of tall chipped enamel .
You could literally see a dot of pulpal tissue thru the thinned dentine...dead center of the hollowed incisal .....like a small red blotch.
Patient had long term cold sensitivity and newly developing heat sensitivity.

Symptoms of irreversbile pulpitis!

Informed pt that rct was a better choice before the fill as post restorative inflamation exacerbation was a distinct possibility.
Patient did not want the rct's and did not want to sign consent form stating rct was discussed before any attempted composite restorations.
So i refused treating sans consent and he went elsewhere.
Three days after getting his incisal composites,he came back in severe pain in 2 of 5 ants restored.He now had diffuse pain on biting,heat,an acute continuous throb relieved with motrin 600mg for decreasing time periods,excruciating sensitivity to cold air/touch.
He was happy after the rct's.
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