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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Mon May 16, 2005 7:00 pm    Post subject: Let's discuss this! Reply with quote

Here is my sequence. Patient came with chipped DL cusp on #3. Tooth vital, no big amalgams. I explain that it could be broken more and the best way to subside sensitivity is to make full coverage restoration/ onlay. Patient is asking for some other option and I told her that it can be done in composite but also have said that she might still feel the sensitivity. Because of $ reasons patient decide to go for composite filling.

After examiining the tooth I don't see any propagation of cracks, just broken cusp.
I did DOL Kerr Premise in dry field of course, in two/three increments and my assistant did light after each for 40 sec. After removing the matrix one more for 40 sec. Contact was established, restoration was finished with white stone and polished with Enhance system.

After 5 days, patient is calling the office with words that she went to another doc in neighborhood and he said that SHE needs crown and "might" need RCT in near future. Reason given "filling is not set-up enough", as evidence he showed to patient the intra oral pic that shows "gap in between filling and tooth".

There were no caries, patient broke the cusp mechanically by biting on pop corn kernel. Now my question is how did other doc determined that "filling wasn't set-up enough"??

OK- your thoughts. We can use this as a teaching case.
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Mark J Fleming DDS



Joined: 11 May 2005
Posts: 736
Location: Sarasota, FL

PostPosted: Mon May 16, 2005 7:17 pm    Post subject: Reply with quote

No pulse cure-seeing white line"gap". Other dentist still out of line, especially saying it will require RCTx. Another question, why did patient end up in another office? Cool
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john kanca



Joined: 14 May 2005
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PostPosted: Mon May 16, 2005 7:18 pm    Post subject: Reply with quote

Very good question but there's more.
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Mark J Fleming DDS



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Location: Sarasota, FL

PostPosted: Mon May 16, 2005 7:24 pm    Post subject: Reply with quote

Other dentist placed cavity detect, curing caused enamel cracking, staining junture, therefore filling did not set. Am I warm? Cool
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john kanca



Joined: 14 May 2005
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PostPosted: Mon May 16, 2005 7:30 pm    Post subject: Reply with quote

Mark J Fleming DDS wrote:
Other dentist placed cavity detect, curing caused enamel cracking, staining junture, therefore filling did not set. Am I warm? Cool


How could anything not set when it was "lighted" for 40 seconds per layer?


Someone even describing that procedure as "lighting" really hurts my head.
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Mark J Fleming DDS



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Location: Sarasota, FL

PostPosted: Mon May 16, 2005 7:36 pm    Post subject: Reply with quote

john kanca wrote:
Mark J Fleming DDS wrote:
Other dentist placed cavity detect, curing caused enamel cracking, staining junture, therefore filling did not set. Am I warm? Cool


How could anything not set when it was "lighted" for 40 seconds per layer?


Someone even describing that procedure as "lighting" really hurts my head.


Bad light!
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Mark J Fleming DDS



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PostPosted: Mon May 16, 2005 7:36 pm    Post subject: Reply with quote

Rather -bad bulb!
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john kanca



Joined: 14 May 2005
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PostPosted: Mon May 16, 2005 7:37 pm    Post subject: Reply with quote

Since it wasn't mentioned, I wonder if a bonding system was even used. Razz
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john kanca



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PostPosted: Mon May 16, 2005 7:38 pm    Post subject: Reply with quote

Mark J Fleming DDS wrote:
Rather -bad bulb!


Possible, but if it wasn't noticed right away it was probably enough to harden the composite reasonably- especially after 40 seconds.
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Mark J Fleming DDS



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PostPosted: Mon May 16, 2005 7:39 pm    Post subject: Reply with quote

john kanca wrote:
Since it wasn't mentioned, I wonder if a bonding system was even used. Razz


AHHHHHHH!!!!!!!!!!!!!!!! Shocked Cool
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Mon May 16, 2005 9:10 pm    Post subject: can you describe the method of pulse curing to me Reply with quote

Mark J Fleming DDS wrote:
No pulse cure-seeing white line"gap". Other dentist still out of line, especially saying it will require RCTx. Another question, why did patient end up in another office? Cool



I have 2 kinds of lights. the apollo bad ass light and the work horse optilux light. I assume one can not pulse cure with the apollo type light, but what exactly do I need to do to "pulse cure" my restoration. is there a setting on the light(my optilux) it is in the time that the light is on the increment. please explain to me so I can make sure I'm maximizing my technique PULEEZ!!! Confused
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john kanca



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PostPosted: Mon May 16, 2005 9:16 pm    Post subject: Reply with quote

Get out your meter and determine the distance you need to hold it over the tooth to give you about 600 mW/cm2.
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cool kid



Joined: 12 May 2005
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PostPosted: Mon May 16, 2005 9:22 pm    Post subject: Reply with quote

john kanca wrote:
Get out your meter and determine the distance you need to hold it over the tooth to give you about 600 mW/cm2.


now I have to get a meter. Kanca, your killin me here! Laughing Once i determine this, then what?
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Howardmg



Joined: 11 May 2005
Posts: 455
Location: Bethlehem, PA.

PostPosted: Mon May 16, 2005 9:26 pm    Post subject: Reply with quote

John- this brings up a subject that I wanted you to give me the lastest on.
Curing.
The local cont. ed group brought in Belvedere last week. As I'm sure you know, he puts everything in at once, bonding agent, flowable and the full bulk of composite, and then takes two lights, and cures through the tooth, buccal and lingual, at the same time. No light on the occlusal.
Would you comment on this and tell me the curing protocol that you recommend?
Thanks...Howard
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Howard M. Goldstein DMD.
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www.exceldentalcare.com
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john kanca



Joined: 14 May 2005
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PostPosted: Mon May 16, 2005 9:43 pm    Post subject: Reply with quote

Howardmg wrote:
John- this brings up a subject that I wanted you to give me the lastest on.
Curing.
The local cont. ed group brought in Belvedere last week. As I'm sure you know, he puts everything in at once, bonding agent, flowable and the full bulk of composite, and then takes two lights, and cures through the tooth, buccal and lingual, at the same time. No light on the occlusal.
Would you comment on this and tell me the curing protocol that you recommend?
Thanks...Howard


The literature is clear - bulk filling is far less desirable than incremental. Paul's techniques leave the middle of the restoration nearly liquid.

Adhesive: 10 seconds
Flowable: 20 seconds
Each 2 mm increment: 10 seconds
Top layer: Pulse
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