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Simplicity and Pulp capping
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john kanca



Joined: 14 May 2005
Posts: 6342

PostPosted: Mon Sep 05, 2005 2:28 pm    Post subject: Simplicity and Pulp capping Reply with quote

Small exposure, not really bleeding:

make believe it's not there, and bond it over.

Small amount of bleeding:

Stem bleeding with 3% NaOCl on cotton pellet, rinse and dry, then seal.

Larger exposure:

Stem bleeding. Cover with carboxylate cement (Durelon). Mix as normal and apply to exposure. Wait for it to set thoroughly, then apply Simplicity as usual.
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spruster



Joined: 28 May 2005
Posts: 23
Location: akron,ohio

PostPosted: Mon Sep 05, 2005 6:34 pm    Post subject: Reply with quote

kiitos john (thanks in finn)


quick question. how often are you seeing bleeding from sim 1 on small exposures. if this happens, i'm assuming you should start all over. but for discussion, lets say one places sim 1 on a small (<1mm) exposure sees no bleeding until sim 1 is placed, immediately places sim2 by exact protocol and then sees no bleeding and a clean shiny surface with no visible red on the dentin after cure. is one doomed?[/b]
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Mon Sep 05, 2005 7:41 pm    Post subject: Reply with quote

JK,

what is the ratio of water to bleach to get 3%?
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Rich (cool kid) Rosenblatt
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john kanca



Joined: 14 May 2005
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PostPosted: Mon Sep 05, 2005 7:59 pm    Post subject: Reply with quote

spruster wrote:
kiitos john (thanks in finn)


quick question. how often are you seeing bleeding from sim 1 on small exposures. if this happens, i'm assuming you should start all over. but for discussion, lets say one places sim 1 on a small (<1mm) exposure sees no bleeding until sim 1 is placed, immediately places sim2 by exact protocol and then sees no bleeding and a clean shiny surface with no visible red on the dentin after cure. is one doomed?[/b]


I would rinse it and start over, but it ought NOT happen because Sim 1 does a nice job of hemostasis all by itself! Cool
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john kanca



Joined: 14 May 2005
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PostPosted: Mon Sep 05, 2005 7:59 pm    Post subject: Reply with quote

cool kid wrote:
JK,

what is the ratio of water to bleach to get 3%?


3 parts NaOCl in the bottle : 2 parts distilled water
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scottie



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

PostPosted: Fri Sep 09, 2005 12:25 am    Post subject: Reply with quote

John thanks for this info which I was trying to get on the DT thread about not getting exposures. Is it critical to use 3%hypo? I've been using chlorox straight from the container which is, I think, 5%.
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john kanca



Joined: 14 May 2005
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PostPosted: Fri Sep 09, 2005 12:41 am    Post subject: Reply with quote

5 percent will work but 3 percent is in the literature. Scottie, this is the place to come for information. Wink
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scottie



Joined: 21 May 2005
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PostPosted: Fri Sep 09, 2005 1:01 am    Post subject: Reply with quote

I'm a believer. Thanks John.
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Gerry



Joined: 13 May 2005
Posts: 448
Location: Tarrytown NY

PostPosted: Fri Sep 09, 2005 10:47 am    Post subject: Reply with quote

Just checked my Clorox bottle. Says it's 6% NaOCl. We've been diluting 1:1

Ultradent's ChloroCid is 3% straight from the syringe.

Vista makes 5.25%

Pool supply Co = 20-30%
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john kanca



Joined: 14 May 2005
Posts: 6342

PostPosted: Fri Sep 09, 2005 5:09 pm    Post subject: Reply with quote

Gerry wrote:
Just checked my Clorox bottle. Says it's 6% NaOCl. We've been diluting 1:1

Ultradent's ChloroCid is 3% straight from the syringe.

Vista makes 5.25%

Pool supply Co = 20-30%


In the past it's been 5.25%
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bj



Joined: 15 May 2005
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PostPosted: Fri Sep 09, 2005 10:18 pm    Post subject: Reply with quote

"5 percent will work but 3 percent is in the literature."

They advised 3% over 5% or just used 3% in the studies?
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bj



Joined: 15 May 2005
Posts: 320

PostPosted: Fri Sep 09, 2005 10:29 pm    Post subject: Reply with quote

"Small exposure, not really bleeding:
make believe it's not there, and bond it over.
Small amount of bleeding:
Stem bleeding with 3% NaOCl on cotton pellet, rinse and dry, then seal.
Larger exposure:
Stem bleeding. Cover with carboxylate cement (Durelon). Mix as normal and apply to exposure. Wait for it to set thoroughly, then apply Simplicity as usual."

1- In all the above, we perform the step "alcohol+ wash off the alcohol" as the 1st step when it comes time to use the Sim?

2- Durelon is the choice material, are any materials acceptable? And your comments on them if so?

3- re Larger exposure, at what point do you say, "endo for sure"? And do you anticipate that changing as you learn over the years that you are getting a superior seal w Sim & related products?

Thank you
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Gerry



Joined: 13 May 2005
Posts: 448
Location: Tarrytown NY

PostPosted: Sat Sep 10, 2005 7:23 am    Post subject: Reply with quote

I judge by the condition of the pulp rather than size of exposure. It there is apparently healthy, non-hemorrhagic, tissue that has not been overly abused, I explain the circumstances to the patient and ask if they want me to do the endo immediately or give a pulp cap a chance. Amazing - very few say "Sure I'd love to have a root canal rght now!" I've done many pulp caps that are doing fine after many many years! If endo becomes necessary the patient s are quite thankful that I at least gave a more conservative treatment a chance.
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Sat Sep 10, 2005 7:35 am    Post subject: Reply with quote

gerry,

This is exactly what I do. I tell them that if they want to help pad my childrens college funs, I'd be glad to do the endo/build up and crown but if it were my mom/wife etc sitting in the chair, I would definitely try the restoration first and see how the tooth responds. Pretty much all my patients have the same reactions:
1) shocked by my honesty
2) happy for the choice of conservative tx with the understanding that if there is pain afterward( due to irreversible pulpitis and not normal post op or a high filling) I will fit them into my schedule ASAP, do the endo and credit them everything that they paid for the filling towards the endo so they don't have to pay twice. They are thrilled at this since it is basically a no lose situation for them. (helps me sleep at night also)
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Gerry



Joined: 13 May 2005
Posts: 448
Location: Tarrytown NY

PostPosted: Sat Sep 10, 2005 8:03 am    Post subject: Reply with quote

Rich:

Nice to know there are still some of us who think of the needs of the patients before the financial desires of our own! One reason I no longer frequent DT. Too many are interested in early retirement rather than the poor patients entrusting care into their hands

About sleeping nights - A few months ago I was playing in a bridge tournament and a pedodontinst (crummy player) came to my table wiht a stupid smile and said "Isn't dentistry wonderful! Every time a kid come in with a flopping baby tooth I flick it out with my finger and charge $95!." My partner - non dental - ask "How do you sleep at night?!" His reply "In a big house". Disgusting!!
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