Apex Information Exchange

[ChrisJordanDDS]

My protocol (all intraoral steps with Isolite isolation):
1.) interface intaglio of crown, air dry
2.) optibond solo + intaglio of crown, air dry and cure
3.) etch enamel and dentin for 20 seconds, thoroughly rinse with water and lightly dry (I start the timer as I begin placing the etch on the ring of enamel, and it continues as I begin to place it on the dentin, so I estimate that the dentin is usually only etched about 15 seconds)
4.) apply optibond solo + to prep, thoroughly air dry and cure
5.) apply Anchor cement and seat crown, allow to self cure for two minutes, clean excess and light cure 20 seconds from all surfaces

Normally the above protocol works well for me. However on a couple of occasions recently I've had persistent post op sensitivity to biting/chewing. Occlusion and all excursive contacts have been reduced, so I'm confident its not an occlusal or parafunctional issue.

THe only variables I can think of would be:
-over-etching (although I actually have my assistant set a timer and rinse after the time allotted)
-over drying after etching
-over drying after applying the optibond solo +
-insufficient curing of the Anchor (although this is a dual cure product, so that shouldn't be an issue, right?)

Any input or suggestions would be welcome. BTW, the preps in which I have had the recent post-op sensitivity to biting were not near the pulp.

THANKS!

[john kanca]

3.) etch enamel and dentin for 20 seconds, thoroughly rinse with water and lightly dry (I start the timer as I begin placing the etch on the ring of enamel, and it continues as I begin to place it on the dentin, so I estimate that the dentin is usually only etched about 15 seconds)

Don't dry at all. Use a cotton pellet the size of the cavity to mop up the excess water and leave the prep visibly moist. Etch everything for 15 seconds minimum. It won't matter if etch times goes to 20-30 seconds.

4.) apply optibond solo + to prep, thoroughly air dry and cure

Sure it's ours, but consider Surpass! It's less sensitive to loss of bond strength when thinned than is Solo and is just plain easier to place than what you're using now. It's not any cheaper.
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[ChrisJordanDDS]

Thanks for your reply, Dr. Kanca. Could any of the above protocol be responsible for the type of sensitivity that I've described?

[john kanca]

The "dry gently" part is a killer.

That's what got you.
_________________
"You need me on that wall."


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[andyhoe]

Jordan,

I used to use total etch & Optibond-s. I switched to Surpass because it was less "technique sensitive". With my previous technique, I worried about over/under etching, leaving the dentin moist but not too wet or dry, and thinning the adhesive without over-thinning it. Surpass technique is way less "twitchy" and I highly recommend it.

[Carney_2]

Nice post!