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What to do now?
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balboa



Joined: 02 Nov 2009
Posts: 5

PostPosted: Mon Nov 09, 2009 5:19 pm    Post subject: What to do now? Reply with quote

#19-MO resin was done 2 weeks ago with Easy Bond. Nothing remarkable about the filling, it was moderate to large size, over 2/3rds occlusal width Pt reported biting pain ever since it was done. I switched to Surpass since then so I decided to redo the resin with Surpass. One week later and pt still has biting sensitivity to the tooth. I checked all excursives today and adjusted. She is now coming back this PM because tooth is very sensitive where I adjusted.

I'm kind of frustrated with this tooth because her dad is freaking hounding me thinking we did something wrong. He has also coached in the NFL for the last 20 years and has a "I will dominate you" personality.
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Tue Nov 10, 2009 7:22 am    Post subject: Reply with quote

Have you checked all excursions for prematurities- including protrusive?

Did you have her grind heavily?

What kind of light are you using?

How deep was it? Is there any chance that there was an exposure?

What kind of sensitivity specifically is there?

What was in there before?
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balboa



Joined: 02 Nov 2009
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PostPosted: Tue Nov 10, 2009 9:08 am    Post subject: Reply with quote

Pt came back in yesterday afternoon. She stated that it was sensitive to breathing in and biting. I douched the tooth in Surpass 2 and it helped fixed the breathing in problem!!! I associate the breathing in sensitivity to my adjustments on enamel that was made earlier in the day. Still perplexed with the biting issue. Is that something that resolves? Or is it a bonding issue?

We are using LED Demetron

Pretreatment was a leaking resin with decay.

Bite stick sensitive on cusps and filling. On closing.

How long can I expect the Surpass 2 desensitization to last?
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Tue Nov 10, 2009 12:09 pm    Post subject: Reply with quote

Are you certain you removed all of the old composite from the pulpal floor? It's really hard to see it. I try to dry the area and look with magnification for any remnants of old composite. If composite is not well bonded to the pulpal floor it'll move slightly during chewing and the pt will feel it. I don't know if, when you leave some that's not well bonded and then bond over it with new composite if that'll be sufficient to keep the old stuff from moving, but I doubt it. JK will know.
Best of luck - Tom Mitchell
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balboa



Joined: 02 Nov 2009
Posts: 5

PostPosted: Tue Nov 10, 2009 12:52 pm    Post subject: Reply with quote

That's been my big issue as well, making sure all the old resin is out. Does it make a difference if I leave a little bit?

Last week I was removing another resin I placed with Easy Bond to rebond with Surpass and while trying to remove all of the flowable from the pulpal floor I exposed the freaking MB pulp horn!

I then used Kanca's protocol the best I could. Instead of Durelon I used Vitrebond. Pt is still coming back with discomfort this week. I assume RCT now.

I've used Easy Bond for 2 years with minimal sensitivity. This last month I've had a rash of redo's. I also recently noticed that the Easy Bond single dose packets have a lot less material in them. They use to last for several fillings, these days I was lucky to have enough for 2 teeth. Hence, the change to Surpass.

Fillings are looking 100x better with Surpass then with Easy Bond. No more white lines and cosmetically just look better. Maybe it's my imagination.
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Tue Nov 10, 2009 1:08 pm    Post subject: Reply with quote

Well, I believe you gotta get it all out for no other reason than, as you found out, you don't know what's under it. JK will say there's times not to look under because of the pulp exposure, but still I want to know if that's there since lots of those teeth need endo AFTER you place your new filling with the uncovered old exposure, so you know who is responsible in the pt's eye. I know JK will address this.
Best of Luck - Tom Mitchell
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Ekrause



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

PostPosted: Tue Nov 10, 2009 1:21 pm    Post subject: Reply with quote

If you placed vitrebond on the pulp, no wonder the patient is experiencing discomfort. GI is extremely toxic to the pulpal cells. GI is very hygroscopic (sucks up water from the pulp), like putting Cavit in a vital tooth.

It says right in the IFU, that it's contraindicated for direct pulp caps.
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balboa



Joined: 02 Nov 2009
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PostPosted: Tue Nov 10, 2009 2:21 pm    Post subject: Reply with quote

I have two separate pt's I'm talking about now. And primarly want to keep it to the 1st pt.

1st original pt and post - #19 MO done with Easy Bond, then redid with Surpass, still bite sensitive.

2nd pt - just happen to come up in my post - Bite sensitive with Easy Bond, while trying to remove all resin from pulpal floor, there was a pinpoint pulp horn exposure. Then I placed Vitrebond which I find out now is contraindicated. Then Surpass and resins.

1st pt - I will call tonight to see if taking tooth out of excursions helped.

2nd pt - I will schedule for RCT since her pulp is probably mummy dust by now.
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john kanca



Joined: 14 May 2005
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PostPosted: Tue Nov 10, 2009 4:22 pm    Post subject: Reply with quote

Quote:
Bite stick sensitive on cusps and filling. On closing.


Cracked tooth syndrome.

Full coverage indicated with possible endo.
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balboa



Joined: 02 Nov 2009
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PostPosted: Tue Nov 10, 2009 4:31 pm    Post subject: Reply with quote

I assumed that it was a bonding issue since the CTS symptoms started after I did the resin. No symptoms of CTS before the resin was done.
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john kanca



Joined: 14 May 2005
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PostPosted: Tue Nov 10, 2009 6:16 pm    Post subject: Reply with quote

balboa wrote:
I have two separate pt's I'm talking about now. And primarly want to keep it to the 1st pt.

1st original pt and post - #19 MO done with Easy Bond, then redid with Surpass, still bite sensitive.

2nd pt - just happen to come up in my post - Bite sensitive with Easy Bond, while trying to remove all resin from pulpal floor, there was a pinpoint pulp horn exposure. Then I placed Vitrebond which I find out now is contraindicated. Then Surpass and resins.

1st pt - I will call tonight to see if taking tooth out of excursions helped.

2nd pt - I will schedule for RCT since her pulp is probably mummy dust by now.


If you want, get the patient back in, re-open it, put some Durelon over the exposure and re-close it.
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priior



Joined: 10 Feb 2009
Posts: 345

PostPosted: Tue Nov 10, 2009 11:09 pm    Post subject: Reply with quote

a few questions (to everyone):

for patient #1: (cracked tooth symdorme)
what would you guys think of redoing the resin and covering the cusps with resin as an interim (or final?) procedure.. while pulp response is being assessed.

if so, how would you design the prep? would you do an occlusal bevel that ends at the buccal and lingual? a mini chamfer? or a butt joint prep (a la flat cerecs) with a bevel on the buccal and lingual surfaces?


balboa: for patient #2:
check out this thread: http://www.apexdentalmaterials.com/bb/viewtopic.php?t=2199

i just saw her earlier today, and still cold testing vital.
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Wed Nov 11, 2009 7:50 am    Post subject: Reply with quote

balboa wrote:
That's been my big issue as well, making sure all the old resin is out. Does it make a difference if I leave a little bit?

Last week I was removing another resin I placed with Easy Bond to rebond with Surpass and while trying to remove all of the flowable from the pulpal floor I exposed the freaking MB pulp horn!

I then used Kanca's protocol the best I could. Instead of Durelon I used Vitrebond. Pt is still coming back with discomfort this week. I assume RCT now.

I've used Easy Bond for 2 years with minimal sensitivity. This last month I've had a rash of redo's. I also recently noticed that the Easy Bond single dose packets have a lot less material in them. They use to last for several fillings, these days I was lucky to have enough for 2 teeth. Hence, the change to Surpass.

Fillings are looking 100x better with Surpass then with Easy Bond. No more white lines and cosmetically just look better. Maybe it's my imagination.


Most definitely not your imagination!
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john kanca



Joined: 14 May 2005
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PostPosted: Wed Nov 11, 2009 7:53 am    Post subject: Reply with quote

twmdds wrote:
Well, I believe you gotta get it all out for no other reason than, as you found out, you don't know what's under it. JK will say there's times not to look under because of the pulp exposure, but still I want to know if that's there since lots of those teeth need endo AFTER you place your new filling with the uncovered old exposure, so you know who is responsible in the pt's eye. I know JK will address this.
Best of Luck - Tom Mitchell


It's always been my opinion that a non-exposure is better than an exposure if it can be helped. A small amount of caries-affected tissue won't matter if the prep is well-sealed. This does need to be documented and explained. Patients will always choose the chance not to have endo.
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john kanca



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PostPosted: Fri Nov 13, 2009 8:37 am    Post subject: Re: What to do now? Reply with quote

balboa wrote:
#19-MO resin was done 2 weeks ago with Easy Bond. Nothing remarkable about the filling, it was moderate to large size, over 2/3rds occlusal width Pt reported biting pain ever since it was done. I switched to Surpass since then so I decided to redo the resin with Surpass. One week later and pt still has biting sensitivity to the tooth. I checked all excursives today and adjusted. She is now coming back this PM because tooth is very sensitive where I adjusted.

I'm kind of frustrated with this tooth because her dad is freaking hounding me thinking we did something wrong. He has also coached in the NFL for the last 20 years and has a "I will dominate you" personality.


Did you use a Tooth Slooth to determine if the pain is coming from the restoration or the tooth structure?
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