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buccal problem

 
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 7:40 am    Post subject: buccal problem Reply with quote

I've had a chronic problem on one patient with teeth 28, 29, 30.

I've tried Sim with gradia
Sim with tetric
Surpass with tetric (on one of them)
Before Christmas I had to replace all three.

This time I thought, I'm really going to get it this time.

I prepped each one to get fresh enamel.
I scrubbed with alcohol.
Sim 1
Sim 2
air
Sim 2
air
cure
layers of Gradia lo flo (flowable composite).

I then adjusted occlusion so she is not hitting on excursives or inclines of the teeth.

I just received a call that one has come out....

Thoughts?

Suggestions?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jan 08, 2007 9:42 am    Post subject: Reply with quote

What have you done with the dentin?

Are you using a flowable?
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 11:38 am    Post subject: Reply with quote

The dentin was lightly prepped.

Flowable was used. Gradia Lo-Flo shade A2
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jan 08, 2007 11:48 am    Post subject: Reply with quote

What kind of light?
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 1:26 pm    Post subject: Reply with quote

optilux 501
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jan 08, 2007 2:24 pm    Post subject: Reply with quote

Have you checked it recently?

Any chance the tip is slimed over?

Who does the placement of the adhesive and insertion of the composite and all?

Want me to come down and place them for you? Razz

Are you drying the prep thoroughly after the alcohol step?
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 2:34 pm    Post subject: Reply with quote

john kanca wrote:
Have you checked it recently?

Any chance the tip is slimed over?

Who does the placement of the adhesive and insertion of the composite and all?

Want me to come down and place them for you? Razz

Are you drying the prep thoroughly after the alcohol step?



1. it has a built in meter. It registers 700mW/cm2....but diminishes to 650 over the course of 10 seconds.

2. I don't think so but I'll check.

3. I place adhesive and composite.

4. I would love that...can I watch?

5. Yes - rinse and dry.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jan 08, 2007 2:49 pm    Post subject: Reply with quote

You are placing the material just as in the video?
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 3:39 pm    Post subject: Reply with quote

to the best of my ability.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jan 08, 2007 4:25 pm    Post subject: Reply with quote

I guess my impression is that the dentin needs to be prepped more than it was. The recurrent problems suggest that, presuming all else is in order, the substrate itself offers the difficulty.

I like to use a coarser diamond to roughen the dentin up.

Failing that, I punch it out 'til it falls over.

Don't forget to make yourself a finish line cervically and bevel the enamel.
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jasonl



Joined: 25 Aug 2005
Posts: 272
Location: Florida

PostPosted: Mon Jan 08, 2007 4:30 pm    Post subject: Reply with quote

john kanca wrote:
I guess my impression is that the dentin needs to be prepped more than it was. The recurrent problems suggest that, presuming all else is in order, the substrate itself offers the difficulty.

I like to use a coarser diamond to roughen the dentin up.

Failing that, I punch it out 'til it falls over.

Don't forget to make yourself a finish line cervically and bevel the enamel.


It's getting to the point where I wonder if a crown is a viable option. The tooth has an MO and this large buccal area.

I will try prepping more aggressively with a diamond and see if that helps. Poor girl probably thinks I'm a p***-poor dentist at this point.....
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bj



Joined: 15 May 2005
Posts: 320

PostPosted: Mon Jan 08, 2007 9:26 pm    Post subject: Reply with quote

Occlusion/parafunction, need a nightguard?

No seep of fluids from the gingiva, right.
Most likely occlusion or else all your buccalls would be failing.
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