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jasonl
Joined: 25 Aug 2005
Posts: 272
Location: Florida
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 Posted: Mon Jan 08, 2007 7:40 am Post subject: buccal problem |
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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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Jason Luchtefeld, DMD, FAGD
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john kanca
Joined: 14 May 2005
Posts: 6346
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| Posted: Mon Jan 08, 2007 9:42 am Post subject: |
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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
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| Posted: Mon Jan 08, 2007 11:38 am Post subject: |
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The dentin was lightly prepped.
Flowable was used. Gradia Lo-Flo shade A2
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Jason Luchtefeld, DMD, FAGD
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john kanca
Joined: 14 May 2005
Posts: 6346
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| Posted: Mon Jan 08, 2007 11:48 am Post subject: |
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What kind of light?
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jasonl
Joined: 25 Aug 2005
Posts: 272
Location: Florida
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| Posted: Mon Jan 08, 2007 1:26 pm Post subject: |
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optilux 501
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Jason Luchtefeld, DMD, FAGD
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john kanca
Joined: 14 May 2005
Posts: 6346
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| Posted: Mon Jan 08, 2007 2:24 pm Post subject: |
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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? 
Are you drying the prep thoroughly after the alcohol step?
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jasonl
Joined: 25 Aug 2005
Posts: 272
Location: Florida
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| Posted: Mon Jan 08, 2007 2:34 pm Post subject: |
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| 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?
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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Jason Luchtefeld, DMD, FAGD
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john kanca
Joined: 14 May 2005
Posts: 6346
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| Posted: Mon Jan 08, 2007 2:49 pm Post subject: |
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You are placing the material just as in the video?
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jasonl
Joined: 25 Aug 2005
Posts: 272
Location: Florida
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| Posted: Mon Jan 08, 2007 3:39 pm Post subject: |
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to the best of my ability.
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john kanca
Joined: 14 May 2005
Posts: 6346
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| Posted: Mon Jan 08, 2007 4:25 pm Post subject: |
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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
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| Posted: Mon Jan 08, 2007 4:30 pm Post subject: |
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| 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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Jason Luchtefeld, DMD, FAGD
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bj
Joined: 15 May 2005
Posts: 320
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| Posted: Mon Jan 08, 2007 9:26 pm Post subject: |
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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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