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direct pulp cap

 
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rich



Joined: 30 Apr 2007
Posts: 22

PostPosted: Tue Nov 20, 2007 5:13 pm    Post subject: direct pulp cap Reply with quote

Is there any contraindications or unsuccessful results that you know of using glass ionomer (Ketac Molar) or resin modified glass ionomer (Photac Fil) in a "sandwich" technique after small vital pulpal exposure (1-1.5mm) was disinfected with NaOCl?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Tue Nov 20, 2007 10:08 pm    Post subject: Reply with quote

If you're asking me if I would use either of those materials for a direct pulp cap, the answer is no.

The literature is strong against classic GI for pulp cap and modestly against for RMGI.
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rich



Joined: 30 Apr 2007
Posts: 22

PostPosted: Wed Nov 21, 2007 1:13 am    Post subject: Reply with quote

thank you for your input. Another question that I have regarding to using base under restorations. It seems from a lot of replies on the topic of direct pulp cap, I get the concensus that a lot of dentists participating in this forum don't use base under deep (pulpally) restorations and not have patients experience sensitivity? When would you use base under a resin restorations or do you use it at all? My experience has been using base (Lime Lite or some sort of glass ionomer) under deep restorations because of past experiences with patients having thermal sensitivity then redoing them and since then very rare complaints. If I can get away from having to use base and still have great success like most of the people here I am all for it. Thank you again.
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john kanca



Joined: 14 May 2005
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PostPosted: Wed Nov 21, 2007 7:08 am    Post subject: Reply with quote

I do not place a base regardless of how deep the restoration goes. Place your adhesive (which one are you using?), light-activate it, then apply a thin layer of flowable (like Titan) and light-activate for NOT LESS than 20 seconds, 30 seconds if your light is not very strong, then incrementally insert resin composite.

There's no reason you ought not be able to get away from bases.

What do you think Limelite is?

Wink
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Pcus



Joined: 17 May 2005
Posts: 434
Location: toronto

PostPosted: Thu Nov 22, 2007 10:26 am    Post subject: Reply with quote

speaking of pulp caps, John, you mentioned a few days ago that saline applied over the exposure is recommended. Is that what you would suggest now instead of the NaOCl?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Fri Nov 23, 2007 10:07 am    Post subject: Reply with quote

I guess I am.
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JKesling



Joined: 24 Oct 2005
Posts: 77
Location: Boise, Idaho

PostPosted: Sat Nov 24, 2007 7:56 am    Post subject: Reply with quote

John,

Do you still use Durelon or Zinc Phosphate for pulp caps?

Thanks,

Jeff
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john kanca



Joined: 14 May 2005
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PostPosted: Sat Nov 24, 2007 8:30 am    Post subject: Reply with quote

JKesling wrote:
John,

Do you still use Durelon or Zinc Phosphate for pulp caps?

Thanks,

Jeff


You can use either. I still use Durelon. And I think that if we're going to do away with the use of NaOCl then we ought to use something of a disinfectant. I think that means something like Consepsis. I have to think about this a little.
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scottie



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

PostPosted: Sat Nov 24, 2007 12:10 pm    Post subject: Reply with quote

John to use saline over a pulp exposure, would you make up a saturated saline solution, dip a cotton pellet in it, and rub that over the exposure? Then rinse off, dry (hopefully bleeding has stopped) and place Durelon over it?
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john kanca



Joined: 14 May 2005
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PostPosted: Sun Nov 25, 2007 12:59 am    Post subject: Reply with quote

scottie wrote:
John to use saline over a pulp exposure, would you make up a saturated saline solution, dip a cotton pellet in it, and rub that over the exposure? Then rinse off, dry (hopefully bleeding has stopped) and place Durelon over it?


That is my initial response.
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brad



Joined: 13 May 2005
Posts: 346
Location: Cincinnati, Ohio

PostPosted: Sun Nov 25, 2007 8:12 am    Post subject: Reply with quote

I have had such a good success rate with NaOcl and Durelon, I am not wanting to change. Do you think the saline (vs hypo) will give pulps a real advantage we will appreciate clinically?
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john kanca



Joined: 14 May 2005
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PostPosted: Mon Nov 26, 2007 7:53 am    Post subject: Reply with quote

Your own experience indicates something significant. It works.

I think what I may do is to only slightly modify the technique to wring out most of the NaOCl and rewet the pellet with saline.

A reasonable compromise.
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brad



Joined: 13 May 2005
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Location: Cincinnati, Ohio

PostPosted: Mon Nov 26, 2007 1:51 pm    Post subject: Reply with quote

are you going to rinse/dry with the a/w syringe prior to placing the durelon?
Thanks
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Bradley A Dorsch, DDS
Forest Hills Family Denitstry
1055 Nimitzview Dr
Cincinnati, OH 45244
513-231-5353
www.cincytoothdoc.com
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Nov 26, 2007 11:48 pm    Post subject: Reply with quote

brad wrote:
are you going to rinse/dry with the a/w syringe prior to placing the durelon?
Thanks


You have to do that, else the Durelon doesn't stick.
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scottie



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

PostPosted: Sun May 18, 2008 10:04 pm    Post subject: Reply with quote

I just wanted to mention the good results I'm getting with pulp capping. Talked to a patient this morning on whom I had pulp capped an asymptomatic tooth recently. There was a fair amount of decay, and I got a pulp exposure. I used hypochlorite straight out the bottle on a cotton pellet and kept it there long enough to stop the bleeding, probably about a minute and half. Washed and dried it and placed durelon over the exposure. Waited till the Durelon set, then Simplicity, flowable etc.
He's doing fine. Now I don't know if I would want to crown a tooth I had pulp capped, for some time, but this pulp capping technique works well.
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