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Dislodged restoration
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Tue Feb 28, 2012 3:32 am    Post subject: Dislodged restoration Reply with quote

Patient presented with this:


dislodged restoration was done 1 month back by me using the same protocol mentioned later.



caries detector, sandblast, H3PO4 enamel margins 30s, rinse 30s and dry



bonding with surpass:
- scrub enamel and dentin with no. 1 for 10s
- 3 brushful of no. 2 with gentle scrubbing
- full strength air blast
- 1 brushful of no. 3 with gentle scrubbing
- full strength air blast
- 3 seconds valo plasma mode 10mm from occlusal
- 3 seconds valo plasma mode touching occlusal



lining dentin with titan flowable approx 0.3mm thick
apply sectional matrix
lining the margins with titan flowable approx 0.3mm thick



closing of the proximal box with 2 increment of regular composites
All composite increments 3 seconds plasma mode 10mm from surface



basic anatomy and gross finishing



check occlusion and adjusted to no contact during centric and lateral occlusion. Polishing with silicone points.

Final cure. 2x 3 secs valo plasma on each surface.

What did I do wrong? I don't want do this free of charge again.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Wed Feb 29, 2012 8:39 pm    Post subject: Re: Dislodged restoration Reply with quote

guanhor wrote:
Patient presented with this:


dislodged restoration was done 1 month back by me using the same protocol mentioned later.



caries detector, sandblast, H3PO4 enamel margins 30s, rinse 30s and dry



bonding with surpass:
- scrub enamel and dentin with no. 1 for 10s

Did you dry Surpass 1?
- 3 brushful of no. 2 with gentle scrubbing

Scrubbing not necessary.

- full strength air blast
- 1 brushful of no. 3 with gentle scrubbing

Scrubbing not necessary

- full strength air blast

- 3 seconds valo plasma mode 10mm from occlusal
- 3 seconds valo plasma mode touching occlusal

I prefer 10 seconds standard mode



lining dentin with titan flowable approx 0.3mm thick
apply sectional matrix
lining the margins with titan flowable approx 0.3mm thick

Was it light-cured?



closing of the proximal box with 2 increment of regular composites
All composite increments 3 seconds plasma mode 10mm from surface

Please check my "pulse protocol" here in this forum. Try it my way and see what happens.



basic anatomy and gross finishing



check occlusion and adjusted to no contact during centric and lateral occlusion. Polishing with silicone points.

Final cure. 2x 3 secs valo plasma on each surface.

What did I do wrong? I don't want do this free of charge again.

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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Wed Feb 29, 2012 8:40 pm    Post subject: Reply with quote

That dentin didn't stain? Are you sure?
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Thu Mar 01, 2012 1:04 am    Post subject: Reply with quote

Thanks for the reply John. Here are my answers:

Did you dry Surpass 1?
No

Scrubbing not necessary.
I was just moving things around to make sure all the surfaces are covered. Is it detrimental?


I prefer 10 seconds standard mode
Touching the occlusal and parallel to long axis of the tooth? Are you concerned about the undercut areas not receiving enough light?


Was it light-cured?
Yes. They are light cured separately with the same protocol as regular composites.

Please check my "pulse protocol" here in this forum. Try it my way and see what happens.
Yes I will. Do you think my curing protocol is the cause of the failure?

That dentin didn't stain? Are you sure?
Note the pinkish hue on dentin in 2nd and 3rd photo. That was dyed after sandblast and before etch. Will you remove them?
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Thu Mar 01, 2012 1:09 am    Post subject: Reply with quote

I didn't orange filter my headlight till surpass 3. Could that be the cause?
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satchdds



Joined: 10 Jun 2005
Posts: 210
Location: niagara falls, n.y.

PostPosted: Thu Mar 01, 2012 1:19 pm    Post subject: Reply with quote

guanhor wrote:
I didn't orange filter my headlight till surpass 3. Could that be the cause?
? #2 would be setting before you air dried it ? also you stated "sandblast, H3PO4 enamel margins 30s, rinse 30s and dry " unnecessary steps with surpass. Did you have a rubber dam on the first time also?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Fri Mar 02, 2012 11:11 pm    Post subject: Reply with quote

guanhor wrote:
Thanks for the reply John. Here are my answers:

Did you dry Surpass 1?
No

Scrubbing not necessary.
I was just moving things around to make sure all the surfaces are covered. Is it detrimental?


Moving around is OK. Scrubbing not.

I prefer 10 seconds standard mode
Touching the occlusal and parallel to long axis of the tooth? Are you concerned about the undercut areas not receiving enough light?

Nah.


Was it light-cured?
Yes. They are light cured separately with the same protocol as regular composites.

Please check my "pulse protocol" here in this forum. Try it my way and see what happens.
Yes I will. Do you think my curing protocol is the cause of the failure?

Maybe. Too much energy too fast can rupture any resin margins

That dentin didn't stain? Are you sure?
Note the pinkish hue on dentin in 2nd and 3rd photo. That was dyed after sandblast and before etch. Will you remove them?

Likely so.

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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Fri Mar 02, 2012 11:12 pm    Post subject: Reply with quote

guanhor wrote:
I didn't orange filter my headlight till surpass 3. Could that be the cause?


Mind if I criticize a little?
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Sat Apr 07, 2012 12:09 am    Post subject: Reply with quote

satchdds wrote:
guanhor wrote:
I didn't orange filter my headlight till surpass 3. Could that be the cause?
? #2 would be setting before you air dried it ? also you stated "sandblast, H3PO4 enamel margins 30s, rinse 30s and dry " unnecessary steps with surpass. Did you have a rubber dam on the first time also?


sandblast to cleanup the surface as I didn't do any prep the second time.
pre-etching enamel gives nicer looking margins in my hands
rubber dam was used


john kanca wrote:
guanhor wrote:
I didn't orange filter my headlight till surpass 3. Could that be the cause?


Mind if I criticize a little?


sure! fire away please.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Apr 09, 2012 7:56 pm    Post subject: Reply with quote

To me the distal looks a little underfilled and that fossa looks a bit deep. The marginal ridge height does not seem to match the one behind it.
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Mon Apr 09, 2012 8:21 pm    Post subject: Reply with quote

john kanca wrote:
To me the distal looks a little underfilled and that fossa looks a bit deep. The marginal ridge height does not seem to match the one behind it.


Yup. The anatomy is far from ideal. Will work on that too.

I often face problems restoring a previously underfilled tooth especially those uncarved ball burnished amalgam restorations. The cuspal inclines that I built up often get removed during occlusal adjustments and they end up looking more or less like the previous filling.

Anyone having similar problems?

BTW I called up the patient yesterday and the filling is still in place.
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ilikecoffee



Joined: 02 Mar 2010
Posts: 123

PostPosted: Tue Apr 10, 2012 11:08 am    Post subject: Reply with quote

Nice photography of the situation. What did you use to photograph?
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guanhor



Joined: 08 Sep 2009
Posts: 14

PostPosted: Tue Apr 10, 2012 7:11 pm    Post subject: Reply with quote

Thanks. Ring flash, canon 100mm macro lens, canon 40D.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Thu Apr 12, 2012 3:40 pm    Post subject: Reply with quote

Was that a bicuspid size Composi-tight matrix?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Thu Apr 12, 2012 3:42 pm    Post subject: Reply with quote

guanhor wrote:

I often face problems restoring a previously underfilled tooth especially those uncarved ball burnished amalgam restorations. The cuspal inclines that I built up often get removed during occlusal adjustments and they end up looking more or less like the previous filling.



Can you guess what I am going to say next? Anyone?
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