Apex Information Exchange

[k_h_d]

Today I had a patient in with recurrent decay under a very large occlusal composite on #18. Using rubber dam isolation the mesial pulp horn was exposed. Blood stopped almost immediately. I cleaned the cavity preparation with NaOCl and placed a base of durelon over the exposure and the visible ceiling of the pulp floor. After it set I then restored as normal with Surpass, thin layer of titan flowable co-cured with surpass. Then incremental buildup of composite (gradia direct X).

I called the patient this evening to see how she was doing. Overall no sensitivity to cold but she did say she had a sharp pain when chewing on the tooth. She has no pain when simply biting together. No cold sensitivity as of yet.

Was this the proper protocol for a pulp cap with durelon? My first thoughts while using this technique were that sensitivity would possibly be caused while biting with pressure being applied to the non bonded durelon. Will these biting symptoms subside?

Please let me know if this was correct protocol and these symptoms are normal.

Thanks,
Kenny

[john kanca]

I am a little concerned with the use of NaOCl as a cavity cleaner. My preference in this case would be use Consepsis to clean the cavity, then 3% NaOCl for hemostasis, followed by Durelon, Surpass and Titan.

Were there any symptoms at all prior to restoration? How long had the lesion been present?
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[ilikecoffee]

Any thoughts on Viscostat clear for this use?

[john kanca]

[scottie]

John, is part of that hemostasis being very gentle using 3% hypochlorite, in other words cutting the regular 6% bleach in half with water?
Also what do you think of using a glass ionomer over the durelon and then the bonding agent, flowable and comp? I hear so many good things about glass ionomers, how they chemically bond to tooth structure and release Fluoride etc.

[john kanca]