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Durelon pulp cap with surpass

 
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k_h_d



Joined: 11 Jul 2011
Posts: 11

PostPosted: Wed May 30, 2012 6:17 pm    Post subject: Durelon pulp cap with surpass Reply with quote

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
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Sat Jun 02, 2012 9:12 am    Post subject: Reply with quote

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



Joined: 02 Mar 2010
Posts: 123

PostPosted: Mon Jun 04, 2012 10:56 am    Post subject: Reply with quote

Any thoughts on Viscostat clear for this use?
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jun 04, 2012 12:39 pm    Post subject: Reply with quote

ilikecoffee wrote:
Any thoughts on Viscostat clear for this use?


No no no. Hemostasis has to be very gentle so as not to coagulate blood within the pulp chamber.
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scottie



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

PostPosted: Tue Jun 05, 2012 11:22 pm    Post subject: Reply with quote

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.
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Mon Jun 11, 2012 7:46 am    Post subject: Reply with quote

scottie wrote:
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.


Scottie, glass ionomers don't bond to the tooth any differently from zinc phosphate or carboxylate. It's all the same. You would not want fluoride being released into a pulp. Yet you can use GI over the Durelon but I do not find it necessary.

And yes, cut the bleach in half- to 3%. It provides a very gentle and superficial hemostasis, which is exactly what is desired.
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