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Stained margins

 
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Thu Aug 17, 2006 12:10 pm    Post subject: Stained margins Reply with quote

Hi to all!
I'm seeing stained margins on some of my posterior composites that are only 1-2 years old. The bonding system I was using then was Bisco One Step with Aqua Prep F as recommended by John at courses I took in Y2K. I recognize that the patients I'm seeing this generally are more non-complient with home care and diet recommendations, so I know lots of pop and plaque are sitting on these teeth. I suspect that's the cause. What do you think? Hope it doesn't happen with Simplicity.
Tom
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john kanca



Joined: 14 May 2005
Posts: 6346

PostPosted: Thu Aug 17, 2006 2:50 pm    Post subject: Reply with quote

One thing that can help with that- and you must have seen the four yr recalls I have posted- is to apply a tiny, thin layer of Sim 2 in between increments. It allows for better adaptation. We are working on a formula dedicated to just that- adaptation.

And why is this under sensivity?

Are you sensitive? Wink
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Thu Aug 17, 2006 4:00 pm    Post subject: Reply with quote

john kanca wrote:
One thing that can help with that- and you must have seen the four yr recalls I have posted- is to apply a tiny, thin layer of Sim 2 in between increments. It allows for better adaptation. We are working on a formula dedicated to just that- adaptation.

And why is this under sensivity?

Are you sensitive? You know I am, that's why this isn't on DT! Laughing Wink

Thanks for the answer. I am using Sim 2 between increments, so time will tell.
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Gerry



Joined: 13 May 2005
Posts: 448
Location: Tarrytown NY

PostPosted: Fri Aug 18, 2006 10:13 am    Post subject: Reply with quote

Judging by the apparent attention to detail I'd bet that if the restorations were stained with disclosing solution there would be no indication of leakage at the margins, merely some superficial staining at the interface.
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Fri Aug 18, 2006 11:21 am    Post subject: Reply with quote

I see the stain mostly on buccal or lingual margins, and often it's in the gingival 1/3, at the BG corner. That reminds me that I place flowable on the gingival floor, and for whatever reason I cure it a full 10 secs instead of my usual pulse curing technique. I remember John saying that flowables either required more energy to cure or they didn't cause damage due to rapid shrinkage??????? Question
Tom
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Gerry



Joined: 13 May 2005
Posts: 448
Location: Tarrytown NY

PostPosted: Fri Aug 18, 2006 11:27 am    Post subject: Reply with quote

Due to the realtively lower modulus of dentin the strain created as a result of the shrinkage of polymerization of composites is far less of concern than with enamel. The final layer of composite which is in contact with the enamel walls must be pulsed. I've been following JK's advice for many years and pulsing makes a big difference!
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Fri Aug 18, 2006 11:33 am    Post subject: Reply with quote

So here's my question:
Does flowable require pulse curing when it is in contact with enamel?

John mentioned a 4 year study on curing. Where can I find that?
Tom
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Gerry



Joined: 13 May 2005
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Location: Tarrytown NY

PostPosted: Fri Aug 18, 2006 1:04 pm    Post subject: Reply with quote

twmdds wrote - Does flowable require pulse curing when it is in contact with enamel?

The only time I palce flowable, which BTW generally has greater finite shrinkage than paste, on enamel is when I do sealants and in these cases I pulse! As for paste composites, some of the consideration has to do with the "C" factor of the cavity prep. The larger the factor (more walls) the more critical it is to pulse. Just to be on the safe side I pulse all composite restorations where in contact with enamel regardless of C factor.
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twmdds



Joined: 16 May 2006
Posts: 142

PostPosted: Fri Aug 18, 2006 1:09 pm    Post subject: Reply with quote

Wow, thanks Gerry. I'll definitely be more careful to pulse the flowables too. Thanks!
Tom
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john kanca



Joined: 14 May 2005
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PostPosted: Sat Aug 19, 2006 8:54 am    Post subject: Reply with quote

Pulse activation is required when two or more opposing enamel surfaces are connected with a layer of composite. If the flowable is a very THIN FLAT layer, such as on the bootom of the cavity, pulse activation is not required.

That staining you're seeing is likely inadequate "wetting" of the composite to the adhesive. Really thin adhesives have a very small oxygen inhibited layer and it's not easy to be certain the composite has been thoroughly adapted to the adhesive or even to the previous layer of composite.

That's why I have been advising to paint on a thin layer of SIm 2 prior to the insertion of each increment of composite. (Flowable is exempt because it is so thin) This is why we've decided to develop a "wetting" resin. It is formulated specicifically for this purpose- entirely hydrophobic.

Cool
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brad



Joined: 13 May 2005
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PostPosted: Sat Aug 19, 2006 10:33 am    Post subject: Reply with quote

When do you expect the wetting agent to be available?

Can you use it to seal the restoration after final shaping/polishing as well?
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cool kid



Joined: 12 May 2005
Posts: 818
Location: chicago

PostPosted: Sat Aug 19, 2006 12:38 pm    Post subject: Reply with quote

brad wrote:
When do you expect the wetting agent to be available?

Can you use it to seal the restoration after final shaping/polishing as well?


Brad, I don't believe you can because it is not light sensitive. I believe it does not cure.
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john kanca



Joined: 14 May 2005
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PostPosted: Sat Aug 19, 2006 7:30 pm    Post subject: Reply with quote

It will copolymerize wonderfully but not set under light.
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Gerry



Joined: 13 May 2005
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Location: Tarrytown NY

PostPosted: Sun Aug 20, 2006 11:09 am    Post subject: Reply with quote

J.

In light of all the "white lines" & cohesive fractures of enamel which occur only in one wall at the occlusal surface of restorations woudn't it be advisble to pulse whenever composite is in contact with even a single enamel surface?
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