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Mark J Fleming DDS



Joined: 11 May 2005
Posts: 736
Location: Sarasota, FL

PostPosted: Mon Jun 06, 2005 11:54 am    Post subject: Theoretically Reply with quote

If a CEREC prep is sealed after prep is finished using Simplicity, then CEREC seated with Anchor and there is cold sensitivity, does that mean somthing did not get sealed with the Simplicity after prepping?

Method

After prepping, Sim 1 for ten seconds, 3 coats Sim 2, air dry 5 sec, 2 coats Sim 2, air dry again, cure UltraLume 5 10 secs B, O and L. After Interface and curing Sim 2 then a coat of Sim 2 no cure on CEREC, clean off prep, apply coat of Sim 2, dry and no cure, then seat.

Thanks Cool
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DrDan



Joined: 11 May 2005
Posts: 160
Location: Longwood, FL

PostPosted: Mon Jun 06, 2005 12:03 pm    Post subject: Reply with quote

Was the tooth sensitive PRE-op?

I don't know about you guys...but if I KNOW that I sealed it well with Simplicity...no contaminates....properly air dried.....etc......and I have post op pain/sensitivity.....then I suspect the pain to be intrinsic instead of extrinsic in it's origin. I have that much faith in Simplicity to seal the exterior....therefore I feel the pain must be coming from the inside out and not the reverse. I'd suspect something going on with the pulp in a case like this.

I also assume the occlusion is not a factor in all of this...

Dan Smile
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Mark J Fleming DDS



Joined: 11 May 2005
Posts: 736
Location: Sarasota, FL

PostPosted: Mon Jun 06, 2005 12:16 pm    Post subject: Reply with quote

DrDan wrote:
Was the tooth sensitive PRE-op?

I don't know about you guys...but if I KNOW that I sealed it well with Simplicity...no contaminates....properly air dried.....etc......and I have post op pain/sensitivity.....then I suspect the pain to be intrinsic instead of extrinsic in it's origin. I have that much faith in Simplicity to seal the exterior....therefore I feel the pain must be coming from the inside out and not the reverse. I'd suspect something going on with the pulp in a case like this.

I also assume the occlusion is not a factor in all of this...

Dan Smile


Dan,

Remember, this a theoretical case! Wink Tooth was cold sensitive with a tooth crack. Occlusion is not a problem. I agree with you and I was wondering if there was anything else I was missing. Cool
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rajeev2003



Joined: 14 May 2005
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Location: WETHERSFIELD, CT

PostPosted: Mon Jun 06, 2005 1:13 pm    Post subject: Reply with quote

Mark,
This are my thoughts on sensitivity to thermal stimuli :
1)Sensitivity,of short duration,disappears immediately when stimulus is removed.....with NO prior history.....iatrogenic, normally.
2)Sensitivity,of short duration,that persists after removal of stimulus,is indicative of pulpitis or pulp necrosis.
3)Sensitivity,of short duration to thermal stimuli , is increased in cases of PULPOSIS initiated by periodontal disease and is indicative of pulpitis esp if sensitivity persists on removing stimulus.

In your case ,there is a history of prior sensitivity to thermal stimuli.You have not indicated if prior to your prep ....whether this prior sensitivity to cold persisted after removing the stimulus? Has the degree of cold sensitivity thereafter changed from "before" to "after" the prep? Is it worsening?The storyline should give a clue of the degree of histo changes and therefore provide a "calculated diagnosis".
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john kanca



Joined: 14 May 2005
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PostPosted: Mon Jun 06, 2005 1:35 pm    Post subject: Re: Theoretically Reply with quote

Mark J Fleming DDS wrote:
If a CEREC prep is sealed after prep is finished using Simplicity, then CEREC seated with Anchor and there is cold sensitivity, does that mean somthing did not get sealed with the Simplicity after prepping?

Method

After prepping, Sim 1 for ten seconds, 3 coats Sim 2, air dry 5 sec, 2 coats Sim 2, air dry again, cure UltraLume 5 10 secs B, O and L. After Interface and curing Sim 2 then a coat of Sim 2 no cure on CEREC, clean off prep, apply coat of Sim 2, dry and no cure, then seat.

Thanks Cool


Boy, tough one. Where is the sensitivity elicited in this theoretical case? On which part of the tooth? Occlusion is the most likely cause of this. Parafunctional.
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Mark J Fleming DDS



Joined: 11 May 2005
Posts: 736
Location: Sarasota, FL

PostPosted: Mon Jun 06, 2005 1:51 pm    Post subject: Re: Theoretically Reply with quote

john kanca wrote:
Mark J Fleming DDS wrote:
If a CEREC prep is sealed after prep is finished using Simplicity, then CEREC seated with Anchor and there is cold sensitivity, does that mean somthing did not get sealed with the Simplicity after prepping?

Method

After prepping, Sim 1 for ten seconds, 3 coats Sim 2, air dry 5 sec, 2 coats Sim 2, air dry again, cure UltraLume 5 10 secs B, O and L. After Interface and curing Sim 2 then a coat of Sim 2 no cure on CEREC, clean off prep, apply coat of Sim 2, dry and no cure, then seat.

Thanks Cool


Boy, tough one. Where is the sensitivity elicited in this theoretical case? On which part of the tooth? Occlusion is the most likely cause of this. Parafunctional.


I thought you had mentioned this in Orlando. I'm seeing the person tomorrow and I will fill all of you in. Thanks.
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john kanca



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PostPosted: Mon Jun 06, 2005 2:03 pm    Post subject: Reply with quote

Mark

Were there any visible cracks in the tooth?
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DrDan



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PostPosted: Mon Jun 06, 2005 2:06 pm    Post subject: Re: Theoretically Reply with quote

Mark J Fleming DDS wrote:


I thought you had mentioned this in Orlando. I'm seeing the person tomorrow and I will fill all of you in. Thanks.


How do you see a "theorectical" patient? Wink

Dan Laughing
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john kanca



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PostPosted: Mon Jun 06, 2005 2:08 pm    Post subject: Re: Theoretically Reply with quote

DrDan wrote:
Mark J Fleming DDS wrote:


I thought you had mentioned this in Orlando. I'm seeing the person tomorrow and I will fill all of you in. Thanks.


How do you see a "theorectical" patient? Wink

Dan Laughing


In your "theoretical" office! Laughing Laughing Laughing
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Mark J Fleming DDS



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Location: Sarasota, FL

PostPosted: Mon Jun 06, 2005 2:33 pm    Post subject: Reply with quote

john kanca wrote:
Mark

Were there any visible cracks in the tooth?


yes. Cool
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rajeev2003



Joined: 14 May 2005
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Location: WETHERSFIELD, CT

PostPosted: Mon Jun 06, 2005 5:27 pm    Post subject: Reply with quote

While we are on this "theoretical breaktime", let me ask another question....saw this patient about 2 hrs ago,new to the office,SEVERE CERVICAL CLEFTS bucc. on # 12/13/14/15.
Patient went by himself to local O.S for extractions and then referred to me by same to save teeth.
OS prescribed Amox500/21/tid and Darvocet.(OS said pt gave history of quite a bit of pain)

Interview at my office went like this:
"When was pain felt the first time"
"Yesterday"
"How long"
"For a few moments, just now....(45 mts after OS)....there is no pain"
"What initiated pain"
"Air-conditioning turned on for first time yesterday"
"How long was AC kept on"
"2 Hours"
"Was pain felt for entire 2 hrs"
"Yes"
"Ever had similar pain before"
"No"
"Ever been to another dentist"
"Yes...1 year ago"
"Did he say anything to you about the cervical defects"
"Well.he said i needed a cleaning.The girl started cleaning .There was a lot of discomfort to cold when she touched this area in my mouth.Not elsewhere.So i asked her to skip the area.But the pain was there for quite sometime even after i went back home"

OK,so i'm trying to gain a perspective on the histology of these teeth.
Very severe cervical wedge shaped areas missing on crown/roots.Cause combination of brush and occln probably.
I see chronic pulpitis with atleast partial necrosis possibly.Irreversible.
Pt did not want me to do thermal tests.

What do you guys see histologically related to subjective history,where pt contradicted himself atleast twice?

I said rct's and fills.(No pain on percussion.Palpation of cervical tissue....some sensitivity.....but the wedge's margins was almost thru the attached gingiva....so a little confusion of the source of discomfort at this area.)
Opinions?
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john kanca



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PostPosted: Mon Jun 06, 2005 7:02 pm    Post subject: Reply with quote

Tell us about the occlusion. Would I be correct in conjecturing that there is considerable wear on the occlusal surfaces? Sounds like a bruxer.

Radiographic findings?
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Ekrause



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PostPosted: Mon Jun 06, 2005 7:28 pm    Post subject: Reply with quote

Quote:
OK,so i'm trying to gain a perspective on the histology of these teeth.
Very severe cervical wedge shaped areas missing on crown/roots.Cause combination of brush and occln probably.
I see chronic pulpitis with atleast partial necrosis possibly.Irreversible.
Pt did not want me to do thermal tests.


I'd highly suspect GERD!!
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john kanca



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PostPosted: Mon Jun 06, 2005 7:32 pm    Post subject: Reply with quote

Maybe, but we need some occlusal damage too.
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rajeev2003



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PostPosted: Mon Jun 06, 2005 9:33 pm    Post subject: Reply with quote

John,
The OS took a panorex,and i'm getting a copy day after.So no xrays till day after.I did inform the patient of my need to see the panorex.Occlusally,definite occlusal wear facets noticed,but not what i thought i should be seeing as a direct corelation to the cervical defect size witnessed.I expect to see serious mineralization radiographically.Thickened lamina maybe?Lets see!
I'm going to take photographs at next visit when definitive treatment begins.I want to address the pain issue (which i think is going to flare up), with rct's,unless someone has a better approach?

Eric,what is GERD?Sorry i'm lost unless you are talking gastric regurgitation.If so, the linguals of all anteriors were perfect....normal enamel thickness.No dentine showthru.
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