Dentaltown April 2018 - 42

message board

Sensitive Composites Are Killing My Energy
Townies share restorative tips with a struggling doc

Blue901
Member Since: 06/04/16
Post: 1 of 176

I'm a year out and I love general dentistry, but it seems like I have 5-7 patients a week come
back with sensitive composites. Patients who used to think I was a young stud dentist have lost
their trust in me. Fixed proths treatment plans are being put on hold because of this lack of trust!
To those of you who rarely get sensitivity, what's your secret?
Here is my protocol:
* Etch 15 seconds, rinse 10 seconds and don't overdry
* Have assistant pour bond only when I'm ready to use it
* Rub it in and cure for only 5-10 seconds, to not overheat dentin
* Layer of flowable on gingival floor, then "snowplow technique" for Class II
* Incremental layering
* Triple-check occlusion
I thought this was textbook-what am I missing? ■
1/22/2018

yolo123
Member Since: 08/10/13
Post: 2 of 176

A lot things could go wrong.
1. Where do you put the bonding agent-i.e., in reusable well? disposable well? piece of
paper? back of your hand?
2. Which generation of bonding agent you are using?
3. How old is your bonding agent? Is it stored properly?
4. After you "rubbed" the dentin with bonding agent, I would gently dry the excess bonding
agent.
5. I think this one is the most important one: Is it treatment planned correctly? Meaning, does
it need a RCT? Sometimes although teeth are asymptomatic, when decay is within proximity
to the nerve chamber, I would elect prophylactic RCT and inform the patient about it.
Just my two cents. ■

1/22/2018

DrDreyDDS
Member Since: 09/03/15
Post: 3 of 176

Well, you may want to switch to a self-etching bond like Optibond. There are others that
will work on prepared teeth surfaces. Read the directions of your bonding agent. A lot of times
they require two applications of the bond, then air drying before light curing.
Be sure you are light curing long enough. JADA had an article about the length of polymerization times for different shades of resin a few years ago. Read the polymerization percentage
of your flow resin. Good luck. ■

1/22/2018

Fondcombe

Also, you should try single dose bonding agent ... and an air-only syringe. Good luck. ■

Member Since: 09/24/11
Posts: 5 and 6 of 176

mooredge
Member Since: 04/22/08
Post: 7 of 176

42

1/22/2018

I'm sure you'll get lots of feedback, but here is my protocol and I rarely have sensitivity even
with really deep fills.
Good isolation is a must-either rubber dam or Isolite, etc.
I use ClearFill SE prime and bond, which is a two-step, self-etch system as opposed to the
total-etch system you are using.

APRIL 2018 // dentaltown.com


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