DentaltownUK April 2017 - 44

General Dentistry
Message Board

Related Message Boards
What to Do with Post-Op
Sensitivity? Redo or IRM Interim
Restoration Then Redo?
IRM Interim

Post-Op Sensitivity Upon Flossing
and Cold Drink on #15 After
Resto. Possible Cause?
Possible Cause

and lots of bonding agent applied to chase out the moisture before drying. Can't recall the
last case of postop sensitivity. Nor can I recall the last time a filling fell out.
If you haven't looked at SEM's showing the difference in wet and dry collagen, it is eyeopening. At least it was for me. It is easy to think that because isolation is so important, the tooth
needs to be dry before bonding agent is applied. But when I really understood wet bonding, I
realized that "not desiccated" does not really convey the message of wet bonding. Total-etch,
wet bonding, means exactly what is sounds like. The dentin has to be wet/moist or the collagen
matrix collapses. I typically rinse and then make a quick pass with the suction over the tooth
and/or use a cotton pellet to remove pools of water.
In my opinion, it's better to leave the dentin too moist because the solvent in the bonding
agent will chase out excess water, so make sure to use plenty of it. I believe that the vast majority
of sensitivity and poor bond is due to overdrying the etched dentin, thereby collapsing the collagen matrix. I also think a leading cause of poor bonding may in fact be due to not etching long
enough. Just my two cents. Thanks to Dr. Kanca for inventing wet bonding! ■

7/24/2016

brettmansfield
Member Since: 08/19/05
Post: 28 of 62

So, with proper rubber dam isolation, you shouldn't have any issues there. Next guesses
would be overdrying the tooth after rinsing the etch, incomplete priming of the dentin (too
short of an application time, or incomplete evaporation of the solvent for the bonding agent), or
curing issues (too thick a layer of composite, or curing the final occlusal layer for too long). ■

8/5/2016

pjmop
Member Since: 02/15/05
Post: 29 of 62

I would add not etching long enough to the list, especially on sclerotic dentin. Most common mistake is overdrying after etch/rinse. ■

8/5/2016

mikebarrdds
Member Since: 03/23/00
Post: 30 of 62

I have used a variety of bonding agents over the years in "total-etch" technique (still do that)
going back to All Bond 2 (Bisco) to One Step (Bisco) to Prime & Bond NT (Dentsply) to today's
materials, Scotchbond Universal (3M) and Surpass (Apex). Why did I change it up? No reason,
really. I like trying new things. All of them work!
I can honestly say that I never have patients returning complaining of postop sensitivity.
It doesn't matter if it's virgin caries or previously restored with a big amalgam. I've never used
Gluma or any other desensitizing agent. I just follow the manufacturer's instructions for the
bonding agents. I don't add any steps. I don't subtract any steps. Ever. Good isolation. Good
prepping. Good condensation. Good curing. Good finishing.
I used to do tons of layering. Lots of small time-consuming increments. More recently, I've
been using 3M's Filtek Bulk material. I was skeptical and nervous about doing a bulk-filling technique. But you know what? It works and I love it. Saves a bunch of time! And I still don't get
patients coming back with sensitivity. Go figure! And I really do mean never. Ask my assistant!
Bottom line: Find the materials you like and read the instructions. ■
8/5/2016

Tom Mitchell
Member Since: 02/16/04
Posts: 33 & 34 of 62

I've taken exactly the same road as you, Mike, but I've gone back from 3M Bulk Fill to
Heliomolar because I could contour the occlusion easier. I've had virtually no sensitivity. The
key with all these products is following the manufacturer's instructions.
It has been shown that there are several mistakes in the bonding procedure that cause sensitivity. If the hybrid layer is not wet enough or too wet, the dentin bonding agent, which is a
combination of a "water chaser" like ethanol and resin, won't penetrate the dentinal tubules so

APRIL 2017 // dentaltownuk.com

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