DentaltownUK April 2017 - 46

General Dentistry
Message Board

has not been a problem. Many good explanations in these posts on how to do proper dentin
bonding. It is the one step in all your protocol that you want to make sure works so take a little
extra time to do it right. Forty to 60 seconds is a bargain if you can eliminate sensitivity in your
restorations. Good thread going on. The best advice anyone can give you is if what you are doing
works keep doing it! ■
11/5/2016

milicichg
Member Since: 09/18/01
Post: 52 of 62

Heaps of advice on bonding protocols. One aspect of old amalgams is very subtle cusp
fractures. I treat all old amalgam removals as fractured teeth until I prove otherwise. A bit like
all upper first molars endo have 2 MB canals until proven otherwise.
Once you remove an old amalgam, particularly if you are using a carbide high-speed bur,
you can exacerbate the fracture (sometimes the cusps actually fly off with these burs, personally
I don't use them.) They need to be dealt with as they can be another source of post-op sensitivity.
Mistreated, these can lead to unnecessary endo because symptoms won't resolve. Just another
complication to throw into the post-op sensitivity conundrum. ■

11/11/2016

lomb
Member Since: 09/24/05
Post: 54 of 62

Handpiece lubricant on prep: Use alcohol in syringe to clean cavity.
Acid-etch: Frequently is not washed off fully, I use a liquid-etch rather than gel-etch for
10-15 seconds and a universal adhesive as belt and braces approach.
Co-curing the bond and flowable: This is crazy as the alcohol, or whatever solvent in the
bond, needs to be evaporated for five to 10 seconds until there is no movement and it is dry.
Otherwise, the bond is poor.
Curing light: As has been mentioned need a good one or at least test on a light meter regularly.
Dentin: The permeability of dentin increases towards the pulp. Modern amalgams don't
seem to corrode as much as old and as such perhaps the pulps don't retreat as much into the root
laying down dentin. I put the finest smear of Dycal over the pulp and then use a spoon excavator
to remove some of it. Nothing seals the pulp better than itself and Dycal gets it going. Research
shows a fourfold reduction in permeability in four weeks I believe.
Gluma: This is one additional product that is likely not needed that could screw up the bond.
Bulk-cure: All composite shrinks. It's wise to respect C-factor if even only in the initial layers
over the pulp
Overdrying dentin: This causes the matrix to collapse and won't allow the bond in as well.
Needs to be moist i.e. glistening but with no pools of water. Any water left is evaporated off with
the five to 10 second blast of air on drying the bond until it doesn't move.
Initial preparation: Use lots of water to remove the amalgam. Remember amalgam conducts
heat faster than dentin would and that could destroy the pulp before you've even applied the etch.
Finishing composite: Be very gentle on composite when finishing it as it's under severe stress
for one week due to internal shrinkage until it absorbs water (and yes bacteria hence the Dycal
over pulp to reduce permeability of dentine) to reduce it. Do as much finishing as possible in the
final cure. I don t apply a lot of pressure with burs to remove excess or polish it. ■
11/12/2016

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Post-Op Sensitivity

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