Dentaltown April 2018 - 46

message board
WilburWonka
Member Since: 01/29/16
Post: 100 of 176

DS3 here so I cannot possibly answer your question but just wondering: It has been emphasized several times at school to do triangular-shaped increments to not bond the walls together,
because of shrinkage that leads to sensitivity. In my experience before school as an assistant, I
never saw increments that were high on one wall sloping down to another wall, but maybe I was
just not looking for it. The diagram they show at school for a Class II has about five increments
that are all triangular and not bonding walls together for a standard-depth Class II. Seems
unrealistic not just due to time but also the small space. If that's what is best for patients I'll do
my best to perfect it that way, but is that how it is done in the real world? ■

1/28/2018

Tom Mitchell
Member Since: 02/16/04
Post: 113 of 176

Yes, for most composites you don't want to bond B-L cusps in one increment because most
shrink so much, so fast, they create enough stress to flex the cusps, and with the early composites
some would fracture a weak cusp. Depends on the molecular configuration of the composite.
For most highly filled composites you can safely cure through only about 2mm increments, and
you need to add light to them in short bursts if the composite touches enamel. (That's called
pulse curing.)
For bulk fi lls, which aren't highly fi lled, you can cure deeper (because they aren't highly
fi lled). With a change in the composite's chemistry you can cure deeper and still have low
shrinkage and low stress. We've been bulk fi lling and incremental fi lling with Exquisite
up to 4mm depths with our light set on plasma mode, so only three-second bursts. No
sensitivity and no white lines. I've shown that at JK's private group several times. Just search
for my posts. ■
1/29/2018

bon
Member Since: 07/22/03
Post: 115 of 290

1. Use my desensitizer first. It is a desensitizer designed in 1997 and many dentists are just
addicted and order 10-12 bottles at a time (they are addicted!) and never got complaints
for sensitivity or soft tissue irritations. My desensitizer DDS (Dentin Desensitizer System)
is designed in water solution, so will protect collage from collapsing and would let the
bonding penetrate the tubules. Use a single layer of bonding spread on the entire surface.
Gently blow to remove the solvent (acetone or alcohol) from desensitizer's water solution.
2. Do not "pour bond only." Just paint the whole area and blow gently to remove any solvent
(acetone or alcohol) from bonding solution.
3. If you do not remove the solvent, the bond will be weak and have a failure in bonding.
4. If you have just a layer of painted bonding solution, I do not expect to get a lot of heat
from polymerization.
5. Use as little possible of flowable composite or do not use any flowable composite. If you use
too much flowable composite, you will have sensitivity or the tooth will crack over time.
Note: Do not use glass ionomers because they're hygroscopic and in time might dissolve
and will have a gap there
6. Use regular composite heavy loaded to minimize the shrinkage and cure in incremental
layering (Dr. Kanka procedure) to decrease the shrinkage and avoid overheat from bulk
polymerization that will release a lot of heat. Check occlusion.
7. Regular composite that I designed since 1980s would cure easy up to 8mm, but I would
not recommend bulk polymerization (see #6).
8. Let polymerization not be disturbed for 1-2 minutes or longer.
Be sure that you are using a good bonding solution and a good composite that would be in
touch with painted bonding solution. ■
1/29/2018

46

APRIL 2018 // dentaltown.com


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Table of Contents for the Digital Edition of Dentaltown April 2018

Dentaltown April 2018 - Intro
Dentaltown April 2018 - Cover1
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Dentaltown April 2018 - 1
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Dentaltown April 2018 - Cover3
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