DentaltownUK April 2017 - 42

General Dentistry
Message Board

Post-Op Sensitivity After Replacing
Amalgams with Composites
After a patient returns complaining of sensitivity to cold, a dentist wonders if he's been doing composite
restorations correctly. Townies weigh in with several possible factors, including etch time and isolation.
Dentaltown.com > Message Boards > Dental "Pearls" > Dental "Pearls" > Post-Op Sensitivity After Replacing Amalgams with Composites

Epicurean74
Member Since: 12/14/13
Post: 1 of 62

Hi everyone, I am wondering if there is a foolproof way of avoiding sensitivity replacing
amalgams with composites. I replaced a few amalgams which had nothing wrong with them
on patient's request. The amalgam restorations had no underlying caries, etc. Now the patient
is back, complaining of sensitivity to cold. Occlusion was checked and no hyperocclusion was
noted. I redid the fills with composites again but I have a weird feeling she is going to be back
again. Somehow I think I am getting punished for going against my gut feeling.
My protocol is total-etch, desensitize with Gluma, bonding and flowable co-cure, flowable
again and then packable composite (Tetric EvoCeram Bulk Fill), Should I be using Vitrebond
liner, more so when replacing amalgams with composites? Any pointers? All input and feedback
is much appreciated! ■

7/19/2016

Tom Mitchell
Member Since: 02/16/04
Post: 2 of 62

Throw away your Gluma. Switch to Surpass and follow the instructions. Be sure you're
pulse-curing. The problem always is poor/incomplete bond to dentin combined with highintensity curing. If it returns, you have to remove them and redo. Best of luck. ■

7/19/2016

ConDrill2000
Member Since: 08/20/14
Post: 3 of 62

Depending on how many years that patient had that toxic mercury in her mouth, this could be a
hopeless case. Kidding! I'm personally not a fan of the bond and flow co-cure. I would cure the bond
before putting down the flow. How long are you leaving the etch on for? What bond do you use? ■

7/19/2016

Epicurean74
Member Since: 12/14/13
Post: 4 of 62

Total-etch for 20 seconds, rinsing out and then Adhese bonding agent. Haven't had an issue
with regular composite restorations. That's why I am a little puzzled. Will switch to Surpass at
my next order cycle. Thank you both! ■

7/19/2016

keepin it simple
Member Since: 10/13/11
Post: 5 of 62

Just follow your manufacturer's bonding instructions to a "T." Since different bonding
agents and composites vary slightly, there is not a purely universal way. I think that people get
into trouble with this because they create shortcuts thinking that it is insignificant. They then
blame the product when they have problems. ■

7/19/2016

mattcosta
Member Since: 07/02/09
Post: 6 of 62

eeznogood
Member Since: 02/23/06
Post: 7 of 62

42

How are you isolating? The most common cause of postop sensitivity is contamination during bonding. ■

7/20/2016

I am a huge fan of Surpass, and if you want to try this product, I think you will love it.
But for this case, it might not make a difference. I have (rarely but it happens) encountered

APRIL 2017 // dentaltownuk.com


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