DentaltownUK April 2017 - 43

cases of postop sensitivity that nothing helps but time. I have seen one case like that. A dentist
had replaced her asymptomatic amalgam. She became symptomatic. He adjusted her occlusion
several times. Eventually she got to me. I removed the composite and placed Vitrebond. The
pain went away. I did a new composite using Surpass. The pain came back. I had removed all of
the Vitrebond. We redid the composite with Vitrebond lining on all of the dentin and the pain
remained. We elected to wait and see if endo was in the cards. At the next recall four-month
postop, she was better. (And I always worked under rubber dam isolation, with the same excellent assistant for over 10 years now.)
There are some cases that cannot be solved simply. Switching to another bonding system
when you have had good success with yours is not the answer. Give it time. It can take up to
three months. ■

7/20/2016

Thank you, Karim! I called to check up on the patient. She stated she felt better but I am
keeping my fingers crossed and hopefully time and a little hand-holding will take care of the
issue. Matt, I use a rubber dam for all composites. ■

Epicurean74
Member Since: 12/14/13
Post: 8 of 62

7/21/2016

I replace amalgams daily. Get yourself some Clearfil SE Protect from Kuraray. This stuff is
bulletproof. Zero sensitivity for four years now. It will give you a good night's sleep. ■

Fayad 2012
Member Since: 03/29/14
Post: 9 of 62

7/21/2016

In total-etch, a poor bond is usually due to overdrying the dentin. If using total-etch, the
dentin needs to be wet when the bonding agent is applied. If you just can't leave it wet, better off
using a self-etch. But, total-etch is better in my opinion. ■

pjmop
Member Since: 02/15/05
Post: 11 of 62

7/22/2016

I also use Surpass and can't remember the last time I had a postop sensitive composite (unless
it was near endo.) ■

THE Token Redneck
Member Since: 09/22/03
Post: 14 of 62

7/24/2016

I'm a huge fan of Gluma (or if you're not rich like myself, MicroPrime G). It lets you rewet
dentin after etching if you overdried, helps disinfect the cavity, reduces postop sensitivity.
I use MicroPrime G on any restoration that hits dentin.
As far as the original post: Are you doing an incremental fill or bulk-filling? A dentist in the
area I know is a bulk-fill guy and I get an appreciable number of his patients with sensitivity
months after the fills. ■

nealofgrafton1
Member Since: 09/05/15
Post: 15 of 62

7/24/2016

I was taught to etch dentin for less than 15 seconds and enamel for more than 15 seconds.
This is done by carefully placing etch on enamel first, then to dentin. You could be overetching
deeper dentin. Or overdrying. Or both. ■

Phil13lance
Member Since: 02/27/15
Post: 17 of 62

7/24/2016

I routinely overetch dentin with no problems. If anyone knows of literature showing how
long it takes for dentin to be overetched, I'd like to see it. In my opinion, it's more likely that the
dentin is not etched long enough ... especially sclerotic dentin. Sclerotic dentin gets roughened
up with a diamond bur and etched for about 30 seconds in my hands. Then rinsed and left wet

pjmop
Member Since: 02/15/05
Post: 18 of 62

dentaltownuk.com \\ APRIL 2017

http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK April 2017