I’m back with another look at clinical sensitivity after routine procedures.
It has become common for Dentists to place a liner prior to the buildup of a composite. The original idea was to place something that would line the deepest part of the tooth to decrease cusp deformation associated with resin polymerization shrinkage during the curing process. The problem begins when we use an unfilled resin in a syringe to do this. Consider that we must bond this layer in with a 4th to 12th generation bonding agent that may or may not use total etch, two bottles, or one bottle self-etch that creates varying degrees of success. At best it is abused and worst it is the wrong material for the wrong reasons. We are bonding to moist dentin with a material that shrinks at least 2-4%, is sensitive to the moisture, poor bond strength, no decay resistance, and inadequate structural support. There is a better way. It will guarantee no sensitivity, will last longer than the composite filling placed over it and is designed to work in a wet environment that activates its cavity fighting fluoride release.
For over 15 years we have used a modified resin modified glass-ionomer to line our crowns and fillings. These are just some of the advantages:
• Counteracts stresses created by the polymerization of your composite
• Eliminates post-operative sensitivity to biting, and temperature
• Lasts 25 years (that’s longer than your composite)
• Adheres to tooth structure intimately
• Wets the dentinal tubules by chemical bonding
• Coefficient of thermal expansion is the same as tooth structure which eliminates marginal leakage
• Fluoride ion release decreasing or eliminating recurrent decay, and creating an antimicrobial effect
• No shrinkage upon cure (this is awesome)
• It can be “bulk” filled because of no shrinkage which speeds the process (I would even use it for children’s fillings, geriatric root decay, and buildups)
• Does not need bonding agents, therefore the danger of using a particular bonding agent is done after the liner is placed so that it only touches the enamel. NOTE: The fourth generation bonding agents are much stronger than subsequent bonding agents, but you must use total etch to use them. The liner eliminates any danger and allows you to have the best of both worlds.
The last area could be classified as a violation of “standard of care” in the clinical arena. I believe that every tooth we open needs to be disinfected, desensitized, and sealed.
• Every tooth prior to placing a temporary, filling, or crown should be scrubbed, cleaned, and disinfected with Chlorhexidine: Consepsis from www.ultradent.com .
• Every tooth should be desensitized with 5% glutaraldehyde and 35% HEMA: GLUMA, Glu/Sense, G5, MicroPrime.
• Deep Restorations: Use TheraCal from Bisco
• Then we use our resin reinforced glass ionomer: Vitrebond Plus from 3M ESPE, Fuji Lining Cement LC form GC, or RelyX.
I hope this helps. As usual, if you have a question about anything, just give me a call.
This is how you Summit.
Michael Abernathy, DDS