A Bonding Protocol That Tackles Sensitivity
While a filling may seem like a routine procedure, we, as dentists, know that it can sometimes be more difficult than a crown or some other procedures. We need to consider many factors prior to preparing and restoring a cavity. What kind of materials should I use? Should I layer a composite or use a bulk fill? What is the depth to pulp and depth of cure needed? How much decay should I remove and where? How can I best prevent postop sensitivity?
While these decisions get easier as we gain more experience and knowledge from continuing education courses, we are always learning and evolving. In an industry that is constantly changing and adding new materials and techniques, it is important to stay one step ahead and strive for perfection. After all, “good enough” is not good enough.
Abolish Postop Sensitivity
When I first started practicing, bonding agents were limited to acid etch and two-part systems, and those techniques presented some challenges like sensitivity, over-etching, or over-drying of the teeth. Then came the all-in-one bonding systems that incorporated an etchant, primer, and bonding agent in one bottle. While the all-in-one bonding systems were definitely easier to use than 3-step systems, many patients I treated with some of the early all-in-one systems experienced postop sensitivity.
Hoping to make postop sensitivity a thing of the past, I finally tried All-Bond Universal, a single-bottle universal adhesive from BISCO, which I’ve found to be the ideal bonding solution for most cases. As soon as I switched to using All-Bond Universal, my sensitivity rates decreased a lot. I also started using a biomimetic technique that layers the floor of the cavity with a flowable composite. By combining All-Bond Universal with the biomimetic technique, postop sensitivity has become ancient history, with almost all postop sensitivity eliminated after fillings or buildups.
For this case, I used BISCO’s All-Bond Universal adhesive with TheraCal LC as a base/liner to ensure that my patient’s restorations would be securely bonded and protected from postop sensitivity, even with the presence of deep decay.
Annihilate Deep Decay
A 31-year-old male presented with several areas of moderate and deep decay that needed fillings (Figure 1). Teeth Nos. 13, 14, and 15 were prepped with high-speed carbide burs using an electric handpiece (ELECTROmatic Premium, KaVo), and decay was excavated (Figures 2 and 3) with round slow-speed burs and
internal water. Tooth No. 15 had deep decay, so I used 2% chlorhexidine to disinfect the area and placed TheraCal LC (BISCO), a resin-modified calcium silicate, as a pulp protectant/liner (Figures 4 and 5). TheraCal LC forms a protective barrier to protect the pulp at the deepest area of the preparation.
I applied All-Bond Universal as the bonding agent (Figures 6 and 7) and placed a layer of flowable composite to seal the pulpal floor of the prep (Figure 8). I then placed a nano-hybrid composite resin using a layering technique to fill the cavity. After checking and adjusting the occlusion, I polished the composite using medium and fi ne polishing cups. The composite blended well to the existing tooth structure, resulting in a more than satisfactory esthetic result in a nonesthetic area. The patient was pleased with the final results of his restorations (Figure 9) and has not experienced any postop sensitivity, even on the deeply decayed tooth No. 15.
ALL-BOND UNIVERSAL
Combining etching, priming, and bonding in 1 bottle, BISCO’s All-Bond Universal is an ethanol/water-based dental adhesive that bonds to dentin and cut and uncut enamel. It can be used with both direct and indirect restorations and also bonds to all indirect substrates. In addition, All-Bond Universal is compatible with all composite and resin-based cements without the need for an additional activator.
THERACAL LC
A light-cured, resin-modifi ed calcium silicate filled liner, TheraCal LC is indicated for direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. The hydrophilic resin formulation creates a durable liner, while its light-cured set permits immediate placement. TheraCal LC results in virtually no postoperative sensitivity.
After earning his DMD from Boston University in 1999, Dr. Jaskiel relocated to sunny South Florida and earned a certifi cate for Advanced Education in General Dentistry. He loves being a dentist in Miami and takes pride in providing excellent service for his patients while helping them overcome their fears. His children share in his passion for dentistry and are both currently in dental school. When he’s not making beautiful smiles, Dr. Jaskiel is involved in charities and his community. He has volunteered and taught at Community Smiles Dental Clinic, where he served on the board of directors in various capacities for over 10 years. He enjoys staying current with the latest technology and advances in dentistry.
