Medical Forum / General / Dentistry / December 2004
UR6 Molar Endo and restoration
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Aosmosis - 16 Dec 2004 01:09 GMT A patient presented with a temp made from ZOE (Kavit) covering the disto bucco occlusal surfaces.
I am halfway performing the endo. When I came to temporize the tooth, as the floor of the cavity is flush with the gingivae, the matrix band kinks inwards. I was advised to use Chemfil and do it freehand, as chemfil is viscous and allows some control, so no ledges occur.
This worked ok!
After I do the endo, I need advice on the core buildup material prior to doing a prep for a gold crown
Choices are
RMGIC Composite Bonded Amalgam
Composite shrinks on curing, and also remnants of Zinc Oxide euginol hamper bonding.
What about Fuji II LC (RMGIC) does this suffer from the same degree of shrinkage upon curing?
The other option is bonded amalgam. I spoke to another instructor, he told me to "shove the matrix band subgingivally, so it wraps round the tooth and wont kink in. Unfortunately there will be bleeding!! You may need upto 3 wedges"
Anyone offer any advice when trying to restore 2 adjacent walls which form a corner?
Thanks
Dr Steve - 16 Dec 2004 14:16 GMT Student days?
Don't fight it. Do whatever method your instructor likes best that day. Do it his way and learn from him. Next time get a different instructor to give you a different perspective. Eventually, you will develop a "feel" for what really works well for you.
Personally, I would skip the core and do a CAD-CAM build up of the missing tooth structure as part of the onlay. Ten years ago, I would have placed minim pins and vibrated amalgam in to form the core. As far as the band goes,,,,,,,,,,,,,,,,, push it sub-gingivally, and place a large enough wedge to push it against the cavo-surface margin. Most times, a large wedge will do the job very well. Sometimes, you need to place a wedge buccal and another wedge lingually to hold the band in place. If wedges will not work, use a thick band, tighten it very tight, and forget about getting proximal contacts.
Personally, I do not like composite cores unless we are trying to re-use an existing crown.
BTW, Cavit and ZOE are different.
 Signature ~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA ....................................................
This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ......................
>A patient presented with a temp made from ZOE (Kavit) covering the disto >bucco occlusal surfaces. [quoted text clipped - 30 lines] > > Thanks StovePipe - 17 Dec 2004 19:34 GMT > Most times, a large wedge will > do the job very well. Sometimes, you need to place a wedge buccal and > another wedge lingually to hold the band in place. If wedges will not work, > use a thick band, tighten it very tight, and forget about getting proximal > contacts. I've found that when I need to do this, if I polymerize a small strip of composite widthwise on a Palodent matrix, I can use that to push the band onto the adjacent tooth as my assistant polymerizes. I place some composite diagonally in the proximal box, push the pre-hardened wedge into that, convex side outward, and push against the matrix. One last pack of the composite in the box to seal any voids and we blast it. The natural curve that the Palodent gives the wedge also helps in establishing a good contact. The trick is to fill in any voids you have before completing the box. This usually means you have to put down the mirror, get on your feet and contort yourself to be able to hold the wedge in one hand and pack the unpolymerized composite against it with the other. It's longer, but hell, it works if you have the patience. HTH SP
 Signature Not a real Addy, yet
Joel M. Eichen - 17 Dec 2004 22:46 GMT >> Most times, a large wedge will >> do the job very well. Sometimes, you need to place a wedge buccal and [quoted text clipped - 5 lines] >composite widthwise on a Palodent matrix, I can use that to push the >band onto the adjacent tooth as my assistant polymerizes. Good tip. Thanks.
So you could say the dental assistant must not forget to give the doc a wedgie so the job turns out good.
Joel
I place some
>composite diagonally in the proximal box, push the pre-hardened wedge >into that, convex side outward, and push against the matrix. One last [quoted text clipped - 7 lines] >HTH >SP StovePipe - 18 Dec 2004 07:11 GMT > Good tip. Thanks. > > So you could say the dental assistant must not forget to give the doc > a wedgie so the job turns out good. > > Joel Good one! SP
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W_B - 18 Dec 2004 07:35 GMT >> Good tip. Thanks. >> [quoted text clipped - 5 lines] >Good one! >SP Attention Ladies and Gentlemen... We have a winner !
Give that man a thong ! {and make him wear it !}
-- W_B
wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE
Roy Brown - 18 Dec 2004 07:58 GMT | >Good one! | >SP [quoted text clipped - 6 lines] | -- | W_B Better one! Roy
StovePipe - 18 Dec 2004 15:30 GMT > Attention Ladies and Gentlemen... We have a winner ! > [quoted text clipped - 6 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Gawd!!!! thet would cause a panic in the city... SP
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Steven Fawks - 16 Dec 2004 14:18 GMT Zinc oxide will not be a factor after it has set for a few days. Clean it out well, scrub it with a little alcohol, rinse, etch, and bond in composite. Layering will take care of shrinkage problems (should use a composite with low shrinkage numbers like Heliomolar).
JMO, Fawks
> Composite shrinks on curing, and also remnants of Zinc Oxide euginol hamper > bonding.
> Thanks StovePipe - 17 Dec 2004 19:34 GMT > Zinc oxide will not be a factor after it has set for a few days. Clean > it out well, scrub it with a little alcohol, rinse, etch, and bond in [quoted text clipped - 3 lines] > JMO, > Fawks There is also a product to clean Eugenol called CaviDry. I don't know how good it is, but the local prostho guy who gives courses in C&B uses it always. HTH SP
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W_B - 17 Dec 2004 22:10 GMT >> Zinc oxide will not be a factor after it has set for a few days. Clean >> it out well, scrub it with a little alcohol, rinse, etch, and bond in [quoted text clipped - 9 lines] >HTH >SP I use CaviDry (Used to be Cavilax) to clear the grossman's after endo Then with the RD still in place, do the Fuji 9 tango.
-- W_B
wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE
StovePipe - 17 Dec 2004 23:56 GMT > I use CaviDry (Used to be Cavilax) to clear the grossman's after endo > Then with the RD still in place, do the Fuji 9 tango. > > -- > W_B Good point.... the eugenol is fresh and that's the opposite of what you want. Why don't you use one of the sealers based on Ca(OH)2 instead????
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W_B - 18 Dec 2004 01:03 GMT >> I use CaviDry (Used to be Cavilax) to clear the grossman's after endo >> Then with the RD still in place, do the Fuji 9 tango. [quoted text clipped - 4 lines] >Good point.... the eugenol is fresh and that's the opposite of what you >want. Why don't you use one of the sealers based on Ca(OH)2 instead???? I follow Dr. Endo's advice.
-- W_B
wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE
W_B - 16 Dec 2004 20:29 GMT >After I do the endo, I need advice on the core buildup material prior to >doing a prep for a gold crown Fuji 9 --
W_B
Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
Aosmosis - 17 Dec 2004 00:13 GMT >>After I do the endo, I need advice on the core buildup material prior to >>doing a prep for a gold crown [quoted text clipped - 6 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Thanks for your help guys!
At dental School, I have come across the eternal dilemma of 1 instructor says one thing, another says do it another way. When you come to get your marks at the end of the session, the instructor may knock some marks off because you didn't do it his preferred way - even though you had no idea what his preference was!.
BTW We are restricted to whatever materials we have on Clinic. I know we have Fuji II LC which is an awkward material to work with. What is Fuji 9 like.
Also we have Kalzinol, but I can never get a nurse to mix it right, so I use Cavit, which I thought was based on ZOE. If it isn't, what is it based on?
thanks!!
I am going to be seeing the endo patient in Jan, I will try and use the subgingival technique! Wish me luck...
W_B - 17 Dec 2004 16:16 GMT >BTW We are restricted to whatever materials we have on Clinic. I know we >have Fuji II LC which is an awkward material to work with. What is Fuji 9 >like. Simple to manipulate, comes in capsules, perfect mix every time, bonds to tooth structure, sets harder than tooth, preps nicely.
I see no downside as a core material. --
W_B
Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com
StovePipe - 17 Dec 2004 19:34 GMT > >BTW We are restricted to whatever materials we have on Clinic. I know we > >have Fuji II LC which is an awkward material to work with. What is Fuji 9 [quoted text clipped - 5 lines] > I see no downside as a core material. > -- I've been using the stuff for a couple of months, now, and I must concurr: You can't sculpt it while applying it (as least _I_ can't...) but it sculpts well with finishing diamonds and my favorite: the 1157 carbide steel bur. This is like an elongated 330 and is concave in the middle part, and no crosswise striations. You can sculpt/polish with this bur just about anywhere you don't need access with a pointed bur. The more you use/sterilize it, the better it gets as a polisher.. If you have them in your supply store, try it.
I've tried Geristore and Fugi 9 and Fugi 9 wins hands down. Only defect I can see is that it is wasteful in that I never seem to have enough sites to apply all that is in the capsule. I would like to see a powder/ liquid set, but that would be hard:you condition for 10 secs and rinse, then you mix ten secs, stick it the applicator and apply ten secs. So, there's no fooling around. You polymerize 10 secs, wait three mins, sculpt/ polish and apply the protective resin. You don't even have to re- etch.
You could try to convince your Profs to order a kit so y'all could fool around with it. I'm sure GC America would be only too happy to furnish an intro kit free of charge.
BE CAREFUL passing it over the patients' face and EYES..... ;-) Bring your amalgammator in close if you're alone, and set it for 10 secs.
FWIW, Jeff Brucia (USAian dentist-researcher, USF) says that for his money, there only two real players in the Glass Ionomer field: GC/Fugi and 3M/ESPE (Vitremer, etc). The others are still perfecting the art. So, take that FWIW: one dentist's opinion concerning JB's lecture seen last May. This guy is worth seeing, IMO.
As to your comment about Fugi II LC being a bitch to manipulate: Get a set of Centrix empty compules. There's one compule that is orange colored and the tip is a bendable metal tube. I cut half the tube off with the High Speed, have my assistant mix up some F II LC, I scoop it up into the compule as you would impression material into a Monoject C&B syringe, place the plastic plunger and a couple of cotton pellets behind that, put it into the Centrix gun, and casually insert the tip into the proximal box. Gently squeeze, and you're away. Don't worry too much about taking too much time. F II LC is slower that F 9 to harden, and if you go smoothly, you have time. The first time I did this in a REALLY deep distal box (I was hearin' Chineese in there...) I was grinning stupidly under my mask at how EASY AND FUN applying F II LC had suddenly become.
If you don't have a Centrix, you can use an Am plugger (Biggest one that fits) and place the stuff as best you can, swearing all the way, wait till the autopolymerization reaction starts, and plug it in there as it becomes stiff. I know I was altering the physical properties of the stuff when I was doing this, but I couldn't see any other way. As soon as it is in, take the handle part of your college pliers and use it as a pen knife and scrape the residual stuff off your plugger. THEN take the light to it in the mouth. HTH SP
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Dr. Steve - 17 Dec 2004 18:53 GMT >>>After I do the endo, I need advice on the core buildup material prior to >>>doing a prep for a gold crown [quoted text clipped - 26 lines] >I am going to be seeing the endo patient in Jan, I will try and use the >subgingival technique! Wish me luck... I thought there was an issue of CAVIT killing vital pulps? .. Stephen Mancuso, D.D.S. Troy, Michigan, USA
Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting.
W_B - 17 Dec 2004 22:10 GMT >I thought there was an issue of CAVIT killing vital pulps? >.. >Stephen Mancuso, D.D.S. Never seen it happen and have used it lots ! It does act as a dessicant though. Place it in a wet cavity... no problemo.
-- W_B
wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE
Dr. Steve - 17 Dec 2004 22:47 GMT >>I thought there was an issue of CAVIT killing vital pulps? >>.. [quoted text clipped - 3 lines] >It does act as a dessicant though. >Place it in a wet cavity... no problemo. I have seen it happen either. Was told this at a seminar many years ago. The Cavit sucks the moisture out of the tubules. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA
Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting.
Dr. Steve - 17 Dec 2004 22:52 GMT >>>I thought there was an issue of CAVIT killing vital pulps? >>>.. [quoted text clipped - 3 lines] >>It does act as a dessicant though. >>Place it in a wet cavity... no problemo. I have NOT seen it happen either. Was told this at a seminar many years ago. The Cavit sucks the moisture out of the tubules. ..
.. Stephen Mancuso, D.D.S. Troy, Michigan, USA
Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting.
StovePipe - 17 Dec 2004 23:56 GMT > >I thought there was an issue of CAVIT killing vital pulps? > >.. [quoted text clipped - 6 lines] > -- > W_B That IS strange.... Cavit has CaO in it.... that is supposed to suck out the water in the nerve... Do you notice calcificatios in later years in the B/W's? SP
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W_B - 18 Dec 2004 01:07 GMT >> >I thought there was an issue of CAVIT killing vital pulps? >> >.. [quoted text clipped - 11 lines] >the B/W's? >SP Temporary fill only. I don't even prep the tooth. A little saliva in that crater ? No problem, stuff some cavit into it. Wet and all that.
-- W_B
wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE
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