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Medical Forum / General / Dentistry / December 2004

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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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Not a real Addy, yet

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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Not a real Addy, yet

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????
Signature

Not a real Addy, yet

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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Not a real Addy, yet

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
Signature

Not a real Addy, yet

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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