Yup.
    Not that I feel too confident about an incisor with everything rotted
away but the labial shell of enamel, which is practically what this
thing sounds like.

Steve

My hemostatic of choice is Visco-Stat, which comes in a 1cc syringe, and
I start by putting some on right after I put on the topical anesthetic.
I repeat all thru the prep, putting it on and RUBBING it into the gum
with a micro-brush. You have to SCRAPE it against the open wounds, which
means you should anesthetize before hand. If you do this at the start,
your highspeed running (in most cases) with water on high, the excess
stuff will be washed out by the time you get to filling. I make a final
test with a generous air/water wash and wait a few seconds. If it's
gonna gush again, NOW is the time to curse and pray, and re-apply the
blessed stuff. If after one minute or so it is STILL oozing, break out a
quarter cc of Xylo with 1:50 000 epi. Put that right next to the worst
bleeding (on the intact gum tissue a couple of mm away) and etch, bond,
etc. You'll have about two minutes before the second (beta receptor)
vasodilation sets in, so plug that area first and then do the rest.

The best chord packer I know of is the Hu-Freidy CVIPC interproximal
carver, while you're holding the chord in place with a perio probe.
Start by snuggling it in to the deepest place using it like dental
floss, hold it with the perio probe and use your chord plugger. The ones
you have in your kit have teeth on 'em....  I prefer the CVIPC, 'cauze
it DON'T have teeth, but use what you have.

Re dentinal sensitivity and being close to the nerve and all that
bullshit: my own standard technique is to go around the enamel using my
etch in a 1cc syringe, waiting about @#$$ seconds, and then plastering
the dentine with the stuff. NOW is the time to start the clock: FIFTEEN
seconds (15...... not 50). If there is sclerotic dentin around (as under
an old Am), I squirt that area at the same time as the enamel. If you're
still using paint brushes to put the etch on, skip this last.

In a case like this, I wash wash wash without air, and blot dry with
cotton pellets (or even the end of a cotton roll, with a sink-like
lesion like this one). Put on your primer/bonding waiting FIFTEEN
seconds each for the stuff to SEEP IN to the dentin. Do this and you get
a good thick hybridized zone, and so sensitivity goes down. This cannot
be over emphasized. There was a story Jeff Brucia told us whereby there
is one of the Japanese companies who put chloro-quinone into their
PRIMER, and they recommend you cure that primer. The reason? To force
the dentist to SLOW DOWN and allow the blessed stuff to seep in before
he freezez it in with the bonding.

So, you see, you have at least 15 seconds etch, 15 seconds primer, 15
seconds bonding, and then you have to run to get the white stuff in if
you've had to use the Xylo for vasoconstriction. That is why I start
with the Viscostat even BEFORE I hit the tooth with the rotary
instruments.

One word of caution: any ferrous oxide (or is it sulphate?) product will
stain permanently. Protect yourself and your patient by carrying it to
the zone on a 2X2, and if it is in a syringe, pull back on the plunger
so it doesn't ooze out onto (hopefully) the patient's bib.

In the back (say, a buccal Cl V that is partly subgingival) I do roughly
the same thing (bonding-hybridized layer, I mean), but often I fill 'em
with (gasp!) Ammmmmmmmmalgam....

Hope this helps.

SP

You will see lots more like this before retirement. Just make sure the
patient knows this treatment is short-term, and that the tooth will be
lost, eventually.

Amatus

..

Amatus

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