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Medical Forum / General / Dentistry / December 2006Equilibration / Abfractions
All, I posted some time ago about a problem my dentist identified with abfractions. I have started the treatment, and he has completed the equilibration. My last visit was the start of the abfraction repair, in which he built the lesions back up with a resin filler. He numbed me for this process...fortunately! The process seemed to be very agressive. He "stringed" my gumline so he could prep the part of the tooth that would be built up with resin. He then applied the resin. The first couple of days after the treatment - I could tell that sensitivity I one had subsided...but now - holy God! The teeth that were fixed, on a scale of 1-10 with 10 being intolerable, are a complete 10. Hurts like HELL. I have some throbbing, and the sensitivity is thermal - cold only. Is this normal? He told me that sensitivity could last for a bit - but this is crazy - and 10 times worse that I ever experienced before. He wants to do the remaining teeth on Monday - but I'm having second thoughts. I want to call him tomorrow - but wanted to check this group first. Any help is appreciated! Chris > All, > [quoted text clipped - 25 lines] > > Chris Get a second opinion. When I restore these (I frequently choose NOT to) I treat them conservatively. With modern adhesive dentistry I see no reason to prepare these teeth, esp. on the root surface where there is proximity to the pulp. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Abfractions may not be stopped with just an equilibration. I would recommend an NTI (small night time bite guard) as well. As far as the pain, it could be the bonding system and technique are to blame, or it could be that the dentist was over zealous in trimming and polishing on the root surface. Sensitivity should be less, not more. D >> The first couple of days after the treatment - I could tell that >> sensitivity I one had subsided...but now - holy God! The teeth that [quoted text clipped - 5 lines] >> Is this normal? He told me that sensitivity could last for a bit - but >> this is crazy - and 10 times worse that I ever experienced before. >> Any help is appreciated! >> >> Chris > Get a second opinion. When I restore these (I frequently choose NOT > to) I treat them conservatively. With modern adhesive dentistry I see > no reason to prepare these teeth, esp. on the root surface where there > is proximity to the pulp. > > Steve He has stated that he would like to look at a splint when the treatment is finished. For the sensitivity - what can be done to correct this if he was "over-zealous"? Chris > Abfractions may not be stopped with just an equilibration. I would > recommend an NTI (small night time bite guard) as well. [quoted text clipped - 27 lines] >> >> Steve > He has stated that he would like to look at a splint when the treatment is > finished. > > For the sensitivity - what can be done to correct this if he was > "over-zealous"? If the root surface was abraded during finishing and polishing of the restoration, it may respond to using a tooth paste for sensitive teeth, high fluoride gel, or application of a self-etch bonding resin (my preferred choice if the sensitivity is severe). DO NOT use tartar control tooth paste or anything that has bleaching/whitening ingredients. I was just cutting a crown prep on a lower molar for a patient and the air/water spray + suction was causing pain on the upper molar. I dried the root surface and applied Clearfil SE bond, cured it, and the problem was solved. Clenching on sensitive teeth tends to keep them sensitive. That's why I make an NTI early in the treatment. You may find you don't need an equilibration at all and if you do, the dentist may find that the actual 'bite' is in a different position than he thought. JME, D Thanks for the response - your thought on modern adhesive dentistry leads me to another question. My DDS commented that these fillers would probably have to be replace every few years...they would probably not stay in place permanently. Is that your experience when you do treat abfractions? Chris >> All, >> [quoted text clipped - 33 lines] > > Steve > Thanks for the response - your thought on modern adhesive dentistry leads me > to another question. [quoted text clipped - 4 lines] > > Chris If these are indeed abfractive lesions, we can expect the same process to continue if the parafunction (see post by Dartos) is not reduced. If it is toothbrush abrasion we can expect the fillings to wear if you don't change your brushing habits. However, composite resins hold up much better than they used to, and this isn't an area of wear from actual chewing. So I have actually seen these hold up 10 years or more. Sometimes I use softer materials, esp. if I am afraid of sensitivity (as you discovered, the bonding process had the potential to cause sensitivity)--esp. on older patients with deep erosions, I often use glass ionomer cement. Even these I've seen hold up several years. Steve >>>All, >>> [quoted text clipped - 33 lines] >> >>Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 OK - back from the dentist. Told him about the problem - and I have to admit - he danced a little. He blew some cold air on the backs of my teeth that he repaired - no pain. Blew it on the fronts, almost jumped out of the chair. He instructed me to take advil, and to use a floride rinse (Dentx). He never really gave me a straight answer on the cause, or the potential cure. He did say that perhaps clenching activity could be pulling the bond away from the tooth? Bottom line - he was not 100% certain of anything...but tell me that he didnt think I needed a root canal at this time???? Now i'm frustrated Chris >> Thanks for the response - your thought on modern adhesive dentistry leads >> me to another question. [quoted text clipped - 55 lines] >>> >>>Steve > OK - back from the dentist. > [quoted text clipped - 9 lines] > > Now i'm frustrated One of those things. The pulps may well recover. The fluoride rinses may help. But you're the one feeling the pain, and only you can decide when you've had it. My suggestion is that you avoid cold liquids for a week or so. You should see gradual improvement. As long as things improve, I'd give it a little more time. If things go backwards or stop improving and there is still significant pain, go back for sure. This procedure was intended to help, not drive you nuts. Steve > Chris > [quoted text clipped - 57 lines] >>>> >>>>Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Hey - thanks for your feedback on this topic! I swallowed some advil yesterday, rinsed with the flouride...very good result! I'm going to stick with the advil and the rinse for a few days and see how it goes. Advil helping tooth sensitity - would have never thought that would be the case! Does this mean that more than likely the scenario is temporary? Also - on the rinse...instructions say once a week. Should I go for more than that? Chris >> OK - back from the dentist. >> [quoted text clipped - 84 lines] >>>>> >>>>>Steve > Hey - thanks for your feedback on this topic! > [quoted text clipped - 9 lines] > > Chris No promises--but if you've really got a hot tooth, ibuprofen ain't doin' squat, so I see it as encouraging. I'm not familiar with the particular fluoride rinse. I'd ask your dentist, but most of them are intended for daily use. Steve As Dartos said, the cause of the abfractions must be addressed. Also recommend the NTI. There are a number of factors that influence whether an abfraction gets restored in my practice, mainly depth, sensitivity, and decay. >Thanks for the response - your thought on modern adhesive dentistry leads me >to another question. [quoted text clipped - 41 lines] >> >> Steve >> All, >> [quoted text clipped - 32 lines] > >Steve I tend to prepare them a little to get some mechanical retention and restore with filtek supreme plus flowable for small ones, larger ones get flowable and Z250. Using Clear Fill Self Etch for bonding. Rarely have to use retraction cord, a 212 rd clamp can be used to retract the gingiva if necessary. > I tend to prepare them a little to get some mechanical retention and > restore with filtek supreme plus flowable for small ones, larger ones > get flowable and Z250. Using Clear Fill Self Etch for bonding. > > Rarely have to use retraction cord, a 212 rd clamp can be used > to retract the gingiva if necessary. Sounds good. I don't remember using retraction cord in a non-carious situation--not many of these are subgingival. I suppose if the gingivae were really boggy it might be necessary. Steve |
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