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Glenn van AsSpectatorOK Ron so my question is what would people have done on this very large hemorrhagic pulp exposure that was carious and wouldnt stop bleeding and in addition was on a pediatric tooth.
Glenn
Glenn van AsSpectatorHi Mark………I will be in town that week and maybe I might be able to drop by during the lecture or at the end……who knows.
Its a busy month for me and I do want to spend some time with my family so make sure you email or phone me in advance.
I got my second set of instruments today and am starting to use Marks instruments for most of my composites.
Check them out if you havent already.
Glenn
AnonymousSpectatorFWIW,
In my neck of the woods I think you’d see-
35% caoh and amalgam
45% direct bond w/ composite
15% GI and composite
5% no exposure, seal decay with GI and then place composite.
Anyone else with some estimates of how they’d see percentages in their area?
Glenn van AsSpectatorOk we agree to disagree, I still believe that in pediatric teeth Caoh is not effective.
If there is an exposure that takes a long time to control , a pulpotomy is the right answer. This carious exposure was huge, I could have got it with a spoon it was so big
I wish I had a preop photo but there was tons of decay in the tooth.
Lets see if it becomes necrotic…….it might.
Its not that I dont trust you but very very few of my pulp caps in kids have ever worked and when they go necrotic its time to exo them and space maintainer. You only have one chance and thats when it is vital.
Glenn
AnonymousSpectatorGlenn,
I’m not disagreeing with your treatment at all. I was just trying to see what it was you used and why. From the thread on DT you can see there are lots of opinions, some appear to have some reasonable thought, some do not. I respect your opinion, that’s why I asked.
I think the GI was a very good choice to seal things off.
As far as the % I posted ,that was just a rough guesstimate as to what I would see the dentists around here do. It wasn’t that my choice would agree with the majority.
Anyway, I think the tooth will make it for you, and from the looks of those pictures, the patient will probably give you lots of other challenges too.
b lashSpectatorDoes anyone else have the color of dentin change to an amber color even though it feels hard after laser caries removal. I am having a tough time telling when I have all the decay out of some of the procedures Im doing. I can tell that if I have the power turned up to high it will scorch the dentin and I either turn down the power or de-focus. However, I still think I have all the decay out, but I still have the amber look of decayed or affected dentin. Am I OK or should I be taking more out.
Ben
Glenn van AsSpectatorYour water spray isnt high enough
Your suction is too close
You are creating such a deep small trough that the water isnt getting down there.You are burning the denti.
I know thats tough to believe but honestly that is what it is.
There is a need for the water to be more of it on the tooth in order to prevent the charring of the dentin.
Glenn
SwpmnSpectatorThat’s amazing healing!!!!!!!
And your buildup held great!!!!
Planning to see you around this time next week.
Al
Glenn van AsSpectatorI completely forgot Allen……….will be fun. Drop by and lets share a laugh or two.
I will be in the Hoya booth for Friday pm and Saturday pm and the rest of the time at the Global booth.
Gotta do a few lectures so I better get some material together for the lectures.
Cya Al……..thanks for the kind words……..heck maybe you should do the lecture.
Glenn
Glenn van AsSpectatorHi Ben: I reread my post and realized it sounded like I was criticizing you, it wasnt intended that way but I was rushing out the door.
I apologize if it came out that way.
If you are seeing this brown when you get into dentin , often it is from the laser not having a high enough water spray. This can be caused because the water % isnt high enough on the setting on the laser.
The suction being to close to the laser tip is a big big issue as with the scope and the monitor my assistant can see when she is too close as the water goes up the suction and the laser beam hits the tooth…….it chars the dentin honestly. In addition its sore!!
If you have a Hoya Con bio laser you sometimes find that this will happen if the tip isnt quite tightened enough in the end of the unit or if you have a tiny fluff of lint or something in the portal for the water inside the laser (that can be cleaned out with a small endodontic file).
In closing one further thing is that if you create a very narrow trough then the laser will cut dentin without water spray to rehydrate it (not acclerate it !! GRIN) and often the laser will then stall out , it hurts and chars the dentin. The color is amber, similar to caries in nature.
Check that out , welcome to the forum and hope that there is some useful information on it.
Glenn
AnonymousSpectatorThought Microdentistry might be a good place for this-
http://www.cda-adc.ca/jcda/vol-69/issue-1/25.pdf
From Jan.2003
I was wondering if anyone was using this approach for Class II’s since it seems like 1 way to leave a stronger tooth and also maybe avoid some of the Class II laser prep sensitivity problems (that I have anyway)?
Thoughts?
BenchwmerSpectatorRon,
I have alot of problems with this sort of presentation, leaving gross caries in the rest of the arch, then showing how to restore the premolar. See gross caries on #19. After removing the restoration on #19 and the caries, #20 could have been restored from the interproximal without touching the facial enamel. This could be done without sacrificing occlussal or facial enamel on #20, probably using a #2 round bur in slow speed, restore with a 6th generation DBA, restore with composite, then properly finish and polish, then prepare #19 for a MODB composite onlay. I haven’t done a GV Black prep since 1995.
I feel that glass ionomers have no use. Since total bonding in 1995, they are not needed as liners, DBAs bond and seal the dentin, why would you even consider a GI as a restorative material when you have hybrid composites? ]
To me this looks like a case from 1989, not this century.
Jeff
Glenn van AsSpectatorHi Jeff: those are pretty strong words…..
I dont necessarily agree with all of them either.
THe restoration on the #20 does NOT presently involve the contact , so you are assuming that you need to remove the distal contact, who knows if it needs doing?
Secondly, if the contact is not involved then how are you going to get at the other one. Now granted you could think that you might want to take the restoration out on the #20 first and then see what happens and if you can get at the#19 to do it.
I dont like preparing an interproximal without protection for the adjacent tooth as for sure you will have scatter affect it, but I wouldnt go so far as your post. In addition there are alot of people out there showing that any generation after 4 th generation is a reduction in steps and in BOND STRENGTH as it degrades significantly after one year (one study suggested bond strength of some 6th and 7th generation bonds went down to 9MPa from a start of 27MPa). That is why some are advocating GI under resins to help with protection of composites from leakage.
Now finally I dont understand your last comment , was it necessary to place that in the post……..Extending a small amalgam into a MODB is an “extension for prevention” type of mentality isnt it? and who said that….
(wasnt it GV Black?)
Finally, we might also find that Mark restored it afterwards.
In closing I dont really have a problem with your post, I can see the value in looking at the other restoration and seeing if once it is removed that it might have decay extending into the contact and then remove that the conventional way, or with the Hoya Con Bios unique tips you could easily get access to it with a 400 micron tip.
I would have liked to have seen the interproximal protected and finally I would like to know how Mark diagnosed the caries in the first place (its such a small prep for radiographically diagnosed caries).
All the best, and my philosophy is to not throw rocks from glass houses……..
Its not your opinion that worried me as much even though I dont agree with some of it, as your last sentence that caused me some concern.
Glenn
Glenn van AsSpectatorOOops Jeff, take it back , I thought you were talking about the case Mark posted not the article.
I apologize for my mistake. In Canada we use a different numbering system and I didnt stop to think about #19 and 20 in your system and where that was.
My apologies…….off to read the article.
(I would have put a crown on the first molar in the article, but he is trying to treat the decay conservatively without treating the molar I guess).
GIs here……..I dont know.
Glenn
Robert Gregg DDSSpectatorHi Guys,
Nice to have strong opinions here, huh?:cheesy:
In reference to the article that Ron posted…..
I understand and agree with Jeff’s post on accessing the distal decay on the pre-molar by first removing the amalgam and the decay on the mesial of the first molar, thus preserving more tooth structure on the occlusal of the Bi. That’s what I would have done.
Jeff’s got a point about GI that’s got me thinking about it. My understanding is that GI can leach FL 2mm beyond its margin, which might make it useful in decay prone areas (like the gingival box of a class II prep), or people.
Happy Easter/Passover All,
Bob
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