By Michael Miller, DDS
One of my patients came back from his orthodontic treatment with yellowish shadows where the brackets were bonded. Even if a thorough polishing has been done, the yellow spots remain. How could we get rid of these spots which seem, under the microscope, as bonding agent into the enamel? I thought of using a solvent agent, but which one and how would I use it?
There is no solvent to accomplish this task. Under the microscope or loupes, begin removing the residual resin with a Sof-Lex XT (3M ESPE, pictured at left) coarse disc at very low speed. Do not use water, since removing it dry will allow you to see the difference between the resin and tooth. When the resin is paper-thin, switch to an Enhance disc, also used at very low speed, until all the resin is removed.
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Based on something I read in a recent issue of REALITY NOW, I have discontinued the use of the self-cure activator (i.e. OptiBond Solo plus activator (Kerr)) when using dual-cure cements (i.e. Nexus2 (Kerr), pictured at right). At this time, is this what you recommend? I understand that the dual-cure activator should probably still be used with self-cure materials (self-cure CBU materials, for example).
If your restoration is 5 mm thick or less, meaning that no area of the restoration is more than 5 mm from the tip of your curing light, we believe you can dispense with dual-cure adhesives and dual-cure cement. You will need to cure from different directions (buccal, lingual, occlusal), but that's a small price to pay to be able to simplify the luting process. With self-cure materials such as core materials, you should still use the dual-cure activator or BondLink.
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I am using dual-cure Calibra (DENTSPLY Caulk, pictured at left) and Nexus2 for bonding OPC crowns. I previously had used the original Nexus and Compolute (3M ESPE), which has been discontinued. I have always placed the primer and adhesive on the tooth prep without light-curing, and then placed the resin cement in the crown and light-cured all together. In REALITY 2000, Volume 14, it is stated not to light-cure until the restoration is seated. This is for Prime & Bond NT Dual Cure (DENTSPLY Caulk). The 2002 publication states that the Prime & Bond Dual Cure should be pre-cured on the tooth prep before the OPC crown is filled with resin cement and seated. What procedure do you feel is the best way to bond the crowns? I always am concerned that the crown will not seat properly if I pre-cure the primer and adhesive on the prep. I would also like to know which material you like better, Calibra or Nexus2.
Prime & Bond NT Dual Cure works better when you cure it before you seat the restoration. This doesn't mean it won't work otherwise and, in fact, you may not be able to tell the difference clinically. However, to optimize sealing of the dentin, curing it first is the way to go. Its film thickness is so minimal that, unless you have pooling somewhere, it will not keep your restoration from seating completely. As far as Calibra versus Nexus2, Calibra probably has slightly better handling, but Nexus2 has better shades.
Cost aside, wouldn't I want to purchase an American Dental Technologies Pac Light for curing my restorations? I believe they now offer a 13 mm tip. From everything I've read, I've seen no problems arising with the 10-second cure. Do you know of any problems with this particular light or with this quick cure time?
While we will still include two plasma arcs in the 2003 edition of REALITY, their limitations, especially the lack of large, full-power tips, make their quick cure advantages vanish by needing to cure your restorations section by section. In particular, the 13 mm tip from ADT does not perform anywhere near as well as the 7 mm tip. We continue to recommend halogen lights as your best bet.
Is there any adhesive — not resin bonding agent — available that is painted on the prepared teeth prior to seating pre-op impression with temp material to better secure temp veneers? I find that, on occasion, one or two temps (out of six) come off before fitting definitive veneers. Also, how does one prevent excess temp material getting into interdental spaces? I use Danville's porcelain veneer kit, which is simple to use, but very runny. Is it time I moved on to Calibra or other cement for superior bond and less mess?
Retaining provisional veneers without locking them into gingival embrasures — with the typical gingival inflammation that follows — is a real challenge in many cases. We suggest trying a self-etch adhesive such as i-Bond from Heraeus Kulzer, placed only in a 2 mm diameter in the center of the preparation and definitely not at the margins. When the patient returns for the definitive luting of the veneers, this area where the adhesive was placed should be lightly disked to freshen the surface and remove residual adhesive.
You can prevent excess provisional material from flowing into embrasures by using a more precision template material such as a relined putty pre-impression, which will itself flow into these areas and, in essence, block them out, or you can physically block them out with wax, Oraseal Putty (Ultradent), etc. Resin cements that have less flow are easier to use (the 2003 edition of REALITY has more information on this). You can also use the so-called Wave technique, where you literally wave your curing light over the veneers to gel the cement just enough to make removal easy. This works if your margins are precise, but don't try it if you are using the cement to fill in gaps.
Looking for more information on the companies mentioned?
3M ESPE www.3MESPE.com
Danville www.daneng.com
DENTSPLY Caulk www.caulk.com
Heraeus Kulzer www.kulzer.com
Kerr www.kerrdental.com
Ultradent www.ultradent.com
Dr. Michael Miller is the publisher of REALITY and REALITY Now, the information source for esthetic dentistry. He is an international lecturer and a fellow of the American Academy of Cosmetic Dentistry, as well as a founding member. He maintains a private practice in Houston. For more information on REALITY and to receive a complimentary issue of his monthly update, REALITY Now, call (800) 544-4999 or visit www.realityesthetics.com.
