By Michael Miller, DDS
Have you tested any of the so-called “turbo” type diamonds for full coverage crown preparations?
By “turbo” diamonds, we assume you mean those that have sequential ridges that presumably make the diamond more aggressive. While we have not specifically evaluated that design, we have evaluated seven different types of preparation diamonds, including the new Zip! (Discus) and G-Force (Garrison Dental Systems) brands, and the CRF (Cuts Really Fast) diamonds from Brasseler. From a speed perspective, G-Force came out on top. The full evaluations can be found in a new section of the 2006 Annual Edition.
I have a 15-year-old patient who is missing #7 and #10. I am very interested in getting information about all-porcelain bridges, from detailed preparation instructions to long-term retention. Where can I get this information?
The preparations for all-ceramic, partial coverage bridges are thoroughly covered in our book called “The Techniques.” These bridges, whether made from reinforced composite or high-strength porcelain, are tricky and require that the patient understand fully the strength challenges. For a 15-year-old, you may want to consider reinforced composite, a more forgiving material that can also be modified chairside, if necessary.
You have suggested in the past that despite RelyX Unicem’s instructions, applying an etchant with and/or without an adhesive significantly increases its bond strength. Can I use Clearfil SE with RelyX Unicem instead of 3M’s Adper Prompt-L-Pop?
Clearfil SE Bond (CSEB) is not indicated for indirect procedures due to its relatively thick film thickness, assuming both the primer and bonding resin are used. In addition, CSEB does not bond well to dual-cure and self-cure materials. Our tests with RelyX Unicem and Prompt-L-Pop were done to ascertain whether a self-etching adhesive would be beneficial when used with a self-adhesive cement. OptiBond FL Prime also boosts the bond strength of Maxcem.
We have no doubt that other adhesives, both self-etching and total etch, would also boost the bond strength of other self-adhesive cements, but we have not performed any additional tests since the main reason to use these cements is their ability to bond to tooth structure without any type of adhesive, even though the bond itself may not be very strong. If you are willing to use an adhesive, then you don’t need to use a self-adhesive cement.
What is the major difference between Gluma Desensitizer and SuperSeal, aside from the cost differential?
Totally different chemistry, use, and performance. Gluma Desensitizer is the superior product when applied prior to placing a bonded restoration. SuperSeal is better for sensitive abfraction lesions. For the full report, see Desensitizers in the 2006 Annual Edition.
Which root canal sealers can you recommend that are good and will not interfere with bonding of post and cores?
Even though it would seem prudent to stay away from a eugenol-containing sealer, our tests with eugenol-containing provisional cements have shown that they have minimal effect on bond strength if they are completely removed prior to the bonding procedure. Therefore, if we can extrapolate this data, your choice of RC sealers should focus on their ease of use and sealing abilities, not whether they contain eugenol or not.
Having said that, resin-based sealers are probably the safer choice. A new product, EndoREZ from Ultradent, has received high marks from our evaluators. It can be used with a single gutta point or multiple points placed passively (no need for lateral or apical condensation).
I was wondering what your thoughts are for seating multiple units at the same time if, for example, I am using OptiBond Solo Plus. Is it acceptable to let the adhesive sit on the teeth for more than 15 seconds while you apply it to all other teeth for 15 seconds each? Does the semipermeable membrane come into effect if the adhesive sits too long?
This is a tough question to answer, but the safest approach would be to seat your restoration as quickly as possible after applying and curing the adhesive. With multiple units, it would be prudent to apply a purely hydrophobic, unfilled resin such as Heliobond over the cured adhesive layer, but make sure the overhead light does not prematurely polymerize it before you can seat the restoration.
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.
