By William C. Strupp Jr., DDS
Most temperature sensitivity is caused by fluid flowing in or out of open dentinal tubules. Sealing open dentinal tubules can markedly decrease sensitivity and improve patient comfort and relationships. Tubules often become patent with direct access to the pulp when dentin is exposed.
Exposed dentin is found in abfraction lesions, along either temporary or permanent restorations that are shy of the margin of the preparation, on freshly scaled root surfaces after cleanings and/or cement removal, on reshaped roots, and on acid demineralized tooth surfaces. An acid chelating potassium oxalate solution SUPERSEAL [Best Buy Discount Dental Supply, (800) 781-2226] can seal the open tubules in short order.
When microbes in the tubules are killed before the tubules are sealed, the decrease in sensitivity can be significantly enhanced. Once the microbes are dead, the SUPERSEAL solution must be placed on a dried tooth surface and allowed to react for 30 seconds before it is gently blown dry. This will leave an acid-resistant precipitant that blocks the tubules and prevents the flow of fluid in or out.
Our perio-restorative protocol requires placement of core buildups and provisionals to allow the periodontist vertical access during surgery to reshape root surfaces. Provisionals must be remade at four weeks postsurgery. We seal the prepared teeth at four specific times:
- Immediately after core buildups and the impression for surgical provisionals is made.
- Immediately after surgery before and after cementation of the surgical provisional.
- Immediately after the impression is made to remake the surgical provisionals four weeks postsurgery and after cementation of the healing provisional.
- Immediately after cement cleanup for the final restorations. (We do not seal tooth surfaces to which bonding will occur and that is why we seal the tooth surfaces apical to the margins of the final restorations after final cementation, not before)
In addition, we seal the teeth anytime there is sensitivity, regardless of the cause. The usual culprit for the cause is acid-containing drinks that open tubules.
The purpose of sealing a prepared tooth is to:
- Decrease dentin permeability by sealing the dentinal tubules.
- Kill bacteria.
- Prevent saliva from contacting open dental tubules.
- Decrease chemical insults from various dental materials.
- Scrub the root surface thoroughly (15 seconds to one minute) with 4% CHG (Surgical Scrub, Dial). Scrub all the teeth, gums, cheeks, palate, and tongue with an end tuft toothbrush (Butler) and water spray.
- Control hemorrhage as necessary with Hemodent (3M ESPE) in a 3-cc syringe (Best Buy Discount Dental Supply) with an Inspiral Brush Tip (Ultradent). Rinse.
- Scrub for 15 seconds with 4% CHG (Surgical Scrub, Dial) from a 3-cc syringe (Best Buy Discount Dental supply) with an Inspiral Brush Tip (Ultradent). Rinse.
- Scrub for 15 seconds with Tubulicid Red (Global Dental) from a 3-cc syringe (Best Buy Discount Dental supply) with a Blue Mini Dento Infusor Tip (Ultradent) Rinse.
- Scrub for 15 seconds with NaOCI (Clorox) from a 3-cc syringe (Best Buy Discount Dental Supply) with an Inspiral Brush Tip (Ultradent). Rinse. Dry.
- Apply Super Seal to a dry tooth surface (Best Buy Discount Dental Supply) for 30 seconds. Dry the treated tooth surfaces with a gentle stream of air before rinsing.
Dr. William (Bill) C. Strupp Jr. is a practicing clinician and inspirational speaker highly acclaimed for his practical and predictable presentation, Simplifying Complex Cosmetic and Restorative Dentistry. He is an Accredited fellow/founding speaker of the American Academy of Cosmetic Dentistry. His memberships include AAFP, AOD, APS, AES, AAIP, IASD, AAOSH, FACD (president/founding speaker), among others. You may contacts Dr. Strupp through his website at www.strupp.com, by phone at (8000 235-2515, or by email at [email protected].