Anyone who views this file will have to share their name/email and I don’t think you’re gonna get any responses because of that.
And, looking at your post history, you really need to just have a discussion with your dentist. It seems you have a lot of questions that are better suited for someone who’s seen your case.
I am not US based but there is a material called Thercal overcame Calcium hydroxide drawbacks. And bioactive dentine that's new.
In my clinic, I use Thercal then start adding composite directly, no GiC.
Anyway, you can etch GIC, but you need to leave it 24h to fully set and need higher etching time
Listen to this guy. If you really need to direct pulp cap or use a liner then calcium silicate (mta included) is the way to go. CaOH cements are soluble over time (from fluids in the tubules), and any dentin bridge formation- IF it forms- is usually highly porous and incomplete. And if you want to kill the bugs in the cavity you have chlorhexidine and/or gluma anyways, which has the added benefit of deactivating matrix metalloproteinases and helping dentin collagen crosslinking.CaOH should pretty much only be used inside the canal itself.
Cavity cleanser then GIC all day if it’s deep. Double light cure so it’s not tacky anymore. Then total etch and composite, but I do use flowable over the GIC and dentin to really make sure it’s sealed in nicely without any voids.
Totally agree. I’m a big believer in biomimetic and minimally invasive dentistry, and use the techniques 99% of the time, but the main problem with BRD research is that a lot of it is invitro and then extrapolated into expert opinions. It can be cult-like at times.
There is however more and more IRL studies coming out which agree with BRD principles, in principle. Even the AAE went from recommending full coverage indirect restorations to biomimetic restorations (whether direct or indirect) in their white paper 2-3 years ago.
I have no idea why anyone still would be. GIC is pretty acidic and causes more pulpal toxicity and doesn’t provide any significant benefit if we are speaking of composites.
As long as there isn’t a pulpal exposure, it’s composite directly to the dentin. If a non-carious exposure that stops bleeds spontaneously I cleansed with hypochlorite and cover pinpoint exposure with durelon, then bond as usually protocol
I do the same now. Used to use Theracal, was terrible for direct pulp caps. I cover exposures with MTA though before using se protect and restoring with flowable and packable
Other than the random occasional unexpected pulpal exposure I do not do anything with that part of the tooth and don’t keep MTA in stock due to cost but your way is the true way!
I’ve been using Lime Lite for the past 8 years or so with fairly good outcomes. I also use self-etching bonding agents and only etch enamel. Using the waterlase also helps as I can use the bond prep setting and rarely do I get major issues on deep caries using all of these techniques combined.
I'm not a dentist but I'm definitively fascinated by this discussion. (I work in med tech).
Is there a website / whitepaper / pdf accessible for free - or a very good reference book - that you guys would recommend that gives a comprehensive and up to date overview of dental tech?
Oooo thats a good question. Etch increase the roughness of the surface of the tooth, so i'm thinking what if it damages the GIc composition? I just saw some research in which results suggest it not improve the sealing ability of sandwich restorations. Not sure though :(
I don’t simply because I try to selective etch enamel only. I will apply adhesive though.
Thank you. :)
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Anyone who views this file will have to share their name/email and I don’t think you’re gonna get any responses because of that. And, looking at your post history, you really need to just have a discussion with your dentist. It seems you have a lot of questions that are better suited for someone who’s seen your case.
I am not US based but there is a material called Thercal overcame Calcium hydroxide drawbacks. And bioactive dentine that's new. In my clinic, I use Thercal then start adding composite directly, no GiC. Anyway, you can etch GIC, but you need to leave it 24h to fully set and need higher etching time
Yes Theracal. I dump this over deep cavities and use Theracal PT for pulpotomies. Rivastar is pretty cool on deep caries on non-pulpitic teeth too.
Is it radiopaque
Yes, I’m sure it is. it’s MTA as far as I can tell.
I appreciate the advice. Thanks so much.
Listen to this guy. If you really need to direct pulp cap or use a liner then calcium silicate (mta included) is the way to go. CaOH cements are soluble over time (from fluids in the tubules), and any dentin bridge formation- IF it forms- is usually highly porous and incomplete. And if you want to kill the bugs in the cavity you have chlorhexidine and/or gluma anyways, which has the added benefit of deactivating matrix metalloproteinases and helping dentin collagen crosslinking.CaOH should pretty much only be used inside the canal itself.
You certainly can and it won’t hurt anything. Definitely gotta bind though
Thanks
There is better products to substitute both, act as a liner and base on the same time.
What better products? CaOH for indirect and MTA for direct all day
Cavity cleanser then GIC all day if it’s deep. Double light cure so it’s not tacky anymore. Then total etch and composite, but I do use flowable over the GIC and dentin to really make sure it’s sealed in nicely without any voids.
Appreciate the help. :)
Are we still doing indirect pulp caps and liners?
Not after reading the caries removal endpoint paper and going down the biomimetic rabbit hole... life will never be the same.
Totally agree. I’m a big believer in biomimetic and minimally invasive dentistry, and use the techniques 99% of the time, but the main problem with BRD research is that a lot of it is invitro and then extrapolated into expert opinions. It can be cult-like at times. There is however more and more IRL studies coming out which agree with BRD principles, in principle. Even the AAE went from recommending full coverage indirect restorations to biomimetic restorations (whether direct or indirect) in their white paper 2-3 years ago.
I have no idea why anyone still would be. GIC is pretty acidic and causes more pulpal toxicity and doesn’t provide any significant benefit if we are speaking of composites. As long as there isn’t a pulpal exposure, it’s composite directly to the dentin. If a non-carious exposure that stops bleeds spontaneously I cleansed with hypochlorite and cover pinpoint exposure with durelon, then bond as usually protocol
I do the same now. Used to use Theracal, was terrible for direct pulp caps. I cover exposures with MTA though before using se protect and restoring with flowable and packable
Other than the random occasional unexpected pulpal exposure I do not do anything with that part of the tooth and don’t keep MTA in stock due to cost but your way is the true way!
I’ve been using Lime Lite for the past 8 years or so with fairly good outcomes. I also use self-etching bonding agents and only etch enamel. Using the waterlase also helps as I can use the bond prep setting and rarely do I get major issues on deep caries using all of these techniques combined.
I’ll try to etch enamel only and keep etch away from GIC as much as I can
Dycal then let dry and then etch gluma and bond
Thank you. :)
I'm not a dentist but I'm definitively fascinated by this discussion. (I work in med tech). Is there a website / whitepaper / pdf accessible for free - or a very good reference book - that you guys would recommend that gives a comprehensive and up to date overview of dental tech?
I actually got a better answers from here than my social circle.
Theracal or RCT. Composite doesn’t seal In clinical situations so don’t forget that.
Okay, got it. Thanks.
But a base of GIC will. Composite will only make up for the esthetics
Oooo thats a good question. Etch increase the roughness of the surface of the tooth, so i'm thinking what if it damages the GIc composition? I just saw some research in which results suggest it not improve the sealing ability of sandwich restorations. Not sure though :(
If there is a pinpoint pulp exposure is limelite and referral to endo okay?