Occlusal Composite of Decayed Tooth

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Quick and Easy Rubber Dam Placement
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[@kvgolfa]

Hello Dr. Cutbirth, love watching your videos! I'm interested in joining your website, but was wondering if there's any discount for dental students? Thank you

[@centerforard]

We would like to gain access to dental students, but have not figured out exactly how to do it. I would have loved to have access to something like DentistryMasterClasses.com when I was in dental school! We have kept the cost very low because we want all interested dentists or dental students to have access. It was suggested we charge $100/month for DMS.com and I said, "No, we want to keep it inexpensive so anyone can afford the material." Glad you like the videos. Please tell your classmates. Where are you in Dental School? I sometimes give seminars in dental schools.

[@salmaalmahdi5524]

Thanks doctor for the vedio, I just wanted to ask at what speed do you use the low speed carbide bur to excavate the caries.

[@centerforard]

Slow speed handpiece.

[@AsimKhan-qd2sr]

MasAllah good teacher

[@centerforard]

Thank you.

[@dromy786]

Hey doc! Love your videos! Ive been having issues with a couple patients experiencing post op pain on some overall minimally invasive restorations. Any tips? Do you think the isopropyl alcohol might be helping to minimize post op sensitivity at all? I place Gluma at the base of each preparation after etching and before bonding. I blow dry the gluma then place bond, blow dry that also. Then fill with my composite...I love your techniques overall so any tips would be greatly appreciated! Keep up the great work!

[@centerforard]

Forget the gluma. Etch dentin 15 seconds, enamel 30 secs. - 1 minute. Rinse thoroughly. Blow off the excess water, but do not desiccate the site you are bonding. Place plenty of primer/ adhesive, blow off the primer adhesive until nothing wiggles, then cure the primer adhesive for 5 seconds. This p/a curing step is very important. Then place a small layer of flowable composite (flowable "wets" better than highly filled composite) and cure it 20 seconds. Follow with either more flowable (if the restoration is small) or highly filled composite. Cure each 1-2mm composite layer for 20 seconds. There should be no sensitivity if you follow these steps precisely. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@doctoredable]

I think you would really like using an Adec primer dryer. It emits a warm and diffuse stream of air and It completely evaporates all the alcohol or acetone solvent in the primer without blowing the primer resin off the surface. I have one in every operatory. I also am an advocate of pulse curing of small increments of composite to reduce polymerization shrinkage.

[@centerforard]

Excellent!

[@PittsburghSonido]

Does the ball burnisher help with drilling down the resin to match the patients bite? Suffice to say, is it so accurate to the point where sometimes you don’t even need to shave the resin down?!

[@centerforard]

The ball burnisher instrument blends the composite into the side of the preparation and contours the composite so that there is normally minimal occlusal adjustment necessary once the composite is cured.

[@LearningAndGrowingInLife]

What do you think about the minimally invasive/medical management of carries alternative like using SDF (Silver Diamine Fluoride) + GIC (Equa Forte Glass hybrid) instead of this invasive surgical approach.

[@centerforard]

It makes no sense to me. The decayed tooth structure is soft and undercuts the enamel and should be removed and the undercuts removed.

[@Mo-vn1we]

can you elaborate on 2X2 point didnt quit catch that, I mean do you place the gauze inside the cavity or you wrap it in the air water syringe

[@centerforard]

I place the 2x2 gauze directly over the cavity prep so when I blow off the excess primer/adhesive it is blown into the 2x2 and does not go all over the tooth and gum tissue.

[@anaisabyhaylaa9879]

Hello Dr. I recently discovered your channel and I am very thankful for that! I have a little question do you cure every 1mm layer of composite for 40secs?

[@centerforard]

No. I cure approximately every 2mm filled resin for 20 seconds, then cure 40 seconds at the end when all the filled resin is placed. I always blow off, then cure the primer/adhesive for 5 seconds prior to placing the filled resin when placing direct composites. If the cavity is deep, I place a thin layer of filled resin, often flowable, cure that layer for 20 seconds, then fill the remaining cavity preparation with a more highly filled resin in approximately 2mm increments, curing 20 seconds every 2mm.

[@anaisabyhaylaa9879]

@@centerforard oh okay thank you! Thank you for sharing your knowledge

[@amirhossein-fs1mz]

Are you agree with pin guide bur for crown preparation instead of conventional bur?

[@centerforard]

I am not sure what you mean by pin guide burr. I use conventional burrs for crown preps. Watch my videos on crown and bridge preps.

[@lannyrubin2600]

is is necessary to rinse out the chlorhexidine solution with anesthetic like you do when using the 3:1 sodium hypochlorite solution? thanks Dr. R

[@centerforard]

I do not use chlorhexidine on decayed teeth following decay removal. I remove the decay as completely as possible, then soak the prepared area in isopropyl alcohol, probably more for my piece of mind than any other reason. I feel like no bacteria could survive several minutes of alcohol soak.

[@bengyingneoh5298]

Do you ever get any post op sensitivity using this particular etch and bonding protocol? I was using total etch technique and Scotchbond universal bonding agent and getting many cases of post op sensitivity. I have since switched to Clearfil se bond 2 and only etch enamel now(although sometimes it is hard to control the etch and some of it can get onto dentine).The number of post op sensitivity cases have decreased but I got one the other day which is just so frustrating. I’m now lining all my cavities even shallow ones with Theracal. What can I do to ensure I don’t get post op sensitivity? Dentine bonding is so technique sensitive that I feel like giving up and just using GIC under all my composite fillings.

[@00192ee]

Beng Ying Neoh You have to massage the adhesive for 20-30 seconds aggresively into the tooth. Do not etch longer than 15-20 seconds an try to leave dentin untouched. Scotchbond and adhese have the best results of all newer bonding agents

[@centerforard]

I do not remember the last time I had any post op sensitivity using this method. Be sure to blow off the excess primer/adhesive, then cure the primer/adhesive prior to placing the filled resin. Cure the filled resin in layers, with each cured layer not more that a mm or so thick. This technique will eliminate sensitivity unless the prep is very close to the pulp or you have a pulp exposure.

[@jotham97]

Do you have good moisture control? I rarely have any issues with postoperative sensitivity and almost all restorations are done under rubber dam.

[@thethanks5876]

Do you advocate caries detecting dye?

[@centerforard]

Sure, I just do not use it myself.

[@valna6219]

I had an occlusal adjustment on my 1st and 2nd premolars and 1st molar (12,13,14) and have been experiencing pain and sensitivity in my teeth ever since. I’m considering doing dental bonding or fissure sealants. Due to the loss of healthy enamel I am certain my teeth desperately need some sort of protective barrier as sensodyne isn’t doing me justice. Any potential advice would be greatly appreciated.

[@centerforard]

Have your dentist place Super Seal or some other sealer on the occlusal surface of the teeth. I do not know how much occlusal adjustment had to be done, but this treatment should do the trick if the adjustment was not major.

[@valna6219]

@@centerforard Thank you for the helpful advice. I’ll be sure to mention it to my dentist. That’s likely exactly what I need. Might this product also benefit procedures in which fissure sealants or dental bonding are being performed? Thanks again.

[@centerforard]

Watch my video titled "Why You Lost Your Dental Sealant."

[@diegolau]

we use 2% chlorhexidine for cavity desinfection

[@centerforard]

Good.

[@dr.abulbasher565]

is blowing can cause pulp death ?

[@centerforard]

Sorry, I do not understand the question. Pulp death (necrotic pulp) can be caused by many things, including trauma, pulp exposure, a deep filling, prolonged hyper stimulation.

[@abdokhalaf6188]

Wouldn't alcohol cause irritation to the pulp esp. in deep cavity.The dentin bridge may be less than 0.5 mm with wider and more numerous dentinal tubules. This definitely will harm the pulp . Is alcohol still applicable in deep cavity?! 🤔 Thanks for your great videos♥️👏👏

[@centerforard]

Good question. In deep cavities I place primer/adhesive after etching for no more than 15 seconds. I cure the primer/adhesive for 5-10 seconds, then place a layer of CaOH. After the CaOH layer sets, I place another coat of primer/adhesive, blow it off into a 2x2 gauze, then cure it for 5-10 seconds. I then place the filled resin in layers of approximately 1mm, curing each layer for 20 seconds. If I think the decay is deep, I always inform the patient ahead of time that the tooth could require endodontics and a crown if they have post op sensitivity.

[@texaspeat1606]

You are exactly the kind of dentist I want to be🙂I’m not joking. How can I have you as my mentor??

[@centerforard]

Subscribe to DentistryMasterClasses.com for starters and watch all the videos. I directed a hands on teaching center in Dallas (CARD) for 20 years, but after 2008 dentists seemed to not be interested in hands on courses, only in online teaching. We went from 50 dentists in a hands on course in 2008 to 6 new dentists signing up for the courses in 2009. Go figure. We nursed the center along until last year, 2019, then shut it down last month except for 1-2 two day courses annually beginning this year (2020). We will see how that goes. You are welcome to attend the course in Dallas in September 2020. If you are subscribed to DentistryMasterClasses.com we will be sending out the date of that course shortly. If that course goes well, we will add another annual course and, possibly, others.

[@texaspeat1606]

@@centerforard Thanks for your reply. I will look into the DentistryMasterClasses.com for sure!

[@centerforard]

Where do you practice?

[@texaspeat1606]

Dental Minute with Steven T. Cutbirth, DDS hi sorry it has been a wild couple of months....i practice in Houston

[@yousefissa5051]

Can we do cavity disinfection by cotton bellet of sodium hypochlorite?

[@centerforard]

I do not know. I do not know if the isopropyl alcohol is even necessary, it just seems like a good idea and doesn't hurt anything. The main thing is to remove all the decay.

[@jamarmckay2209]

@@centerforard I like that idea, doesn't hurt to add that extra step. I also use Peridex.

[@drarunsuraj1]

R u sure about your Rubberdam placement?

[@centerforard]

What are you referring to? I know that few dentists use a rubber dam. The method is am demonstrating is very effective and much easier to place that the technique of placement between every tooth we were taught in Dental School. It may not be perfect, but effective and easy so dentists will use a rubber dam. I use a rubber dam for most procedures with this method. It takes me about 30 seconds to place it.

[@Bordondental]

What justification is there to "nuking " the potential bugs ? Ever heard of conservative dentine removal ?

[@centerforard]

Sorry, I am not sure what part of the procedure you are disagreeing with.

[@Bordondental]

@@centerforard the advice is good,, however with imunofloresence techniques we find that most marginal dentine removed can be shown to be stable and protective. Great series any way, it is a pleasure to see how different masters tackle different problems.

[@sirbustefan6690]

if i could, i would give this video 10 likes

[@centerforard]

Why thank you!

[@sirbustefan6690]

@@centerforard because there are good, simple and clean informations