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Recent CommentsVitrebond Plus: Reduce Post-Op Sensitivity to Zero?
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Dr. G. asks:
I have had occasional problems with pos-op sensitivity after doing routine composite restorations. I am considering using a glass ionomer base in deeper cavity preparations. Vitrebond Plus (3M ESPE) glass ionomer base material has just come out and looks easy to dispense, mix and light cure. Some of my colleagues that use glass ionomer bases claim that it reduces post-op sensitivity to almost zero. Before I start using this I just wanted to find out if any of you have used this and what were your impressions. Is the post-op claim accurate? Thanks.
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12 Responses to “ Vitrebond Plus: Reduce Post-Op Sensitivity to Zero? ”
This such an interesting question….
What is the cause of bonding sensitivity? Biting, temperature hot or cold?
So if you seal the tubules with a bonding agent…….Using SE BOND or DC BOND
When you use a glass ionomer…..if the seal is not great or your get compression of the layer…pain anyway. There is also a thing called C factors that can cause problems. Lots to think about.
But, Vitrebond is easy to use.
Applying a layer of glass ionomer to the pulpal floor is supposed to prevent or reduce post-op sensitivity — according to some leaders in the field. I would do anything to eliminate post-op sensitivity. I hate it when patients return and are angry because ‘their fillings hurt”. All I want to know is if it works.
I use vitrebond under most composite and amalgam restorations with great
success and reduced post op sensitivity. My personal dentist, Dr. Sajid Jivraj,
has done a few large posterior composites on me with no liner and with no
post op sensitivity and he says his secret is using etch, optibond FL system, and
many many many many layers of composite per restoration with nooooooo
flowable composite at all…in other words the several layers of composite make
it a more denser restoration, and therefore I would assume less polymerization
shrinkage, etc. and so on…so I started doing the same on my patients, i.e., several several layers of composite with vitrebond and they seem to be happy.
Sounds good. We need a clinical study to back-up all the case-based and/or tooth based opinions. In the clinical reality, each case is differenet. No pain or reduced pain, where is your base-line?
How thick a layer of Vitrebond Plus do you apply to the pulpal floor? Is the thickness of this layer important?
Flowables, GI must be light cured. Thus their shrinkage would be towards the light source, invariably upwards away from the pulpal floor. Self curing resins though more time consuming provide excellant protection with shrinkage TOWARDS the pulpal floor. I’ve had excellent success with this technique.
post op pain is too common to a dentist using composite restorations.It depends on many facture as described by “hjdmd” including allergic to bonding or composite.But it is clear when i use flowable Ca(OH)2 [light cure] as a subbase it reduces post op sensitivity of composite by nutralizing the ph, Some-times any GI can be used as a base over the Ca(OH)2 layer to increase the strength as my openion.
i have had one or two sensitivity patients during my three years of practice and i use only composites , no amalgam in all cases and they have been more than a few. i use vitrebond as a liner but in some cases, generally i use no liner. there was a n article in quintessence last year and i think it covered pretty much sensitivity. a major factor is the adhesive , the golden standard is total etch and three steps. one bottle adhesives copletelly disappear with function . no flowables also because they tend to get lifted away from the surface when the first layer of composite is cured, they are pulled up due to the shrinkage of the composite ( i also am postgraduate of materials science and these are not just personal oppinion )
Shrinkage towards the light source is an OLD wives tale that has not been quoted for some time . I am surprised you guys bring it up. Glass ionomer is acid based so althogh CHRISTENSON
sorry isomehow pushed send before i finished. G. I. is acid based so although G. Christenson pushed Vitrebond under fillings to reduce sensitivity I got burned a few times and stopped using it about 6 years ago. I etch only the enamel then use a one bottle self etching bond like GC G bond and cure it and then place a small amount of flowable composite on the dentin floor and cure it and then slowly build up in increments and do not have sensitivity at all for years. Under large amlgams i use Amalgambond plus from Parkell and have much less sensitivity for over 10 years. i have not used the new vitrebond.
In dental school we were trained to cover the pulpual floor with Vitrabond. It’s an RMGI, that gives a acid/base bond to dentin and bonds well to composite.
I absolutely love the Clicker by 3m way less waste!
wow come on people this is 1st/2nd year stuff, its alarming that there a dentists out there that dont understand their basic materials.
post op sensitivity for composite is cause by hydrolytic pressure of dentinal fluid filling the gaps between resto-tooth interface cause by composite shrinkage and poor curing techniques.
like any good RMGIC, vitrebond bonds well to enamel and dentine via the ion exchange layer, fluoride release, enhances reminerlisation, antibacterial, HEMA monomer crosslinks with composite polymers.
it probably best as a mid sized cavity liner, deeper cavities might be better off with calcium hydroxide liner and conventional GIC base (for super reminerlisation).
make sure you use you composite bonding agent and incremental curing. Because composite alone DOESNT bond to the tooth (the larger restoration type filler particles cannot penetrate into the exposed collage matrix to provide your resin tags and hybrid layer)
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