Vitrebond Plus: Reduce Post-Op Sensitivity to Zero?

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.

18 thoughts on “Vitrebond Plus: Reduce Post-Op Sensitivity to Zero?

  1. 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.

  2. 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.

  3. 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.

  4. 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?

  5. How thick a layer of Vitrebond Plus do you apply to the pulpal floor? Is the thickness of this layer important?

  6. 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.

  7. 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.

  8. 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 )

  9. 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

  10. 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.

  11. 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!

  12. 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)

  13. i’ve been using vitrebond for so many years now and i’ve way avoided patients from coming back due to post op pain. i use vitrebond as base especially in deep seated cavities. well, it works for me and i’ve just trusted the product over the years and watched out for its upgrade as well..definitely, no to flowables in this case. i’ve had pretty much success with 3M’s P60 for posterior restorations.

  14. The first part of my message is to the dental student. What you had stated is what they teach in school but what do you know about private practice? Have you worked in private practice and for how long? The theories make sense because it is only theory. If all the theories worked, we wouldn’t have an ongoing issue with post-op sens and in order to come up with theories, it would have to be a problem first, which is seen in CLINICAL PRACTICE. Word of advice, don’t attack your colleagues without knowing the whole story. But that’s another issue.

    Now to my fellow colleagues:
    I use vitrebond + a 1 step adhesive for comp resins. Seems to work 99% of the time. The odd post op sensitivity could be due to a variety of reasons. First I usually eliminate the possibility of leakage with incremental curing and ensure my “adhesive seal” on the dentin surface is not wet and as glossy as possible after the adhesive is cured. Even then it isn’t guaranteed that it will work but give that a try and see if it helps a bit.
    Worse come to worse, bonded amalgam when all else fails and I don’t usually see issues with post-op sens in those.

    Also check for heavy occlusion/bruxing as that may speed up the failure of composite resins as I have seen through the years.

  15. Dent student:

    You would do well to heed Dr. Brady’s advice. Don’t be so cocksure… it will only get you in trouble. When you graduate dental school, you still have MUCH to learn, some say you haven’t even learned half of what you need. Most of us remember everything you stated, but theories are only theories. Real world applications for this particular problem don’t always succeed… Hence the reason so many people still complain about it.

    As far as your comment about using composite bonding agent… I haven’t heard of anybody that doesn’t use it, and I get around. Is this something your school sees alot of that would prompt you to mention it?

  16. Forgot to mention my experiences about this subject:

    Last year, I went to a seminar by Gordon Christensen and he recommended the following:

    1. etch only the enamel margins, rinse & dry
    2. apply gluma to the entire prep (he said that it enhances the composite bond!), air dry
    3. place RMGI liner
    4. self-etching prime&bond like xeno4
    5. layer the composite

    When I have used this technique, it does seem to minimize sensitivity more than other methods I’ve tried. Most of the time, I do a total-etch instead of just enamel margins and it still works well. I also exclude the RMGI if the prep is too shallow. There are still pts that report sensitivity when asked, but most of the time they say that it passed within a few days.

  17. Guys,

    The answer to your sensitivity problems lies in one word: CONTAMINATION (I think it leads to a poor bond and inevitable bacteria invasion), hydrolytic pressure my derriere, it would not happen if your bond is done well to begin with.

    For posterior teeth, finish your well done prep, apply a RMGI liner only to that portion of your prep that is very deep (I do that occasionally) and do not contaminate your cavo-surface margin with it, also I like to avoid shocking the RMGI with very strong sudden close curing light.

    Next isolate (this is a big word and an art by itself), rinse with your prep with Chlorhexidine to disinfect, follow with a rinse of water and dry, NO SALIVA or WATER ON TOOTH, but do not kill the pulp as you are drying the tooth!

    I use a single step bonding system like Brush & Bond – Parkell (love it, simple, works well on etched and non-etched enamel and dentin, dual cure resin compatible), I use a bristle head brush to invigorate the tooth surface with the single step bonding system and make sure no dentin is left un-bonded to, then I thin with CLEAN gentle air stream and light cure.

    Apply your first thin lawyer of flowable or dual cure resin like StarFill 2B (for hard to reach places) on the entire prep floor and forget all the BS you heard about flowable composites, they are the best thing since GV Black created the classification if you know where and how to place it!, with your explorer tip, poke it carefully to eliminate any voids and spread it on the ENTIRE PREPARATION floor, stretch your loosened pre-contoured matrix band (for class II’s) with an instrument and have your assistant light cure and then light cure yourself again!

    I personally add and cure a second layer of flowable if needed.

    I leave the last 2 mm for regular posterior composite which after condensing, I paint a very thin layer of a simple non-sticky bond (optibond solo for instance) to its surface and apply gentle clean gloved-finger pressure on it to get that hermitic seal with the occlussal margin and great void-free adaptation to the lower layers. I light-cure and finish with high-speed white stones & slow-speed polishing rubber burs for the final luster.

    God be my witness, I do not recall the last time I had a patient complain about post-op sensitivity and my composite restorations speak for themselves clinically and radiographically.

    Abandon the amalgam mentality if you want to do great resin fillings, this is my advice to you… (like a little bit of contamination or sloppyness is fine, condensable composite to get a contact, have the patient bite down prior to curing your last layer and other weird/hasty ideas), otherwise stick to your good old silver friend.

    Good Luck…

    Northern Virginia Dentist

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