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quarter 3 | 2013 | cerecdoctors.com | 61
getting ALL the powder off; we scrub and don’t rely solely
on water spray.
2. Hold the crown seated until fully cured so you don’t get
spring-back. I have heard from other people this isn’t true,
but we started doing this as well as managing the powder a
lot better, and we have had minimal issues with sensitivity.
Hope this helps,
Jill
Bob & Pete Hoffman | Lancaster, Wisc.
I also had the same issues early on. I agree that
occlusion on the molars is a big factor, but I still
had some issueswith sensitivitywhenanewocclusionwasn’t
a factor. I became even more meticulous about bonding
protocol, and added Gluma to the process. Results were
immediate, and almost no sensitivity since. I don’t know if
Gluma is always needed anymore since I’mbetter at bonding,
but I amNOT going to find out. I will continue to use it every
time. Plus, there’s evidence the bonding is better withGluma.
So ... if you aren’t using it, I would suggest starting.
Also, I had a couple of cases of tooth sensitivity and throb-
bing that seemed to be irreversible pulpitis. Before I thought
about doing endo, I removed the crown and placed a temp.
The sensitivity vanished and both cases returned to normal.
Shortly after, I made new crowns and followed the bonding
with Gluma and both had no sensitivity. Point is: don’t do any
more endo on these teeth until you remove the crown and see
if it is just the bonding. You may end up needed to do RCT,
but you may not. It is worth finding out. My two cents.
Brent R. Browning | Houston
May be something else ... with crownlays, the
amount of enamel tooth removal probably
equates close to a PFM. However, with a full CEREC crown,
with the shoulder preps and 2.0 mm occlusal reduction,
there can be a lingering sensitivity issue if it’s too aggressive,
with inadequate hydration and over-prepping. Any photos?
Selma Yucedal
I switched fromBiFix QM to NX3/XTR. I isolate
the tooth, apply Gluma for one minute, dry, apply
XTR primer scrub for 20 seconds, dry until I see no more
movement in the primer (i.e., all the solvent evaporated,
which takes about ten seconds), apply the XTR adhesive,
dry till thin, light-cure 10 seconds, and cement crown with
NX3. Crown is e.max, etched 20 seconds and silanated.
That is my protocol now with the new cement. Before, it
was Futurabond and BiFix QM. I did not cure the bonding
with this cement system. Thanks again.
Selma Yucedal
What do you use to keep the tooth hydrated
while it’s milling and glazing? I have shown my
preps to several trainers, and they said it was fine, but I
will try posting the cases with the sensitivities. Thanks all
for your reply. I just added Gluma to my bonding protocol;
hopefully it will help.
Alan McCaffrey | Las Vegas
Gluma will rehydrate the tooth. You can have your
assistant scrub for 30seconds afterpowder removal.
Grady Twohig | Green Bay, Wisc.
Hard to tell from what you said, but maybe you
are air-drying the primer too long. Also, you
don’t have to cure the adhesive if you’re using XTRwith the
NX3 (you can, but you don’t have to).
Ross Enfinger | Orlando
Are you also using XTR with your direct resin
placement and, if so, are you getting hypersensi-
tivity in molars with it? The point everyone else made about
occlusion is well-taken, but maybe it’s a system-wide problem.
Dr. Richard Osler | Medford, N.J.
I am also having sensitivity issues with NX3/XTR
e.max crowns, and have been using Gluma. Have
done my first 80 crowns or so on the Omnicam, and prob-
ably have had eight to 10 sensitive, with two teeth that wound
up needing endo to relieve the symptoms. As previously
mentioned by another poster, this certainly is adding stress to
my introduction to CEREC. I have either selectively etched
margins or no-etchusing the self-etchingprimer only. It seems
like I’m not alone, and would love to "squash" this problem
ASAP!!! Anyother thoughtswouldbewelcome. This ismyfirst
post although I’ve readmore than I’d care to admit!