Page 64 - CEREC Q3|2013

62 | cerecdoctors.com | quarter 3 | 2013
| | | d i s c u s s i o n f o r u m
Cody Olson | Humboldt, Iowa
Lots of this has already been said, but I had
similar sensitivity issues when bonding e.max
crowns with MultiLink when I first started. I even had a
few teeth that ended up having RCT to relieve the discom-
fort. I found out that my bonding protocol was not correct.
I no longer have sensitivity for e.max crowns and patients
often comment on recall that their crowns feel great. Here
are a few things that improved my results:
1) Retraction cord on all preps. Ensures the soft tissue is
out of the way and also makes cleanup much easier.
2) Isolite. I use this for imaging andwhen I bond the crown.
It makes life so much easier, especially on lower teeth.
3) Gluma. I apply Gluma prior to bonding. I feel that it
removes any powder that may have been left behind. I actu-
ally have my assistant place Gluma while the crown is being
milled, and then we do it again after try-in. I don’t know if
this is necessary, but it makes me feel better.
Basically, no step is too small to overlook (as is the case
with everything in dentistry). A few cases of sensitivity
were enough for me, and it really opened my eyes. Good
luck and hope this helps!
Dr. Richard Osler
I feel I’m following protocols as meticulously as
possible and still having these issues. I appre-
ciate your input. Haven’t invested in Isolite yet, but I
have been sure to isolate the teeth well. Is anyone total
etching?
Rich Rosenblatt (Faculty)
My strong guess would be lateral excursions
being missed. It is very common with e.max.
Jack Griffin | Eureka, Mo.
Howdy Selma,
I hope by now your sensitivity issues are
resolved. I think the answers you have been given are
correct and occlusion is always a possibility.
Since that didn’t work for you, try doing what you
were doing before with your PFMs that weren’t sensitive,
CEMENT your e.max. If your prep is good (4-8 degrees of
taper, 3-4 mm axial wall height, 1.5-2 mm occlusal clear-
ance), then cement them with a resin modified GI (i.e.,
RelyX Luting, G Cem) or a bioactive calcium aluminate
cement (Ceremir - Doxa), and see if your problems are
resolved. [This is] less technique sensitive than a dual-cure
resin, and it would likely rule out luting as a cause of your
sensitivity.
There are three reasons to bond e.max or zirconia:
increase restoration retention, sealing/strengthening of
the porcelain and increased esthetics. Certainly while
being a fine way to routinely place restorations, any time
we deal with resins, we run the potential for sensitivity
with less than ideal dentin bonding, contamination issues,
poor cement conversion, poor removal of DBA solvent, too
moist or too wet, and others. Isolation with dam, Isolite,
DryTips, DentaPop, and others are critical, as mentioned.
And also, rewetting agents that are bactericidal, like 2%
chlorhexidines (Consepsis, Cavity Cleanser, G5 ...) are
great for potential contamination but cannot compensate
for poor isolation and faulty bonding. These products are
also awesome at removing the powder by scrubbing with
a microbrush or Ultradent infusor tip. But most of the self-
etch, self-bonding materials do not recommend the use
of these products without total etching (which most of us
don’t do).
Therefore, back to basics. Cement restorations when you
can, especially when encountering repeated problems.
Also, and lastly, never underestimate the effect of pulpal
irritation from the prep. New bur, concentric turbines, light
pressure and continuous moisture are critical.
Drillin’ on,
Jack
Mitchell Katz | Avon, Conn.
I, too, had sensitivity issues when I first started
placing e.max crowns. I was always using Vario-
link II, and switched to MulitLink; then I started experi-
encing sensitivity issues. I went back towhat I was comfort-
able with, and have not had the sensitivity issue like I had
in the beginning. I also scrub the powder off the prep with
alcohol and copious amounts of water.
I would say, if it’s not broken then don’t fix it. Stick with
what adhesive cement you were using prior to receiving
your CEREC unit.
Mitch