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    3 ways mishandling adhesives contributes to restorative failure

    Success and failure in adhesive dentistry has much to do with how dentists treat the tooth underneath.

    Dr. Justin Chi, clinical research associate at Glidewell Laboratories, has firsthand experience with postoperative sensitivity with his restoration—as a patient. After his doctor placed his e.max crown on his #30 First Molar 10 years ago, he couldn’t eat on the right side of his mouth for over a year.

    “Every time I bit on it, it was so painful I thought I needed a root canal,” he says. The crown eventually came off (via a Jolly Rancher). When his doctor fixed the crown, she used a desensitizing agent on the tooth, scrubbing it in and following with the same cement. Once the crown went back on, he hasn’t had sensitivity since.

    It was an important lesson for Dr. Chi, who wasn’t a dentist at the time. His experience with misdiagnosing his crown adhesive postoperative sensitivity as a compromised tooth “stuck” with him.

    “Lots of endodontic procedures are performed every day for post-op sensitivity when in reality it is because of dentists not following the right protocol in adhesive dentistry,” Dr. Chi says.

    Related article: 5 things you need to know about adhesives

    Adhesive dentistry has revolutionized the dental practice. However, it requires a bond between the restorative material and the tooth underneath. Success and failure in adhesive dentistry has much to do with how you treat the tooth underneath. Here are three ways mishandling adhesives contributes to restorative failure. 

    #1: Forgetting to follow the directions

    Every adhesive has instructions, and they all have specific details to them. No matter which adhesive you use, following the directions is paramount to your success. Dr. Alex Kalmanovich, DDS, believes this is the most important aspect of any bonding technique. When dentists begin mixing in their ideas, they start experiencing failures. Dr. Kalmanovich thinks each adhesive’s instructions are essential to its success.

    “The companies have done the research. The companies have tested their products. They know what works—but based on their recipe. If you follow that you will be successful and get the results they get. If you start doing other things or forgetting to do certain steps, that’s when you have problems,” Dr. Kalmanovich says.

    “With adhesive dentistry, it is all about the technique,” Dr. Chi says. “In a busy practice, you are moving quickly and there are a lot of steps, so you have to be diligent about following them properly.”

    Dr. Ford Gatgens, DDS, says several problems can occur for your restoration if you don’t follow the manufacturer’s steps precisely, such as:

    • Too little or too much of the adhesive where you don’t want it

    • Problems with uniformity from lack of air drying the adhesive adequately

    • Materials that preset because the vial wasn’t closed all the way or was exposed to light before it should have been

    Dr. Gatgens recognizes that there can be more potential for mistakes when there are more steps to follow. He looks for products with a decreased number of steps, even if that doesn’t result in less time spent on the bonding process.

    “If you don’t have three or four individual bottles of something that you have to do things with, you are going to decrease the risk of contamination or another problem,” he explains. 

    Up next: Why isolation is crucial for adhesive restoration ...

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