ImmediateDentinSealing.pptx

Protocolo de sellado inmediato de la dentina

1. Immediate Dentin Sealing A Fundamental Procedure for Indirect Bonded Restorations

2. Introduction The application of a dentin bonding agent to freshly cut dentin when it is exposed after tooth preparation for indirect restorations (inlays/ onlays , crowns). A procedure recommended before final impression making to preserve the dentinal collagen network and develop an adequate hybrid layer.

3. Dentin exposure after preparation Freshly cut dentin is susceptible to bacterial contamination during provisionalization period. (1-2) The colonization of bacteria through the exposed dentinal tubules leads to post-operative sensitivity and a compromise in bond strength. Whenever dentin is exposed, the application of a dentin bonding agent is recommended.

4. Cont’d Dentin bonding strength is weaker when subjected to occlusal forces immediately in direct restoration. Demineralized dentin can easily collapse by the seating pressure of the restoration. (3-6) Stress-free dentin bond development improves restoration adaptation. (6)

5. Main issues in dentin bonding Dentin contamination Susceptibility of the hybrid layer to collapse until it is polymerized.

6. Rationale for IDS Freshly cut dentin is the ideal substrate for dentin bonding. Creating a hybrid layer that both mimics the dentino -enamel junction (DEJ) and promotes proper adaptation and adherence of the final restoration is the basis of minimal intervention dentistry. Precuring of dentin bonding agent leads to improved bond strength. Dentinal tubules are blocked by the movement of dentinal tubule fluids which hinder the penetration of the resin into them. (1-2)

7. Advantages Limits the needs for anesthesia during insertion. Reduced post-op sensitivity. (7) Significantly increases retention when combined with GIC, RMGI cements. Exceeding the cohesive strength of the tooth. (8) Improves the retention for teeth with short clinical crowns and excessively tapered preparations.

8. Clinical Steps

9. How to identify dentin? A short etching (2-3 secs) followed by thorough drying of the prepared surfaces. Dentin can be easily recognized because of its glossy aspect, whereas enamel is frosty.

10. Preparation When margins terminate in dentin, a marked chamfer (0.7 mm to 0.8 mm) is recommended to provide adequate margin definition and enough space for the adhesive and overlaying restoration (Figures 2A through 2C). A shallow chamfer would cause the adhesive resin to pull over the margin and compromise both margin definition and porcelain thickness.

11. Etching Immediately after tooth preparation, the uncontaminated dentin surfaces are etched for 5 to 15 seconds (depending on the adhesive system used). It is recommended to extend etching 1 mm to 2 mm over the remaining enamel to ensure further adhesion of eventual excess resin.

12. Priming + Bonding

13. Final layers + Glycerin The adhesive is initially cured for 20 seconds. A layer of glycerine is applied on the sealed dentin to cure the air-inhibited layer of the resin. Another technique that has been suggested to reduce or eliminate the OIL is to wipe the sealed surface with a cotton pellet soaked in 70% ethyl alcohol for 10 s (9) . or covering the IDS surface with a liner (flowable composite) if space permits. (10)

14. Impression procedure Polyether is not recommended ( Impregum Soft) The OIL may in turn inhibit the polymerization of vinyl polysiloxane (VPS) impression materials, depending on the type of DBA. (11) Air blocking and pumicing was the best method to reduce the effect of OIL. (12)

15. Caution with provisionalization Sealed dentin surfaces have the potential to bond to resin-based temporary cements/materials. Usage of non-resin-based cements is recommended. (Non-eugenol ZnO and Calcium hydroxide) Cover tooth preparation using a separating medium ( e.g petroleum jelly or Pro-V coat) to avoid locking of restorations. (13)

16. Summary

17. Final insertion Various authors have evaluated methods for removal of provisional cement in vitro. Reviewing these studies, it was found that the highest bond strength values were reported with soft-air abrasion (14) , air borne particle abrasion with aluminium oxide and fluoride-free pumice paste systems.

18. Question time! The ideal time to seal the dentinal tubules is? After tooth preparation before blocking undercuts After tooth preparation after blocking undercuts After taking the impression All of the above

19. Case report

20. Pre-operative condition

21. (A) Intraoral condition immediately after restoration removal; (B) self-etch primer application for 20 seconds; (C) gentle air blowing for solvent evaporation; (D) bond layer application; (E) adhesive layer light curing for 40 seconds; and (F) flowable composite resin coat application

22. (A) Undercut filling with composite resin; (B) enamel margins finished with fine diamond bur; (C) preparation finished and ready for impression; (D) negative mold of the prepared tooth; (E) glycerin application; (F) temporary restoration

23. (A) Virtual design of the restoration; (B) final restoration on stone model; and (C) final intraoral condition of the restored tooth

24. (A) Clinical condition of the restored tooth after 15 months of follow-up; and (B) radiographic condition of the restored tooth after 15 months of follow-up

25. Conclusion Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin, before impression taking, is recommended. The immediate dentin sealing appears to achieve improved bond strength, fewer gap formations, decreased bacterial leakage, and reduced dentin sensitivity.

26. References Bertshinger C, Paul SJ, Luthy H, Schaerer P. Dual application of dentin bonding agents: its effect on the bond strength. Am J Dent. 1996;9:115-119. Paul SJ, Schaerer P. Effect of provisional cements on the bond strength of various adhesive bonding systems on dentine. J Oral Rehabil . 1997;24:8-14. Paul SJ, Schaerer P. The dual bonding technique: a modified method to improve adhesive luting procedures. Int J Periodontics Restorative Dent. 1997;17:536-545. Magne P, Douglas WH. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont . 1999;12:111-121. Dietshi D,Hertzfeld D. In-vitro evaluation of marginal and internal adaptation of ClassII resin composite restorations after thermal and occlusal stressing. Eur J Oral Sci. 1998;106:1033-1042. Pashley EL, Comer RW, Simpson MD, et al. Dentin permeability: sealing the dentin in crown preparations. Oper Dent. 1992;17:13-20. Cagidiaco MC, Ferrari M, Garberoglio R, et al.Dentin contamination protection after mechanical preparation for veneering. Am J Dent. 1996;9:57-60.

27. References Johnson GH, Hazelton LR, Bales DJ, et al. The effect of a resin-based sealer on crown retention for three types of cement. J Prosthet Dent. 2004;91:428-435. Van Meerbeek B, De Munck J, Yoshida Y, et al. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges. Oper Dent. 2003;28:215-235. De Munck J, Van Meerbeek B, Satoshi I, et al. Microtensile bond strengths of one and two-step self-etch adhesives to bur-cut enamel and dentin. Am J Dent. 2003;16:414-420. Paul SJ. Scanning electron microscopic evaluation of the influence of the oxygen-inhibited layer of resins on the polymerization of impression materials. In: Paul SJ, editor. Adhesive luting procedures. Chicago: Quintessence; 1997. p. 99–110. Magne , P., & Nielsen, B. (2009). Interactions between impression materials and immediate dentin sealing. Journal of Prosthetic Dentistry , 102 (5), 298–305. https://doi.org/10.1016/S0022-3913(09)60178-5 Qanungo , A., Aras, M. A., Chitre , V., Mysore, A., Amin, B., & Daswani , S. R. (2016). Immediate dentin sealing for indirect bonded restorations. Journal of Prosthodontic Research , 60 (4), 240–249. https://doi.org/10.1016/J.JPOR.2016.04.001 Rocca GT, Gregor L, Sandoval MJ, Krejci I, Dietchi D. In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect class II composite restorations with different resinous bases and interface treatments. Post-fatigue adaptation of indirect composite restorations. Clin Oral Investig 2012;5:1385–93. Leite , M. M., de Souza, D. R., Carvalho, M. A., Lopes, L. G., & de Torres, É. M. (2017). Immediate dentin sealing with self-etch dentin bonding agent for indirect restoration. World Journal of Dentistry , 8 (6), 490–495. https://doi.org/10.5005/jp-journals-10015-1492

28. Thank you!