Endo - hipo - obturatie compozit

[MDSK]

Nu am reusit sa-mi fac o parere clara dupa ce am citit diverse studii, asa ca sunt curios ce credeti voi despre ceea ce o sa scriu in continuare.

Din ceea ce am citit, folosirea hipo pentru toaleta cavitatii este un pic controversta pentru ca unele studii au aratat ca poate scadea forta adeziunii compozit/dinte.

Eu fac obturatia endo + obturatia cu compozit in aceeasi sedinta si ma gandeam ce influenta ar putea avea hipo care practic balteste tot timpul in dinte asupra adeziunii compozitului. Nu este un timp scurt ca la o toaleta ci este vorba chiar de 1 ora uneori.

Pot fi probleme ? Banuiesc ca da.
Ce as putea face ? Sa mai intru iarasi cu freza inainte de obturatia cu compozit sau nu este necesar ?

[augustin]

esti mai catolic decat Papa. Parerea mea . :wink:

[dentapro]

Publicat initial de MDSK

... Sa mai intru iarasi cu freza inainte de obturatia cu compozit sau nu este necesar ?

Si eu procedez la fel, un tur de freza diamantata cu granulatie fina (inel rosu) cu atingerea usoara a peretilor laterali ai cavitatii de acces. Planseul ramine asa, amin

[k-nin]

io dau cu acid pete tot adica inclusiv in cam pulpara , spal cu apa 15-20 sec, uscare cu bulete , adeziv peste tot ( peretii cavitatii, camera pulpara , podeaua camerei pulpare) , 2 aplicari de adeziv , uscat adezivu cu ceva jet de aer si polimerizare dupa care protocolu uzual ca la oricare obturatie ....
cred ca hipo de la endo ar fi chiar util pentru ca dizxolva eventuale detritusuri oganice , oricum trebuie sa speli dupa hipo deci se hidrateaza dentina + smalt ......

[dentapro]

un rezumat dintr-un review sharuit de robbycarlos acu' vreun an (cred) Schwartz, Fransman JOE martie 2005

Endodontic Issues in Dentin Bonding
Some of the materials used in endodontics may have a significant impact on the bonding process. These issues apply not only to restoration of access cavities, but also to the obturating materials that utilize adhesive resin technology, which will be discussed in a subsequent article.

Eugenol

In endodontics, eugenol containing materials are widely used in sealers and temporary filling materials. Eugenol is one of many substances that can prevent or stop the polymerization reaction of resins (138) and can interfere with bonding (139). If resin bonding is planned for a dentin surface that is contaminated with eugenol, additional clinical steps are needed to minimize the effects of the eugenol. The surface should be cleaned with alcohol or a detergent to remove visible signs of sealer. Many temporary cements, whether they contain eugenol or not, leave behind an oily layer of debris that must be removed before bonding procedures (140, 141). Air abrasion is an effective method for cleaning the dentin surface (Fig. 7). Once it is clean, the dentin should be etched with an acid, such as phosphoric acid and then rinsed. The acid demineralizes the dentin surface to a depth of about 5
removesves the eugenol rich layer. Several studies have shown that the total etch (three step) procedure allows effective bonding to eugenol contaminated dentin surfaces (24, 142). An etch and rinse adhesive system should be used, because the self etching systems incorporate the eugenol rich smear layer into the hybrid layer, rather than removing it. Eugenol has no effect on glass ionomer cements (143).

Sodium Hypochlorite
Sodium hypochlorite is commonly used as an endodontic irrigant because of its antimicrobial and tissue dissolving properties (144). Sodium hypochlorite causes alterations in cellular metabolism and phospholipid destruction. It has oxidative actions that cause deactivation of bacterial enzymes and causes lipid and fatty acid degradation (144).
Several studies have shown that dentin that has been exposed to sodium hypochlorite exhibits resin bond strengths that are significantly lower than untreated dentin (145–149). One study reported bond strengths as low as 8.5 Mpa (147). Increased microleakage was also reported (150). This phenomenon probably occurs because sodium hypochlorite is an oxidizing agent, which leaves behind an oxygen rich layer on the dentin surface. Oxygen is another substance that inhibits the polymerization of resins (151). Morris et al. showed that application of 10% ascorbic acid or 10% sodium ascorbate, both of which are reducing agents, reversed the effects of sodium hypochlorite and restored bond strengths to normal levels. Lai et al. and Yiu et al. reported similar results (149, 150). Because sodium hypochlorite is likely to remain the primary irrigant used in endodontics for the near future, and because adhesive resin materials are used routinely in restoring endodontically treated teeth, this issue will have to be addressed. Future adhesive resin products for endodontic applications may contain a reducing agent to reverse the effects of the sodium hypochlorite. A nonoxidizing irrigant would also solve this problem. Sodium hypochlorite and EDTA have also been shown to reduce the tensile strength and microhardness of dentin (152). These are particularly timely issues for endodontics as adhesive resin materials gain popularity as obturating materials.

Other Materials Applied to Dentin

Other materials that are applied to dentin during endodontic procedures have been tested for their effects on bonding. Not surprisingly, hydrogen peroxide leaves behind an oxygen rich surface that inhibits bonding (147, 148). Reduced bond strengths were shown after the use of RC prep (Premier) (146). Electro-chemically activated water has gained a following as an irrigating solution. It probably reduces bond strengths of adhesive resins because it has the same active ingredient as sodium hypochlorite, i.e. hypochlorous acid (153, 154). No loss of bond strength is reported from chlorhexidine irrigation before resin bonding (147, 155, 156) or placement of resin-modified glass ionomer materials (157). Caries detector did not affect resin bond strengths (158, 159), but chloroform and halothane resulted in significant loss of bond strength (160).

[MDSK]

Mersi Dentapro.
Acum m-am lamurit.

@Augustin

Sau mai ortodox decat IPS Daniel.


@k-nin

Poate ar fi bine sa speli un pic mai mult cu apa sa reusesti sa faci o rehidratare mai buna. Eu rehidratez cu jet continuu vreo 2 minute si apoi las un pic si apa sa balteasca acolo.

O sa ma uit intr-un studiu pentru ca nu mai stiu exact de cat timp este nevoie pentru a obtine o rehidratare a matricii de colagen.

[augustin]

daca colagenul a fost desicat, rehidratarea se obtine in 30 de minute

[MDSK]

Eu am citit ca in mai putin timp.
Era pe undeva pe la 5 maxim 10 minute.

[augustin]

nah, studii. Ideea e sa nu desicam ca dupa aia oricum nu prea putem sta sa rehidratam. Sau putem balti apa si bem o cafea, dar pacientul nu o fi prea fericit sa vada asta.

[dentapro]

Publicat initial de MDSK

Sau mai ortodox decat IPS Daniel.
...

Acum e PF, nu prea inteleg de ce e asa fericit da' daca asa e gradu'

La topic, daca dati un search pe PubMed o a gasiti mai multe studii referitoare la scaderea adeziunii la dentina expusa la NaOCl in cursul tratmentului endo si la efectul acidului ascorbic sau ascorbatului de Na ca antioxidanti in restabilirea capacitatii de adeziune. Vitamina C se gaseste din belsug si e si ieftina asa ca n-ar fi greu de folosit. Ceva protocol in acest sens? Tot ce-am citit pe acolo era doar in vitro.

Mai mult am gasit asta:

1: Dent Mater. 1999 Sep;15(5):323-31.
Effect of removal of surface collagen fibrils on resin-dentin bonding.
Prati C, Chersoni S, Pashley DH.

School of Dentistry, University of Bologna, Italy. Link [Necesita inregistrare pentru acces.]

OBJECTIVES: The aim of this study was to evaluate the effects of NaOCl at removing the demineralized layer by examining the morphology of the hybrid layer and measuring shear bond strengths after different dentin treatments. METHODS: Dentin disks were treated with: (1) 35% phosphoric acid (PA) 20 s; (2) PA treatment followed by 1.5% NaOCl, 2 min; (3) PA treatment, followed by a 10% NaOCl immersion for 120 h. SEM was used to analyze the morphology of dentin and its interface with dentin bonding agents (DBAs), while shear bond strength tests were used to measure adhesion. All specimens were then fractured into two halves: One half was inspected under SEM; the other half was sequentially placed in 10% PA followed by 12.5% NaOCl for 70 h, to remove all dentin from the resin replica of the original bonded interface. RESULTS: SEM observations showed that collagen fibrils were completely removed from the acid-etched surface by NaOCl treatment. The diameter and the size of dentinal tubules and the number of lateral branches of the tubules were increased following NaOCl treatment. NaOCl applied on dentin smear layers did not significantly modify their SEM morphology. Resin tags were larger in diameter after phosphoric acid/NaOCl treatment than after only phosphoric acid treatment. Resin-infiltrated dentin-layers were only observed after the single phosphoric acid (i.e. conventional etching) procedure, and were not observed after combined phosphoric acid/NaOCl treatment. Etched/NaOCl samples showed a lower bond strength using Scotchbond MP and 3M Single Bond, but were higher in Optibond FL and unmodified in Prime & Bond 2.0 groups when compared with acid-etched controls. Treatment of etched dentin with NaOCl for 120 h produced an unusual type of resin infiltration of mineralized dentin that could be called a "reverse hybrid layer" which may explain the mechanism of resin bonding to NaOCl treated dentin. SIGNIFICANCE: The use of acidic conditioners for exposure of the collagen matrix exposes a soft delicate mesh that can collapse, thereby interfering with resin infiltration. If acid-etching is followed by NaOCl treatment, high bond strengths can be achieved via "reverse hybrid layer" formation, a proposed new mechanism of micromechanical resin retention. This mechanism is not yet recommended for clinical use but demonstrates a new type of resin retention.

care cam contrazice ce scrie in review-ul ala.