I had a patient in today to complete a quadrant of teeth on the upper right. She did great through the local anesthetic and placement of the Isolite. As we began to work, she raised her left hand to stop us. The cold caused by the water spray and the high volume suction were causing her to experience sensitivity on her lower teeth where she has root exposure. This is a common experience and one I have sought to rectify over the years. I have tried placing a cotton roll in the buccal vestibule by the sensitive teeth. This tends to work for awhile until the cotton roll becomes super wet, or their lip pushes it out.
Another way to protect the teeth that aren’t anesthetized is to place a rubber dam. As I was contemplating how to proceed and keep the patient comfortable with something short of doing a lower inferior alveolar nerve block my assistant had a suggestion. She wondered why we couldn’t simply inject bite registration material around the teeth? This is the way we hold down the rubber dam when using a split dam technique, so I figured it ought to work. She got out the bite registration silicone. I dried the teeth ( with cotton of course not a stream of air) then injected the bite registration along the necks of the teeth. While I was waiting for it to set I took a perio probe and pushed some into the embrasures.
Sure enough when it set it stuck in place to the teeth and created a protective barrier against the cold air. When we were done with the procedure we teased it off from around the teeth without hassle. Our new technique resulted in a comfortable patient who wondered if she could come in and have us put the silicone on her teeth when she got a craving for ice cream!
Never thought about silicone, might give it a try in the future. I use Kerr’s Occlusal Indicator wax in a long strip that once I dry the teeth I’m able to fold it over the buccal surfaces and tease it into the embrasures. It’s quick, cheap and easy to remove to check clearances etc, the only downside is it can lift a bit.
The hardest part of the silicone was waiting for it to set.
Lee,
That’s a great pearl. You are wise beyond your years:)
What I have used is Cavit which is in every operatory in my restorative tub or the blockout material you use for in office whitening. It tends to stick better to wet teeth and soft tissue than silicone
Can you tell me more about the split dam technique? What do you use it for, and how is it done?
Thanks!
Mike,
Split dam uses a rubber dam, but does not isolate each tooth individually. Punch the holes for the rubber dam as you would typically and place a clamp on the most distal tooth. Take a pair of suture scissors and cut between the holes to separate the rubber dam material that will go interproximally. Now place the rubber dam. Once in place turn the edges on the buccal and lingual dam material under, dry and you can place a bead of silicone bite registration to seal the edge and hold it in place. This is a great technique for crown and onlay preps or seating multiple indirect restorations.
Another option: really easy to paint fluoride varnish on the sensitive cervical areas. Takes a few seconds, has a bonus effect to help with residual sensitivity later.
We use the liquidam material that comes with zoom kits, we always have some handy for this and blocking out undercuts for impressions of needed. It light cures and is soft and easy to remove