29115 359 368 - REALITY Publishing Company · cover it after blasting the teeth with air and then watch as the ... bonding resin is the most effective technique. ... cardboard box

Office1. Gluma Desensitizer

Heraeus Kulzer

2. Super SealPhoenix

3a. HurriSealBeutlich Pharmaceuticals

3b. MicroPrimeDanville Materials

4. Hemaseal & CideAdvantage

5. D/Sense 2Centrix

Home1. UltraEZ

Ultradent

REALITY’S CHOICESDesensitizers

©2005 REALITY Publishing Co. Vol. 19 The Ratings 359

Desensitzers

©2005 REALITY Publishing Co. Vol. 19360 The Ratings

Office Cost/ml CompositionOptiBond Solo plus

Prime &Bond NT

OptiBond Solo plus

Prime &Bond NT

MicroleakageBond Strength

Gluma DesensitizerHeraeus Kulzer

Super SealPhoenix

$19.37–$21.76

$10.00–$12.49

5% Glutaraldehyde, 35% HEMA, water

Potassium oxalate-based salt, water

�

�

�

�

$4.163% potassium nitrate,

0.11% with fluoride ion N/A N/A N/A N/AUltraEZUltradent

� �

= �

pH

6.8

1.8

1.6

Available inUnit Dose

No

HurriSeal Beutlich

Pharmaceuticals$3.33

Benzalkonium chloride,HEMA, sodium fluoride,

water= � � �5.5No

D/Sense 2Centrix

$7.14–$11.19

Step 1: Potassium phosphate, potassium

carbonate, waterStep 2: Calcium chloride,strontium chloride, water

N/A N/A N/A N/AStep 1: 6.9Step 2: 5.3

No

Hemaseal & CideAdvantage $8.33 HEMA, 4% chlorhexidine

digluconate, water � � � �5.6No

MicroPrimeDanville Materials $4.40

5% benzethonium chloride,35% HEMA, sodium

fluoride 10ppm, water= � � �3.6No

Yes

No

� Less than Control

� More than Control

= Equal to Control

Home

It seems that every patient who comes into our offices has at leasta few sensitive teeth. These sensitive teeth are usually discoveredearly in the patient’s visit, typically when we pick up the air syringeto dry the teeth during the initial exam. The patient’s eyes will getreal big, prompting a comment (or plea) like “You’re not going toblow air on my teeth, are you? They’re real sensitive to air.” If thepatient does not actually tell us about the sensitivity, we soon dis-cover it after blasting the teeth with air and then watch as thepatient pulls the arms of our dental chair out of their moorings.But, even if the patient is real macho during the exam, the dread-ed prophy will break through even the most stubborn defensesand reduce the patient to begging us not to use the torturemachine, a.k.a., the ultrasonic/sonic scaler, on those “sensitiveareas.”

Treatment ApproachesTraditional approach Uses desensitizing toothpastes and/or top-ical fluoride treatments. Even today, there is nothing wrong withtrying these modalities first, since they are inexpensive and requireminimal if any staff time.Seal tubules If the sensitivity does not respond to these simpletreatments and since the sensitive areas are usually exposed rootsurfaces, it makes sense to try to seal these areas using an in-officeapplied treatment or with potassium nitrate gel in a bleaching-liketray at home. Definitive restoration If the exposed root is accompanied withan actual lesion (carious or abfracted), then a definitive restorationwould be indicated.

Other UsesDesensitize Preparations for Indirect Restorations (atthe preparation appointment)Sealing your preparations at the preparation appointment prior toor immediately after taking the impression has become popular asa way of keeping patients comfortable during the provisionaliza-tion period and possibly negates the need to administer localanesthesia at the seating appointment. Using it before the impres-sion would alleviate the concern that the film thickness of thedesensitizing layer could prevent full seating of the definitiverestoration if this layer was applied after the impression. However,the film thickness of these materials is very low, minimizing thispossible problem.

Nevertheless, there are no data on the effect this desensitizinglayer may have on the accuracy of the impression and the abilityof the lab to read your margins. In addition, if your provisional isfabricated out of a composite material, it may bond with thisdesensitizer, even if the preparation was lubricated liberally priorto fabricating the provisional.

To test the effect on impression materials, we took impressionsof a quadrant of preparations with Aquasil and Honigum beforeand after applying Gluma Desensitizer to the preparations. Wewere unable to detect any visible differences either in the impres-sions themselves or on the die stone models between the controland test groups.

Effect on the bond strength of the definitive restoration is alsoa concern with this procedure. In other words, if you actuallyhybridize the dentin at the preparation appointment, will thatmake it more difficult to bond the definitive restoration? To inves-

tigate this issue, we tested the bond strength of OptiBond Soloplus/Nexus2 under the following pretreatment conditions:

• Preparation was etched, OptiBond Solo plus was applied andcured, Temp-Bond Clear was applied, and the specimen wasstored in the T/H chamber for seven days. Then Temp-BondClear was removed, the preparation was cleaned, etched, andbonded using OptiBond Solo plus/Nexus2. Bond strength ofthis group = 28.5MPa.

• Preparation was not etched, OptiBond Solo plus was appliedand cured, Temp-Bond Clear was applied, and the specimenwas stored in the T/H chamber for seven days. Then Temp-Bond Clear was removed, the preparation was cleaned,etched, and bonded using OptiBond Solo plus/Nexus2. Bondstrength of this group = 28.5MPa.

• Preparation was etched, All-Bond DS Primers A&B weremixed, applied, and cured, Temp-Bond Clear was applied,and the specimen was stored in the T/H chamber for sevendays. Then Temp-Bond Clear was removed, the preparationwas cleaned, etched, and bonded using OptiBond Soloplus/Nexus2. Bond strength of this group = 25.7MPa.

• Control = 34.2MPa

These results suggest there is a price to pay for sealing your prepa-rations at the preparation appointment, although the clinicalsignificance of the lower bond strength is questionable. If yourpatients are not having sensitivity now during the provisional peri-od, then there is probably no reason you should seal yourpreparations at the preparation appointment. Otherwise, thediminution in bond strength may be worth it to keep yourpatients comfortable.

Desensitize Preparations for Indirect Restorations (atthe cementation appointment)We have all experienced calls from patients who have sensitiveteeth after their new indirect restorations have been luted. If youare bonding the restorations, proper application of an adhesiveshould seal the tooth, minimizing or eliminating this problem.But for more conventional cementation, applying a desensitizerprior to seating the restoration should help alleviate the typicalpost-cementation sensitivity.

Desensitize Preparations Prior to Applying anAdhesiveDesensitizers are also being applied to preparations after etching,but before the adhesive is applied. This is supposed to enhancebond strength, minimize the chances for sensitivity postoperative-ly, and to reduce gaps at the margins. We tested the effect of thisapplication on both bond strength and microleakage. The resultsare listed in the commentary for the products recommended forthese functions.

pHThe significance of pH is uncertain in this group. Nevertheless, itwould seem that a low pH would be counterproductive for adesensitizer.

Desensitzers


http://a.k.a

Composition 5% glutaraldehyde, 35% HEMA, water.

pH1.8

UseBlot dry. Apply with a cotton pellet or applicator tip by rubbingthe preparation for 30 seconds and dry thoroughly (except if youare using a wet or moist adhesive protocol). Be careful about get-ting it on the soft tissue—it can irritate the gingiva. One patientactually had an allergic reaction.

Effect on Bond StrengthOptiBond Solo plus Slightly higher than control. Prime & Bond NT Slightly higher than control.

Effect on Microleakage OptiBond Solo plus Less than control. Prime & Bond NT Less than control.

Dedicated Product vs. Dental AdhesiveMost desensitizers that are professionally applied have their originsin dental adhesives. Indeed, some components of these productsare straight out of the adhesive kits. So, the big question is: Doyou really need a dedicated product for desensitizing dentin or willthe primers, with or without the bonding resin, in your currentadhesive system do just fine? The best answer is: depends on thepurpose for which you are using the desensitizer. If you want amaterial to desensitize cervical abfractions, our experience hasfound an adhesive system with a primer followed by a light-curedbonding resin is the most effective technique. Or, you can use adouble application of a single-component adhesive.

If you are desensitizing a preparation, there could be two goodreasons to use a dedicated product: ease of use and film thickness,the latter of which needs to be minimal to allow complete seatingof your restoration. However, most single-component adhesivesalso have minimal film thicknesses.

Sequence for Application on AbfractionLesionStep 1Clean the sensitive area. This is usually done with a cavity clean-er/disinfectant, mixed with pumice if the preparation isdebris-laden. If you are desensitizing a non-anesthetized patient,this cleaning step may not be the most comfortable procedure.

Step 2Rinse and leave lesion with the amount of moisture specified asoptimal for that specific product.

Step 3Apply the desensitizer according to the protocol specific to theproduct you are using.

Office vs. HomeWe have divided these products into two categories:

Office Must be applied professionally. Can be used for a varietyof purposes.

Home Potassium Nitrate Gel applied by a patient in a modifiedbleaching tray. Can presumably occlude the dentinal tubules. Wehave not found them to be as effective as the resin-based products,but they can be of some benefit for general sensitivity or sensitiv-ity caused by bleaching.

Desensitzers


Gluma DesensitizerHeraeus Kulzer(4.5)

BottleCost: $96.83/5ml ($19.37/ml)

Includes: • 1 btl (5ml)

Single DoseCost: $65.28/3ml ($21.76/ml)($1.63/unit dose)

Includes: • 40 unit doses (0.075ml ea)

Shelf life: 3 years

MSDS: Included w/ bottle, not w/unidose

REALITY’SC H O I C E S1

Office

Only product to decrease leakage with both adhesivesLong track record

Very expensiveGlutaraldehyde use still questioned by some

CompositionOxalic acid, potassium salt, water.

pH1.6

UseApply with cotton pellet for 30 seconds on a clean tooth (we sug-gest blotting dry before application). Presumably, it willdemineralize the smear layer and peritubular dentin and willrestructure the demineralized material as a calcium oxalate precip-itate within two minutes.

Effect on Bond StrengthOptiBond Solo plus Much lower than control. Prime & Bond NT Much lower than control.

Effect on MicroleakageOptiBond Solo plus Same as control. Prime & Bond NT More than control.

PackagingTypical plastic squeeze bottle shipped in a small box, with expira-tion date. Label on bottle includes the expiration date and ismoisture-resistant.

Directions Plain paper, very short and to the point.

PackagingBottle Simple as it gets. Bottle comes in small, cardboard box.Labels on bottle and the box include expiration date. However,the section of the label on bottle that contains the expiration dateis protected by adhesive tape, but the label in general rubs off aftera few disinfection procedures.

Single Dose Large cardboard box with rear-attached lid. The sin-gle dose applicators come in foil pouches that are loose in the box.It is easy to open the foil pouch due to a notched area at one end.The pouches are well identified, have the expiration dateembossed, and include three line drawings on how to actually usethe single dose applicator. This applicator has a gray plastic han-dle, which inserts into a two-stage black plastic cylinder. Using thehandle, you push the smaller stage into the larger one. Then youpull out the applicator to find the head immersed in desensitizer.You then apply the product as you would with any applicator tip.

Directions Bottle Typical thin paper. Various procedures explained reason-ably well. Instructs you to use a “gentle, but firm” rubbingmotion, but how do you perform both “gentle” and “firm” at thesame time?

Single Dose Small, plain paper booklet in 11 languages plus alarge, plastic-coated treatment room card with color illustrationsdisplaying the application steps. While the illustrations are well-done, the lack of words hinders the card’s usefulness. There is alsoa single sheet of plain paper illustrating how to open the singledose unit.

Desensitizers


Cost: $80.00 ($10.00/ml)


Cost: $49.95 ($12.49/ml)


Shelf life: 2 years

MSDS: Included

Shelf life: 2 years

MSDS: Included

Super SealPhoenix(3.9)

Very effective clinically on abfraction lesionsEasy to apply

No improvement over controls for leakageMuch lower bond strengths than controls

2SAMPLING

Composition Benzalkonium chloride, HEMA, sodium fluoride, and water.

pH5.5

UseBlot dry. Apply with an applicator tip. There is no stipulated dwelltime—you are merely supposed to apply and allow the material toair dry for 20 seconds, then repeat two more times. Then, if youare using it as a remoistener prior to applying the adhesive, removeany pooled material by suctioning. If you are treating a cervical

lesion, gently dry with an indirect air flow. We tested this tech-nique as well as a more conventional one.

Effect on Bond StrengthOptiBond Solo plus Same as control (both techniques).Prime & Bond NT More than control (both techniques).

Effect on MicroleakageOptiBond Solo plus More than control. Prime & Bond NT More than control.

PackagingConventional plastic squeeze bottle comes in small, cardboardbox. The expiration date is printed directly on the bottom of thebottle and on the box. On the bottle, it cannot be removedthrough disinfection.

Directions Typical thin paper. Procedure explained reasonably well.

Desensitzers


HurriSealBeutlich Pharmaceuticals (3.8)

Cost: $39.95/12ml ($3.33ml)


Shelf life: 3 years

MSDS: Not Included

Least expensiveLess leakage with OptiBond Solo plus

More leakage with Prime & Bond NTSlightly lower bond strengths with both adhesives

3aENCORE

Composition 5% benzethonium chloride, 35% HEMA, sodium fluoride10ppm, and water.

pH3.6

UseBlot dry. Apply Microprime and wait 30 seconds. Dry thorough-ly with air (unless you are using a moist or wet adhesive protocol.)

Effect on Bond StrengthOptiBond Solo plus Same as control. Prime & Bond NT Lower than control.

Effect on MicroleakageOptiBond Solo plus Less than control. Prime & Bond NT More than control.

MicroPrimeDanville Materials (3.8)

Cost: $43.95/10ml ($4.40/ml)


Shelf life: 3 years

MSDS: Included

InexpensiveLess leakage with OptiBond Solo plus

More leakage with Prime & Bond NTLower bond strength with Prime & Bond NT

3b

PackagingTypical plastic squeeze bottle comes in small, cardboard box. Labelon bottle includes the expiration date, but it will be rubbed offduring disinfection procedures.

Directions Coated paper, gives direction for non-bonded and bonded appli-cations.

Desensitzers


Composition HEMA and 4% chlorhexidine digluconate and water.

pH5.6

UseBlot dry. Apply with an applicator tip, scrub the preparation for10-15 seconds. Suction excess and leave dentin moisture level tooptimize performance of the adhesive you are using.

Effect on Bond StrengthOptiBond Solo plus Higher than control. Prime & Bond NT Higher than control.

Effect on Microleakage OptiBond Solo plus Slightly more than control. Prime & Bond NT Significantly less than control.

PackagingConventional white plastic bottle comes in small, cardboard box.Label on bottle includes expiration date and is moisture-resistant.

Directions Plain paper, brief, to the point. However, there is no instructionon use under bonded crowns. In addition, applying it prior toplacing a self-etching adhesive is listed as one of the indications.But a desensitizer is rarely if ever used with a self-etcher, sinceminimizing sensitivity is one of the main reasons self-etchers areused in the first place.

Cost: $83.30/10ml ($8.33/ml)


Shelf life: 3 years

MSDS: Not included

Hemaseal & Cide Advantage(3.6)

Only product with chlorhexidineEnhances bond strength

Recommends use with self-etching adhesivesNo single dose

4

Composition3% potassium nitrate, 0.11% with fluoride ion.

pH6.8

Composition:Step 1 Potassium phosphate, potassium carbonate, water.Step 2 Calcium chloride, strontium chloride, water.

pHStep 1 6.9Step 2 5.3

UseApply Step 1 to the sensitive area first by rubbing it into the drytooth surface for 10 seconds. Then apply Step 2 in the same man-ner. Film thickness is approximately 3µ.

Effect on Bond Strength and MicroleakageIt is not recommended for use prior to placing a restoration. Ourtests confirm that it does significantly lower bond strengths.Because of these results, we did not test microleakage.

Packaging Relatively large cardboard box mainly used to house the disposableBondLogic wells and BendaBrushes. Expiration date is on the topof the box and on bottles. Bottles have moisture-resistant, color-coded labels and caps.

DirectionsTwo-sided, plain paper in nine languages. There is a second smallpaper insert with “essential points to remember”. Very short, tothe point, effective.

Desensitizers


D/Sense 2Centrix (3.5)

7ml Kit: Cost: $99.95/14ml ($7.14/ml)

Includes:• 1 btl of Step 1 (7ml)• 1 btl of Step 2 (7ml)• 72 BendaBrushes• 36 BondLogic dispensing wells

Kit Cost: $19.99/4.8ml ($4.16/ml)

Includes: • 4 syringes with dispensing tips (1.2ml ea)

Shelf life: 2 years

MSDS: Included

UltraEZUltradent (3.8)

Less expensive than office-based serviceBest syringes for convenience

Relies on patient complianceDon’t use immediately prior to bonding

Nothing toxicMimics what body does to plug tubules

Cannot be used to desensitize preparationsTwo steps/multiple applications

Home

5

1

ENCORE 2.5ml KitCost: $55.95/5ml ($11.19/ml)

Includes:• 1 btl of Step 1 (2.5ml)• 1 btl of Step 2 (2.5ml)• 40 BendaBrushes• 10 BondLogic dispensing wells

Shelf life: 3 years

MSDS: Included

http://19.99/4.8ml

UseDesensitizing gel designed to be used with custom tray. Dispensegel in reservoir of custom tray in the same manner you would formost home bleach systems. Recommended treatment times rangefrom 15 minutes to eight hours depending on the condition.

Effect on Bond Strength and MicroleakageIt is not recommended for use prior to placing a restoration. Ourtests confirm that it does significantly lower bond strengths.Because of these results, we did not test microleakage.

PackagingCardboard box with removable translucent plastic tray securingthe contents. The syringes have the tips already attached.Expiration date is on a sticker on the outside of the cardboard boxand chiseled into the syringe itself. However, on the translucentplastic, the numbers are hard to read.

Directions Plain paper, 11 languages, nine photos, annoying foldout design.Straightforward and easy to follow. Includes instructions on howto make a modified bleaching tray for this purpose.

Desensitizers


Shelf life: 2 years

MSDS: Included

OFFICE

Gluma Desensitizer started the trend of desensitiz-ing crown preparations prior to conventionalcementation. It has at least one clinical study that vali-dates its claims and a long track record. Our tests showit was the only product not to have a negative effecton bond strength and to decrease the leakage whenused with both test adhesives. However, it also con-tains glutaraldehyde, which has come under attackdue to the potential toxicity, although it has the abili-ty to coagulate plasma proteins in the tubules and thusprovides a mechanism for the desensitization effect.Our evaluators found it to be an effective productunder restorations and crowns, but not as effective onabfractions. It is available in single dose packaging aswell as bottles, but it is quite expensive.

Super Seal is recommended for use under restora-tions as well as on abfractions. Unfortunately, it hadnegative effects with bond strength and leakage in ourtests. On the other hand, it has been very effective atdesensitizing abfractions. Furthermore, it is not asexpensive as Gluma Desensitizer.

HurriSeal has either a positive or neutral effect onbond strength of both test adhesives, using either themanufacturer-mandated application procedure, whichis time-consuming and requires multiple coats or ourtruncated method, in which it is applied for 15 sec-onds. However, using the manufacturer’s technique,both test adhesives exhibited increased levels ofmicroleakage. On the other hand, it is the least expen-sive product in this group.

MicroPrime is designed to be a non-glutaraldehyde,low-cost version of Gluma Desensitizer. While its effi-cacy has not been as well documented as that of

Gluma Desensitizer, anecdotal reports are encourag-ing. Our evaluators found it to be an effective productunder restorations and crowns, but not as effective onabfractions. In addition, it had mixed results with bondstrength and microleakage.

Hemaseal & Cide Desensitizer is the only product inthis group containing chlorhexidine in a concentrationusually reserved for hand scrubs. Its ability as a rewet-ting agent was highly touted, enhancing the bondstrength of both test adhesives, but its effectiveness oncervical sensitivity was less stellar and its effect onmicroleakage was mixed. Nevertheless, there is a 110%guarantee, so that if it doesn’t work to your satisfac-tion, you will get your money back plus 10%.

D/Sense 2 is designed to be used on sensitive areas ofteeth that are not destined for restorations, althoughthere is some indication that conventional etching willremove it and allow the tooth to be restored. Its twobottle/two step application protocol is presumably nec-essary to achieve profound desensitization. This typeof material desensitizes via the precipitation of calciumphosphate. However, it requires the deposition ofthese crystals in a particle size that is small enough toenter the dentinal tubules. There is no point simplyhaving lots of calcium phosphate deposits merely onthe surface of the intertubular dentin, since these willeventually be rinsed off or dislodged.

Our clinical evaluation found it was quite effective,but not in all cases. However, most evaluators found itto be a real hassle to apply one solution, then a secondsolution, especially when treating hard-to-access andhard-to-isolate molar areas. On the other hand, it hasno resin, glutaraldehyde, or anything else that couldbe considered less than totally safe from a toxicitystandpoint — just two solutions of inorganic salts.

REALITY

Desensitzers


HOME

UltraEZ has convenient packaging (smaller unit dose syringes)and is less expensive than an office treatment. This is a goodoption when a patient has generalized sensitivity, especiallyafter bleaching.

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Documents

29115 359 368 - REALITY Publishing Company · cover it after blasting the teeth with air and then watch as the ... bonding resin is the most effective technique. ... cardboard box