Desensitizers - REALITY Publishing Company

Desensitizers
REALITY’S CHOICES
Office
1.
Gluma Desensitizer
Heraeus Kulzer
2.
Super Seal
Phoenix
3a.
HurriSeal
Beutlich Pharmaceuticals
3b.
MicroPrime
Danville Materials
4.
Hemaseal & Cide
Advantage
5.
D/Sense 2
Centrix
Home
1.
UltraEZ
Ultradent
©2005 REALITY Publishing Co. Vol. 19
The Ratings
359
Desensitzers
Bond Strength
Office
Cost/ml
Gluma Desensitizer
Heraeus Kulzer
$19.37–
$21.76
Super Seal
Phoenix
Available in
Unit Dose
Microleakage
OptiBond
Solo plus
Prime &
Bond NT
OptiBond
Solo plus
Prime &
Bond NT
Composition
pH
Yes
5% Glutaraldehyde,
35% HEMA, water
1.8
$10.00–
$12.49
No
Potassium
oxalate-based salt, water
1.6
=
HurriSeal
Beutlich
Pharmaceuticals
$3.33
No
Benzalkonium chloride,
HEMA, sodium fluoride,
water
5.5
=
MicroPrime
Danville Materials
$4.40
No
5% benzethonium chloride,
35% HEMA, sodium
fluoride 10ppm, water
3.6
=
Hemaseal & Cide
Advantage
$8.33
No
HEMA, 4% chlorhexidine
digluconate, water
5.6
D/Sense 2
Centrix
$7.14–
$11.19
No
Step 1: Potassium
phosphate, potassium
carbonate, water
Step 2: Calcium chloride,
strontium chloride, water
Step 1: 6.9
Step 2: 5.3
N/A
N/A
N/A
N/A
$4.16
No
3% potassium nitrate,
0.11% with fluoride ion
6.8
N/A
N/A
N/A
N/A
Home
UltraEZ
Ultradent
=
360
The Ratings
Less than Control
More than Control
Equal to Control
©2005 REALITY Publishing Co. Vol. 19
Desensitzers
It seems that every patient who comes into our offices has at least
a few sensitive teeth. These sensitive teeth are usually discovered
early in the patient’s visit, typically when we pick up the air syringe
to dry the teeth during the initial exam. The patient’s eyes will get
real big, prompting a comment (or plea) like “You’re not going to
blow air on my teeth, are you? They’re real sensitive to air.” If the
patient does not actually tell us about the sensitivity, we soon discover it after blasting the teeth with air and then watch as the
patient pulls the arms of our dental chair out of their moorings.
But, even if the patient is real macho during the exam, the dreaded prophy will break through even the most stubborn defenses
and reduce the patient to begging us not to use the torture
machine, a.k.a., the ultrasonic/sonic scaler, on those “sensitive
areas.”
Treatment Approaches
Traditional approach Uses desensitizing toothpastes and/or topical fluoride treatments. Even today, there is nothing wrong with
trying these modalities first, since they are inexpensive and require
minimal if any staff time.
Seal tubules If the sensitivity does not respond to these simple
treatments and since the sensitive areas are usually exposed root
surfaces, it makes sense to try to seal these areas using an in-office
applied treatment or with potassium nitrate gel in a bleaching-like
tray at home.
Definitive restoration If the exposed root is accompanied with
an actual lesion (carious or abfracted), then a definitive restoration
would be indicated.
Other Uses
Desensitize Preparations for Indirect Restorations (at
the preparation appointment)
Sealing your preparations at the preparation appointment prior to
or immediately after taking the impression has become popular as
a way of keeping patients comfortable during the provisionalization period and possibly negates the need to administer local
anesthesia at the seating appointment. Using it before the impression would alleviate the concern that the film thickness of the
desensitizing layer could prevent full seating of the definitive
restoration if this layer was applied after the impression. However,
the film thickness of these materials is very low, minimizing this
possible problem.
Nevertheless, there are no data on the effect this desensitizing
layer may have on the accuracy of the impression and the ability
of the lab to read your margins. In addition, if your provisional is
fabricated out of a composite material, it may bond with this
desensitizer, even if the preparation was lubricated liberally prior
to fabricating the provisional.
To test the effect on impression materials, we took impressions
of a quadrant of preparations with Aquasil and Honigum before
and after applying Gluma Desensitizer to the preparations. We
were unable to detect any visible differences either in the impressions themselves or on the die stone models between the control
and test groups.
Effect on the bond strength of the definitive restoration is also
a concern with this procedure. In other words, if you actually
hybridize the dentin at the preparation appointment, will that
make it more difficult to bond the definitive restoration? To inves©2005 REALITY Publishing Co. Vol. 19
tigate this issue, we tested the bond strength of OptiBond Solo
plus/Nexus2 under the following pretreatment conditions:
• Preparation was etched, OptiBond Solo plus was applied and
cured, Temp-Bond Clear was applied, and the specimen was
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. Bond strength of
this group = 28.5MPa.
• Preparation was not etched, OptiBond Solo plus was applied
and cured, Temp-Bond Clear was applied, and the specimen
was stored in the T/H chamber for seven days. Then TempBond Clear was removed, the preparation was cleaned,
etched, and bonded using OptiBond Solo plus/Nexus2. Bond
strength of this group = 28.5MPa.
• Preparation was etched, All-Bond DS Primers A&B were
mixed, applied, and cured, Temp-Bond Clear was applied,
and the specimen was 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. Bond strength of this group = 25.7MPa.
• Control = 34.2MPa
These results suggest there is a price to pay for sealing your preparations at the preparation appointment, although the clinical
significance of the lower bond strength is questionable. If your
patients are not having sensitivity now during the provisional period, then there is probably no reason you should seal your
preparations at the preparation appointment. Otherwise, the
diminution in bond strength may be worth it to keep your
patients comfortable.
Desensitize Preparations for Indirect Restorations (at
the cementation appointment)
We have all experienced calls from patients who have sensitive
teeth after their new indirect restorations have been luted. If you
are bonding the restorations, proper application of an adhesive
should seal the tooth, minimizing or eliminating this problem.
But for more conventional cementation, applying a desensitizer
prior to seating the restoration should help alleviate the typical
post-cementation sensitivity.
Desensitize Preparations Prior to Applying an
Adhesive
Desensitizers are also being applied to preparations after etching,
but before the adhesive is applied. This is supposed to enhance
bond strength, minimize the chances for sensitivity postoperatively, and to reduce gaps at the margins. We tested the effect of this
application on both bond strength and microleakage. The results
are listed in the commentary for the products recommended for
these functions.
pH
The significance of pH is uncertain in this group. Nevertheless, it
would seem that a low pH would be counterproductive for a
desensitizer.
The Ratings
361
Desensitzers
Dedicated Product vs. Dental Adhesive
Most desensitizers that are professionally applied have their origins
in dental adhesives. Indeed, some components of these products
are straight out of the adhesive kits. So, the big question is: Do
you really need a dedicated product for desensitizing dentin or will
the primers, with or without the bonding resin, in your current
adhesive system do just fine? The best answer is: depends on the
purpose for which you are using the desensitizer. If you want a
material to desensitize cervical abfractions, our experience has
found an adhesive system with a primer followed by a light-cured
bonding resin is the most effective technique. Or, you can use a
double application of a single-component adhesive.
If you are desensitizing a preparation, there could be two good
reasons to use a dedicated product: ease of use and film thickness,
the latter of which needs to be minimal to allow complete seating
of your restoration. However, most single-component adhesives
also have minimal film thicknesses.
Sequence for Application on Abfraction
Lesion
Step 1
Clean the sensitive area. This is usually done with a cavity cleaner/disinfectant, mixed with pumice if the preparation is
debris-laden. If you are desensitizing a non-anesthetized patient,
this cleaning step may not be the most comfortable procedure.
Step 2
Rinse and leave lesion with the amount of moisture specified as
optimal for that specific product.
Step 3
Apply the desensitizer according to the protocol specific to the
product you are using.
Office vs. Home
We have divided these products into two categories:
Office Must be applied professionally. Can be used for a variety
of purposes.
Home Potassium Nitrate Gel applied by a patient in a modified
bleaching tray. Can presumably occlude the dentinal tubules. We
have not found them to be as effective as the resin-based products,
but they can be of some benefit for general sensitivity or sensitivity caused by bleaching.
Office
1
Gluma Desensitizer
REALITY’S
Heraeus Kulzer
(4.5)
CHOICES
Bottle
Cost: $96.83/5ml ($19.37/ml)
Single Dose
Cost: $65.28/3ml ($21.76/ml)($1.63/unit dose)
Includes:
• 1 btl (5ml)
Includes:
• 40 unit doses (0.075ml ea)
Shelf life: 3 years
MSDS: Included w/ bottle, not w/unidose
Composition
5% glutaraldehyde, 35% HEMA, water.
Only product to decrease leakage with both adhesives
Long track record
pH
1.8
Use
Blot dry. Apply with a cotton pellet or applicator tip by rubbing
the preparation for 30 seconds and dry thoroughly (except if you
are using a wet or moist adhesive protocol). Be careful about getting it on the soft tissue—it can irritate the gingiva. One patient
actually had an allergic reaction.
Very expensive
Glutaraldehyde use still questioned by some
Effect on Bond Strength
OptiBond 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.
362
The Ratings
©2005 REALITY Publishing Co. Vol. 19
Desensitizers
Packaging
Bottle 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 date
is protected by adhesive tape, but the label in general rubs off after
a few disinfection procedures.
Single Dose Large cardboard box with rear-attached lid. The single dose applicators come in foil pouches that are loose in the box.
Shelf
2 years
It is easy to open the foil pouch due
to alife:
notched
area at one end.
The pouches are well identified,
have
the
expiration
date
MSDS: Included
embossed, and include three line drawings on how to actually use
the single dose applicator. This applicator has a gray plastic handle, which inserts into a two-stage black plastic cylinder. Using the
handle, you push the smaller stage into the larger one. Then you
pull 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 reasonably well. Instructs you to use a “gentle, but firm” rubbing
motion, but how do you perform both “gentle” and “firm” at the
same time?
Single Dose Small, plain paper booklet in 11 languages plus a
large, plastic-coated treatment room card with color illustrations
displaying the application steps. While the illustrations are welldone, the lack of words hinders the card’s usefulness. There is also
a single sheet of plain paper illustrating how to open the single
dose unit.
Super Seal
2
Phoenix
(3.9)
Cost: $80.00 ($10.00/ml)
Shelf life: 2 years
Includes:
• 1 btl (8ml)
MSDS: Included
SAMPLING
Cost: $49.95 ($12.49/ml)
Includes:
• 1 btl (4ml)
Composition
Oxalic acid, potassium salt, water.
pH
1.6
Use
Apply with cotton pellet for 30 seconds on a clean tooth (we suggest blotting dry before application). Presumably, it will
demineralize the smear layer and peritubular dentin and will
restructure the demineralized material as a calcium oxalate precipitate within two minutes.
Effect on Bond Strength
OptiBond Solo plus
Much lower than control.
Prime & Bond NT
Much lower than control.
©2005 REALITY Publishing Co. Vol. 19
Very effective clinically on abfraction lesions
Easy to apply
No improvement over controls for leakage
Much lower bond strengths than controls
Effect on Microleakage
OptiBond Solo plus
Same as control.
Prime & Bond NT
More than control.
Packaging
Typical plastic squeeze bottle shipped in a small box, with expiration date. Label on bottle includes the expiration date and is
moisture-resistant.
Directions
Plain paper, very short and to the point.
The Ratings
363
Desensitzers
3a
HurriSeal
Beutlich Pharmaceuticals
ENCORE
Least expensive
Less leakage with OptiBond Solo plus
More leakage with Prime & Bond NT
Slightly lower bond strengths with both
adhesives
Composition
Benzalkonium chloride, HEMA, sodium fluoride, and water.
pH
5.5
Use
Blot dry. Apply with an applicator tip. There is no stipulated dwell
time—you are merely supposed to apply and allow the material to
air dry for 20 seconds, then repeat two more times. Then, if you
are using it as a remoistener prior to applying the adhesive, remove
any pooled material by suctioning. If you are treating a cervical
3b
(3.8)
Cost: $39.95/12ml ($3.33ml)
Shelf life: 3 years
Includes:
• 1 btl (12ml)
MSDS: Not Included
lesion, gently dry with an indirect air flow. We tested this technique as well as a more conventional one.
Effect on Bond Strength
OptiBond Solo plus
Same as control (both techniques).
Prime & Bond NT
More than control (both techniques).
Effect on Microleakage
OptiBond Solo plus
More than control.
Prime & Bond NT
More than control.
Packaging
Conventional plastic squeeze bottle comes in small, cardboard
box. The expiration date is printed directly on the bottom of the
bottle and on the box. On the bottle, it cannot be removed
through disinfection.
Directions
Typical thin paper. Procedure explained reasonably well.
MicroPrime
Danville Materials
Composition
5% benzethonium chloride, 35% HEMA, sodium fluoride
10ppm, and water.
(3.8)
Cost: $43.95/10ml ($4.40/ml)
Shelf life: 3 years
Includes:
• 1 btl (10ml)
MSDS: Included
pH
3.6
Use
Blot dry. Apply Microprime and wait 30 seconds. Dry thoroughly with air (unless you are using a moist or wet adhesive protocol.)
Effect on Bond Strength
OptiBond Solo plus
Same as control.
Prime & Bond NT
Lower than control.
Inexpensive
Less leakage with OptiBond Solo plus
More leakage with Prime & Bond NT
Lower bond strength with Prime & Bond NT
Effect on Microleakage
OptiBond Solo plus
Less than control.
Prime & Bond NT
More than control.
364
The Ratings
©2005 REALITY Publishing Co. Vol. 19
Desensitzers
Packaging
Typical plastic squeeze bottle comes in small, cardboard box. Label
on bottle includes the expiration date, but it will be rubbed off
during disinfection procedures.
Directions
Coated paper, gives direction for non-bonded and bonded applications.
Hemaseal & Cide
Advantage
(3.6)
Cost: $83.30/10ml ($8.33/ml)
Shelf life: 3 years
Includes:
• 1 btl (10ml)
MSDS: Not included
Composition
HEMA and 4% chlorhexidine digluconate and water.
4
Only product with chlorhexidine
Enhances bond strength
Recommends use with self-etching adhesives
No single dose
pH
5.6
Use
Blot dry. Apply with an applicator tip, scrub the preparation for
10-15 seconds. Suction excess and leave dentin moisture level to
optimize performance of the adhesive you are using.
Effect on Bond Strength
OptiBond 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.
©2005 REALITY Publishing Co. Vol. 19
Packaging
Conventional 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 instruction
on use under bonded crowns. In addition, applying it prior to
placing a self-etching adhesive is listed as one of the indications.
But a desensitizer is rarely if ever used with a self-etcher, since
minimizing sensitivity is one of the main reasons self-etchers are
used in the first place.
The Ratings
365
Desensitizers
D/Sense 2
5
Centrix
(3.5)
ENCORE
Nothing toxic
Mimics what body does to plug tubules
7ml Kit:
Cost: $99.95/14ml ($7.14/ml)
2.5ml Kit
Cost: $55.95/5ml ($11.19/ml)
Includes:
• 1 btl of Step 1 (7ml)
• 1 btl of Step 2 (7ml)
• 72 BendaBrushes
• 36 BondLogic dispensing wells
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
Cannot be used to desensitize preparations
Two steps/multiple applications
MSDS: Included
Composition:
Step 1 Potassium phosphate, potassium carbonate, water.
Step 2 Calcium chloride, strontium chloride, water.
pH
Step 1 6.9
Step 2 5.3
Packaging
Relatively large cardboard box mainly used to house the disposable
BondLogic wells and BendaBrushes. Expiration date is on the top
of the box and on bottles. Bottles have moisture-resistant, colorcoded labels and caps.
Use
Apply Step 1 to the sensitive area first by rubbing it into the dry
tooth surface for 10 seconds. Then apply Step 2 in the same manner. Film thickness is approximately 3µ.
Directions
Two-sided, plain paper in nine languages. There is a second small
paper insert with “essential points to remember”. Very short, to
the point, effective.
Effect on Bond Strength and Microleakage
It is not recommended for use prior to placing a restoration. Our
tests confirm that it does significantly lower bond strengths.
Because of these results, we did not test microleakage.
Home
1
UltraEZ
Ultradent
Kit
Cost: $19.99/4.8ml ($4.16/ml)
(3.8)
Shelf life: 2 years
MSDS: Included
Includes:
• 4 syringes with dispensing tips (1.2ml ea)
Composition
3% potassium nitrate, 0.11% with fluoride ion.
Less expensive than office-based service
Best syringes for convenience
Relies on patient compliance
Don’t use immediately prior to bonding
pH
6.8
366
The Ratings
©2005 REALITY Publishing Co. Vol. 19
Desensitizers
Use
Desensitizing gel designed to be used with custom tray. Dispense
gel in reservoir of custom tray in the same manner you would for
most home bleach systems. Recommended treatment times range
from 15 minutes to eight hours depending on the condition.
Effect on Bond Strength and Microleakage
It is not recommended for use prior to placing a restoration. Our
tests confirm that it does significantly lower bond strengths.
Shelf life: 2 years
Because of these results, we did not test microleakage.
MSDS: Included
Packaging
Cardboard box with removable translucent plastic tray securing
the contents. The syringes have the tips already attached.
Expiration date is on a sticker on the outside of the cardboard box
and chiseled into the syringe itself. However, on the translucent
plastic, the numbers are hard to read.
Directions
Plain paper, 11 languages, nine photos, annoying foldout design.
Straightforward and easy to follow. Includes instructions on how
to make a modified bleaching tray for this purpose.
REALITY
OFFICE
Gluma Desensitizer started the trend of desensitizing crown preparations prior to conventional
cementation. It has at least one clinical study that validates its claims and a long track record. Our tests show
it was the only product not to have a negative effect
on bond strength and to decrease the leakage when
used with both test adhesives. However, it also contains glutaraldehyde, which has come under attack
due to the potential toxicity, although it has the ability to coagulate plasma proteins in the tubules and thus
provides a mechanism for the desensitization effect.
Our evaluators found it to be an effective product
under restorations and crowns, but not as effective on
abfractions. It is available in single dose packaging as
well as bottles, but it is quite expensive.
Super Seal is recommended for use under restorations as well as on abfractions. Unfortunately, it had
negative effects with bond strength and leakage in our
tests. On the other hand, it has been very effective at
desensitizing abfractions. Furthermore, it is not as
expensive as Gluma Desensitizer.
HurriSeal has either a positive or neutral effect on
bond strength of both test adhesives, using either the
manufacturer-mandated application procedure, which
is time-consuming and requires multiple coats or our
truncated method, in which it is applied for 15 seconds. However, using the manufacturer’s technique,
both test adhesives exhibited increased levels of
microleakage. On the other hand, it is the least expensive product in this group.
MicroPrime is designed to be a non-glutaraldehyde,
low-cost version of Gluma Desensitizer. While its efficacy has not been as well documented as that of
©2005 REALITY Publishing Co. Vol. 19
Gluma Desensitizer, anecdotal reports are encouraging. Our evaluators found it to be an effective product
under restorations and crowns, but not as effective on
abfractions. In addition, it had mixed results with bond
strength and microleakage.
Hemaseal & Cide Desensitizer is the only product in
this group containing chlorhexidine in a concentration
usually reserved for hand scrubs. Its ability as a rewetting agent was highly touted, enhancing the bond
strength of both test adhesives, but its effectiveness on
cervical sensitivity was less stellar and its effect on
microleakage was mixed. Nevertheless, there is a 110%
guarantee, so that if it doesn’t work to your satisfaction, you will get your money back plus 10%.
D/Sense 2 is designed to be used on sensitive areas of
teeth that are not destined for restorations, although
there is some indication that conventional etching will
remove it and allow the tooth to be restored. Its two
bottle/two step application protocol is presumably necessary to achieve profound desensitization. This type
of material desensitizes via the precipitation of calcium
phosphate. However, it requires the deposition of
these crystals in a particle size that is small enough to
enter the dentinal tubules. There is no point simply
having lots of calcium phosphate deposits merely on
the surface of the intertubular dentin, since these will
eventually be rinsed off or dislodged.
Our clinical evaluation found it was quite effective,
but not in all cases. However, most evaluators found it
to be a real hassle to apply one solution, then a second
solution, especially when treating hard-to-access and
hard-to-isolate molar areas. On the other hand, it has
no resin, glutaraldehyde, or anything else that could
be considered less than totally safe from a toxicity
standpoint — just two solutions of inorganic salts.
The Ratings
367
Desensitzers
HOME
UltraEZ has convenient packaging (smaller unit dose syringes)
and is less expensive than an office treatment. This is a good
option when a patient has generalized sensitivity, especially
after bleaching.
OTHER PRODUCTS IN THIS CATEGORY
AcquaSeal BENZ
AcquaMed
Pain-Free
Parkell
AcquaSeal G
AcquaMed
Prep-Eze
Pentron
Admira Protect
Voco
Quell
Pentron
BisBlock
Bisco
Relief
Discus
Desensitize!
Den-Mat
Systemp.desensitizer
Ivoclar Vivadent
Desensitizer w/ FL
Healthdent’l
Therma-Trol Desensitizer
Gel
Premier
D/Sense Crystal
Centrix
Gel-Kam Dentin Bloc
Colgate Oral
Pharmaceuticals
368
The Ratings
©2005 REALITY Publishing Co. Vol. 19