Immediate Dentin Sealing (IDS) refers to the immediate treatment of the freshly cut and exposed dentin surface with an adhesive and its curing before taking impressions for abutment teeth that have just undergone tooth preparation.
Identifying Dentin
If dentin cannot be identified with the naked eye, the surface can be etched for 2 – 3 seconds, then the etched surface is rinsed and dried. The enamel will appear chalky, while the dentin will be shiny. If initial etching has been carried out, it is necessary to perform tooth preparation again before IDS to expose freshly cut and uncontaminated dentin.
Selection of Resin Adhesives in IDS
Currently, the mainstream resin adhesives are divided into two major systems: etch-and-rinse adhesives and self-etching adhesives. Both of these resin adhesives can be applied in IDS. Duarte S Jr et al. used two resin adhesives, Adper Single Bond (total-etch resin adhesive) and Adper Prompt L-Pop (self-etching resin adhesive), in an in vitro experiment for IDS. They found that whether using a total-etch resin adhesive or a self-etching resin adhesive could increase the adhesive retention force, and there was no difference in the retention force between the two. Therefore, the most important thing in the selection of resin adhesives is to use the resin adhesive for IDS in accordance with the product instructions.
Step-by-step Process of IDS
A. After tooth preparation, rubber dam isolation is preferred. Dentin is trimmed with a low-speed carbide bur to reduce the smear layer.
B. Clean the tooth surface. Apply the self-etching primer on the dentin for 20 seconds, then gently blow for 5 seconds to evaporate the solvent.
C. Apply the adhesive resin on the dentin for 20 seconds, with air dilution for 5 seconds, followed by light curing for 15 seconds, and then rinse it clean.
D. Flowable composite resin is used to protect the hybrid layer and reinforce the immediately sealed dentin.
E. Use a small brush or a periodontal probe to apply a thin layer of flowable composite resin over the entire IDS area.
F. Remove the excess flowable composite resin with a clean small brush or a periodontal probe.
G. After removing the excess resin, enhance the appearance of the IDS layer (flowable resin coating).
H. Enhance the light curing of the IDS layer (resin coating) for 20 seconds for all areas of tooth preparation.
I. Apply glycerin gel to eliminate the anaerobic layer and add an additional 10 seconds of light curing for each area of tooth preparation.
J. Finish the enamel margin at a low speed to remove the excess resin.
K. Take a conventional impression or a digital scanning impression. If a conventional impression material is used to make a model, we need to use a soft rubber cup with talcum powder to clean the debris and residues of the oxygen-inhibiting layer.
L. Temporary restoration. Before using temporary resin bonding, cover the entire prepared surface with a separating agent (petroleum jelly). If a temporary “immediate bonding” is to be done, a small area should be left uncovered.
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