Side effects of pin retained amalgams??

[Tooth Pulp]

---

Members don't see this ad.

The other day I placed a DOB pin retained amlagam on #31 and today my patient came back in for some more operative. At the end of the procedure today, which was a class V on #29, I polished the amalgam from the other day. As I was polishing, my patient almost jumped out of the chair when the side of my handpiece grazed #31. I got my mirror and barely touched the occlusal aspect of the restoration and he jumped again, saying that he was experiencing some sort of "shocking" pain. I have never experienced this with an amaglam until this one. Of course this was my first pin retained amalgam and was curious if there was some sort of correlation that anyone knew about. The pin was placed on the buccal surface of the disto-buccal root where I had to extend my box. I am pretty sure the pin did not make it's way into the pulp canal because if anything it was too buccal. Does anyone have any knowledge of what is making the restoration "shock" when a handpiece or handtool touches it? I tapped it with a bur and he said he felt nothing... My professor who overlooked the procedure seemed surprised as well

 

[ziptree]

lol. Pin-retained amalgams. The last one you do will be in dental school.

TMS pin? Probably microfracture of the dentin causing pulpal pain. Did the patient complain of sensitivity upon biting prior to the appointment?

 

[Tooth Pulp]

lol. Pin-retained amalgams. The last one you do will be in dental school.

TMS pin? Probably microfracture of the dentin causing pulpal pain. Did the patient complain of sensitivity upon biting prior to the appointment?

Haha I know, pin retained amalgams are a bit out-dated. No, he said nothing about pain when he came in. And he had been eating with it. I had him bite on a tongue depressor to check for a fracture and negative. It was simple contact with the metal handtools or hand-piece that gave him the shocking pain. I'm definitely going to address the issue with a professor because something is not right.

 

[ziptree]

Does he get radio reception? 😉

Did you snap a new PA or bitewing?

If all else fails, remove, place a base/liner and a dentin de-sensitizer then place a new amalgam...or better yet, a resin-bonded porcelain restoration.

 

[Mackchops]

They still teach pin-retained amalgams in dental school?? Wow... do you still make vulcanite dentures and hammer gold foil too?

Try touching the tooth with something non-metal (not your mirror) and see if he gets the same shock. Could be a little galvanic conduction going on...

 

[7 Iron]

They still teach pin-retained amalgams in dental school?? Wow... do you still make vulcanite dentures and hammer gold foil too?

Try touching the tooth with something non-metal (not your mirror) and see if he gets the same shock. Could be a little galvanic conduction going on...

We still do pin retained amalgams too. I can never see myself ever placing one after I graduate. Even the faculty say you should do composite build-ups.

 

[DrJeff]

I wonder if it's the pin that's the issue or the thermocycling that you sent it through as you were polishing that amalgam? Why exactly they still have you polishing an amalgam, aside from essentially hazing you in clinic, is beyond me??? 🙄

The reality is, it's probably a bit of dentin micro fracture from the pin placement + the thermocycling from the abrassive polishing points that caused it.

Pin wise, well I will admit to having a TMS mini pin kit in my office. It's been the same one for the 11.5 years I've been here, and about the only time it gets touched is every so often when one of my assistants decides that she wants to reorganize the drawer that it's stored in 😉

That being said, I have literally hundreds of patients with 15+ year old large pin retained amalgams, that both clincially and radiographically are fine, so they do have their place (even in certain circumstances today). The reality is though, and there's plenty of clinical evidence that backs it up, that if one is considering a pin retained amalgam to restore a tooth, that there are better alternatives that exist. And as a result, the vast majority of the time, after considering the options, you and your patient will decide on something other than using that pin!

 

[ziptree]

Forgot to mention. Try Rx: Decadron for two days and see how the patient feels in a week. It'll help with the pulpal inflammation if it was caused during the prep or heating of the Ag by the polishing procedure.

 

[Tooth Pulp]

Thank you for the advice everyone. I see him next week and will take everything you have said into consideration.

 

[doc toothache]

Galvanic shock.

 

[Tooth Pulp]

Galvanic shock.

This was what I actually told the patient when he first jumped. But I wasn't exactly sure if I was right. And my knowledge about metal interactions is slim, or slimmer than it should be I guess.

 

[Kam1]

The other day I placed a DOB pin retained amlagam on #31 and today my patient came back in for some more operative. At the end of the procedure today, which was a class V on #29, I polished the amalgam from the other day. As I was polishing, my patient almost jumped out of the chair when the side of my handpiece grazed #31. I got my mirror and barely touched the occlusal aspect of the restoration and he jumped again, saying that he was experiencing some sort of "shocking" pain. I have never experienced this with an amaglam until this one. Of course this was my first pin retained amalgam and was curious if there was some sort of correlation that anyone knew about. The pin was placed on the buccal surface of the disto-buccal root where I had to extend my box. I am pretty sure the pin did not make it's way into the pulp canal because if anything it was too buccal. Does anyone have any knowledge of what is making the restoration "shock" when a handpiece or handtool touches it? I tapped it with a bur and he said he felt nothing... My professor who overlooked the procedure seemed surprised as well

When you restored the class V on #29 didn't you give a IA block ?

 

[ziptree]

When you restored the class V on #29 didn't you give a IA block ?

I can sometimes infiltrate with Septocaine and get enough anesthesia to do a class V on the lower premolars without blocking.

 

[Kam1]

I can sometimes infiltrate with Septocaine and get enough anesthesia to do a class V on the lower premolars without blocking.

Yes, me too.

 

[bigstix808]

When you restored the class V on #29 didn't you give a IA block ?

sounds like if all they got was the mental (from the "infiltration") then 30/31/32* would be wide awake. im going to go with galvinic shock on this one.

side note ... i was actually told to a place a pin on a rather large comp build up on a lower molar 😕

 

[Kam1]

sounds like if all they got was the mental (from the "infiltration") then 30/31/32* would be wide awake. im going to go with galvinic shock on this one.

side note ... i was actually told to a place a pin on a rather large comp build up on a lower molar 😕

Hah...I know; I've been in practice for 20 years. 🙂
Dental school is the place to practice techniques; even if
you opt to never use some of the same techniques again.

 

[Tooth Pulp]

When you restored the class V on #29 didn't you give a IA block ?

No, mental