Question: If we etch dentin can we compliment the clohexidine with Gluma for MMP inhibitors?

Question: If we etch dentin can we compliment the clohexidine with Gluma for MMP inhibitors?

Johan Figueira: Of course papapapappa

Pancho Lopez: So the protocol would be, 1 etch 2 chx 3 gluma 4 bond?

DelfĂ­n Barquero Barquero: Etch/Rinse/GLUMA/Rinse/Clx/suction/Primer/BOnd

Jason Smithson: very simple 😉

Max Ar Qsada: 4th generation adhesive? Not universal?

Pancho Lopez: 4th gen is gold standart for dentin

Salvatore Sauro: If you use gluma, why d you want to use CHX?

Salvatore Sauro: Does Gluma requires rinse after application? If I am not mistaken, it contains HEMA…….

DelfĂ­n Barquero Barquero: Thats part of my question. Are we redundant if we use both? Mainly I used GLuma as a desensitizer but then I read about a possible MMPÂŽs inhibition.

Salvatore Sauro: No need to use both 😉

AndrĂ©s DĂĄvila SĂĄnchez: Salvatore Sauro wouldn’t you potentialize the effect of both by using them concomitantly?

Salvatore Sauro: I do not think so. GLU is a potent cross-linking agent so there is not need to potentiate. Actually if you use so many things at the same time you increase the risks of contamination and further mistakes. I beleive, in etched dentine we should use a wa…See more

DelfĂ­n Barquero Barquero: GLuma requires rinsing yes.

Umer Daood: Delfin your approach is OK but I have one issue. With this mixed bag we will have a discrepancy in the bond strength. Glum with chx may alter that. Remember you are preferably washing away the chx after application. Look at it from clinical perspective.

DelfĂ­n Barquero Barquero: Should we rinse CLX or just dry it?

Umer Daood: I would prefer rinsing. The bond that it creates is electrostatic and is not immobile anyways. CHX needs a certain concentration in milli molar to wet or react with the collagen. If not rinsed, it may precetipitate with the crystals and may affect bonding. The other thing is people should also realise that it is not the best mmp inhibitor. Here I am touching a very sensitive part but it’s true.

Umer Daood: The adhesive needs an adequate penetration.

Umer Daood: I would prefer CHX only instead of gluma

Stefano Daniele: If I remember well gluma does not require rinse after his application. MMP inhibition may be related to cross link on dentin collagen I suppose. It’s quite toxic anyway…

DelfĂ­n Barquero Barquero:

John Comisi: Any time I see a label that states “use the smallest amount possible”, it makes me not want to use it.

DelfĂ­n Barquero Barquero:

DelfĂ­n Barquero Barquero:

Bassam Zidane: Many in vitro studies showed an improvement in the bond strength of bonding when combined with Gluma

John Comisi: initial bond strength or long term bond strength?

Bassam Zidane: Most of the studies done with thermocyclin around 60000 cycles, so long term, but I have no idea about short term outcome

Umer Daood: I agree Bassam Zidane.

DelfĂ­n Barquero Barquero: Umer Daood can you provide a protocol for total etch with the use of Gluma or you prefer only to stick with CLX.

DelfĂ­n Barquero Barquero: And with self etch, how would be the protocol with CLX?

Umer Daood: With self etch it may require air drying

Bassam Zidane: I think the surface needs to be wet, not dry

Umer Daood: There are at times no parallels when it comes to invtro studies and when it gets translated into a clinical application. CHX diacetate is also used for studies when dissolved in ethanol as compared to the normal chx digluconate dissolved in water

Salvatore Sauro: HEMA can embed water after rinsing, which will then be hardly removed by adhesive solvents. The parameters of solubility of dentine and adhesives will be very far and resin infiltration will be compromised. Would be nice to test application with and without rinse……………..

DelfĂ­n Barquero Barquero:

Roberto Caldeira: I believe it is much better to treat with NanoHAP product.

Salvatore Sauro: What is the rational behind that choice ?

Adriano Lima: For the bonding procedure, you can use Gluma 4 bond, tha adhesive system from Kulzer which contains GLU in its composition, lower amount compared to the Gluma Desensitizer, but has GLU to promote collagen crosslinking

Renato Cilli:…

Influence of glutaraldehyde priming on bond strength of an experimental

Salvatore Sauro: It seems that in this paper the authors did not rinsed the glu-primer; did they?

Renato Cilli: The glu-primer was just an aqueous solution of 5% glutaral. After application, dentin was only dried with absorbant paper in one group and in other group was additionally dried with 5-second air jet. Primer B was a solution of hema and ethanol.

Salvatore Sauro: Renato Cilli what did the author did with primer B after application? Was it rinsed or just dried ?

Renato Cilli: They applied on dentin surface primed with glutaral (or not, another group) and left to evaporate the ethanol, then applied bonding resin (scotchbond mp)

Renato Cilli: Regarding the question that promoted this discussion session, yes, I guess glutaraldehyde can inhibit MMPs. But GUESS is not science, lets go to lab!

Umer Daood: Tore you nailed it. The HEMA issue within the bond. The inevitable hydrolysis of the ester bonds which than releases alcohols and further degradation. The evaluation with or without rinse is yes fruitful

Hakam Shuqer: Fadi Khuffash

Patricia Pereira: They have different purposes… chlorhexidine inhibits MMPs, whereas glutaraldehyde crosslinks collagen…

DelfĂ­n Barquero Barquero: Should we use it together?

John Comisi: I believe that we reviewed some papers in earlier conversations stating that the best we can hope for CHX to help inhibit MMP’s is 2 years. I know Umer Daood “loves” that stuff (not really).

Umer Daood: well John Comisi, not really :). Glutraldehyde crosslinking collagen is fine but has reports of toxicity. But in a recent transdentinal work, Pashley group have suggested glutraldehyde as ok and non toxic to use. The work that I have recently done with…See more

DelfĂ­n Barquero Barquero: But if we inhibit with Chx and Crosslink with Gluma may make sence to use it together right?

Umer Daood: so u want to utilize both together to get use of both properties is it?

Patricia Pereira: Unfortunately it’s not that simple…

Umer Daood: Ill agree with Patricia Pereira

DelfĂ­n Barquero Barquero: Yes, both properties. Im a clinitian looking for the best protocol

Umer Daood: DelfĂ­n Barquero Barquero there are a myriad of problems here that come in my mind. You see when u are looking for a dual use of CHX and Glu, there can be a discrepancy between the solvent-monomer resulting in a resin phase separation ( I am speculating…See more

Patricia Pereira: DelfĂ­n Barquero Barquero use a well published adhesive system, follow correctly the manufacturer’s instructions, use a good light source, careful with the air-water spray contamination. Avoid mix and matching of brands and techniques. Then, you should be fine clinically. I hope this helps!

DelfĂ­n Barquero Barquero: I just lovento go deeper.

DelfĂ­n Barquero Barquero:

Umer Daood: ill try to make a post with a demineralised dentin collagen image i took last week. Will take opinions on the bonding. The structure we are bonding too requires far more attention in many areas which we have not looked into

Patricia Pereira: DelfĂ­n Barquero Barquero, when I said well published, I wanted to say published showing good results long term. I apologize for the confusion. If you stick to the gold standards, you will be fine. Newer generations do not mean they are better…unfortunately

DelfĂ­n Barquero Barquero: Yes Patricia thank you so so much!!!!

DelfĂ­n Barquero Barquero: Muito obrigado

Adriano Lima: Perfect comments Patricia! And, in my humble oppinion, we need always consider clinical studies regarding survival rates according to different adhesive protocols.

John Comisi: In the long run, bonding to dentin is not simple, and mixing and matching materials without knowing their individual results not to mention the combining of them is problematic. Ultimately, I think we need to remember that the tooth is alive, respondin…See more

Jonathan Esquivel: BOND… DEL BOND…

Renato Cilli: The way that glutaral might inhibit MMPs is the same as its ability to fix collagen and to denaturate dentin fluid proteins. My speculation.

Mario Osvald: You do realize that EU allows use of max 0.1% of glutaraldehyde in products for direct human use?! Gluma contains 5%, same as Telio cs desensitizer, and their use is highly legally questionable on the patients in the EU. Just read the instructions for use of Gluma. IMHO, Best option is chx protocol, or use of bonding agents that already contain CHX, like for example Peak Universal Bond. For desensitization protocol one can use Oxalate containing products, like one from Bisco.

Renato Cilli: Yes, thats a concern. Glutaral in dental adhesive systems was used for years as 5% solution in Gluma and also on Syntac, with no major problems reported due to its high toxicity. Dental adhesives present other high toxic components like tertiary amine for instance.

John Comisi: Ah yes, and there’s the rub. Toxicity on living tissue, both soft and hard. There has to be a better way.

Larry Clark: It’s coming to a dealer near you in 2017

Susan Simoni: .

DelfĂ­n Barquero Barquero: I ordered Activa to test it from the clinical point of view.

John Comisi: If you have any questions about it let me know DelfĂ­n Barquero Barquero

DelfĂ­n Barquero Barquero: Im a neewie in this technology.

DelfĂ­n Barquero Barquero:

John Comisi: I’m not 🙂

Larry Clark: DelfĂ­n Barquero Barquero : Don’t worry we are all learning at this point. John Comisi has more clinical evidence than anyone in the US or world for that matter.

DelfĂ­n Barquero Barquero: Looking forward!!!!!

El Sadek Dyana: Fadi Khuffash wt do u think dr

Fadi Khuffash: IMHO I don’t use it as I don’t need it .. Extra step with no need ,, my patients doesn’t have any sensitivity at all The protocol is the key

El Sadek Dyana: Thx de for the reply

DĂ©bora Scheffel: Glutaraldehyde is able to nonspecifically cross-link proteins such as collagen, MMPs and cathepsins. Gluma applied on acid-etched dentin for 60 s may inhibit the total MMP activity by 86% in situ. 5% glutaraldehyde solution seems to present no transdentinal cytotoxicity against MDPC-23. However, when glutaraldehyde is combined with other components like HEMA (Gluma), the final material becomes cytotoxic in a deep cavity scenario. Glutaraldehyde solution applied on dentin surface in order to inhibit proteases and biomodify collagen may be rinsed once Glutaraldehyde reacts with the proteins and is no longer removed by rinsing.

Transdentinal cytotoxicity of glutaraldehyde on odontoblast-like

Salvatore Sauro: Exactly!!!!

DelfĂ­n Barquero Barquero: How much time we should rinse it?

Salvatore Sauro: DelfĂ­n Barquero do you mean for Gluta solution or Gluma-Hema?

DelfĂ­n Barquero Barquero: In the market is easier to get GLUMA rather than Glut.

DelfĂ­n Barquero Barquero: I want to conclude if using GLUMA can be considered as a crosslinking promoter. If not, I shoult look for Gluta solution.

Salvatore Sauro: Gluma is a cross linking agent that can also block MMPs. The only issue is the presence of HEMA that increase the toxicity of the product and may cause interference when rinsed with water …….. Although it is an hydrophilic monomer …

Delfín Barquero Barquero: 🙁

DelfĂ­n Barquero Barquero: Which is the best way to go then avoid using GLUMA and get GLUTA

Salvatore Sauro: DelfĂ­n Barquero Barquero I suppose there are other HEMA free Gluta on the market …..

DelfĂ­n Barquero Barquero: will look for it

Renato Cilli: Gluta + hema will chemically combine with collagen forming a complex, thus rinsing might be not too effective. Thats the essence of ‘adhesion in a water environment’, the essence of Gluma mechanism. Hema is cytotoxic to pulp in very deep cavities.

DelfĂ­n Barquero Barquero: Renato Cilli your are not ok using Gluma right? Or I misunderstood

Renato Cilli: DelfĂ­n Barquero Barquero I have been studied Gluma since my PhD. Its mechanism for adhesion by binding to collagen is very interesting although nowadays other crosslinking agents such as flavonoids are studied in order to substitute glutaraldehyde as they seem to be less toxic. In clinics, for dentin hipersensitivity, i prefer try to use potassium oxalate gel at first.

Salvatore Sauro: Renato Cilli you are great 🙂

Renato Cilli: Thanks Salvatore, but great is this discussion and this facebook group. Congratulations

Salvatore Sauro: Renato Cilli I am happy you enjoy this group

El Sadek Dyana: Fatima Moh’d

El Sadek Dyana: Tariq Nmr

Mohammad Bustani: Mohammed Alrababah… Thank u for the seminar

Mohammad Bustani: We cant truly appreciate your seminars until we face a problem clinically or read such a debate.. Only now I can say, I know SOME of the basics

Larry Clark: Please forgive me, this is not a shameless plug. We did make a Glut product that is 5% Glutaraldehyde, 1% FL and the rest water. No HEMA. Pulpdent Dentin Desensitizer It is you all that inspires us to do things differently.

Salvatore Sauro: Larry are you currently distributing it?

Larry Clark: Yes, we are. Mr. Dubois is just training our new dealer in Portugal and next is Spain.

Salvatore Sauro: Larry Clark , however, Renato Cilli is right……………… you should focus more on “natural” cross-linker……………that is the future for collagen cross-linking 😉

Larry Clark: Trust me we are!!! You will see. I only posted about the Glut because it does not have HEMA. Our future adhesives/Composties do not contain HEMA or TEGMA

Salvatore Sauro: I know you and your company are years far in terms of evolution in dentistry

Larry Clark: Our intention are simple, Seal Margins, give back the minerals lost, and reduce the variables when placing restorations.

DelfĂ­n Barquero Barquero: Finally!!!!!! A hema free Glut!!!!

DelfĂ­n Barquero Barquero: Is it safe to use it deep in the dentin?

Salvatore Sauro: I would avoid any kind of GLUTA-based product if you are too close to the pulp

Salvatore Sauro: However, with 0.4-mm-thick dentine, no cytotoxicity of Carbodiimide (EDC) and Glutaraldehyde has been observed on odontoblast-like cells (

Transdentinal Cytotoxicity of Carbodiimide (EDC) and

DelfĂ­n Barquero Barquero: Lovenit

Ed Mclaren: Yes

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