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Pulp protection
ELECTRICAL
BIOLOGICAL
0.5mm 1 mm 2 mm
2.
3.
Knowledge about pulp dentin complex, its defensive mechanism as a function of the intensity and duration of irritants. Clinical signs of pulpal irritation and its healing capacity The irritating capabilities of the diseases affecting the tooth, operative procedures and the materials used.
Proper understanding of the nature of diffusability and the factors affecting it. The functions of the intermediary bases.
Type of dentin
The types and nature of penetrants depending upon Compatibility and reactivity with dentinal constituents Their valencies Degree of ionization Molecular size Molecular mobility Wetting ability Driving forces
Plaque acids-penetrate quickly and extensively Salivary ions-depends on molecular size and reaction potential Corrosion products readily penetrate dentin
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
The degree of mineralization of dentin Dentin exposed during tooth preparation Effective depth (dentinal bridge) Induced stresses Hydraulic pressure Deficient resistance and retention form Microleakage Cracks and microcracks in the dentin and enamel Type of intermediary base or restorative material Dessication of dentin
Should be capable of creating an impervious layer on cut vital dentin Biocompatible Chemically compatible Should be thermal, chemical and electrical insulator. Should not discolour Should harden quickly Should withstand condensation forces Should stabilize or diminish dentin permeability. Should be easily manipulated Should impart sedative action Should promote repair and healing
Zinc oxide eugenol Calcium hydroxide Zinc phosphate cement Polycarboxylate cement Varnishes and film forming resinous materials Glass ionomer cements
No therapeutic effect
Using sonic probes By correlating the items recognizable in the preoperative radiograph. E.g., sclerotic dentin, dead tract etc.
CAVITY LINER
Thin layer of cement such as calcium hydroxide suspension in an aqueous or resin carrier (after evaporation), used for protection of pulp: certain glass ionomer cements that are used as an intermediate layer between tooth structure and composite restorative material are also considered liners.
Liners are aqueous or volatile organic suspensions or solutions. They leave a thin film and shining surface on the cavity, the thickness of this film very minimal not exceeding 0.5 mm. Their solvents evaporate quickly, leaving behind a film residue.
Composition
Suspension of calcium hydroxide in an organic solvent such as methyl ethyl ketone or ethyl alcohol Other liners include
Type
Properties
Do not possess mechanical strength Very less thermal protection Calcium hydroxide-soluble-should not be applied at the margins Flouride added to some liners to reduce secondary caries
Types of liners
Solution liners Suspension liners
Calcium Hydroxide
Indications for use
Protects
the pulp from chemical irritation by its sealing ability. Stimulates the production of reparative or secondary dentin. Compatible with all types of restorative materials.
Calcium Hydroxidecontd
Application process
Placed
only on dentin. Placed directly over the deepest portion of the preparation.
Commercial Examples:
a. DYCAL (LD Caulk): Catalyst Paste= 51% CH, 39.7% Ethyl Toluene Sulfonamide, 9% ZnO, 0.3% Zn Stearate Base Paste= 39% Glycol Salicylate, 45% TiO2, 15% Ca Tungstate, 0.6% CH Reaction= Moisture allows Ca+2 ions to dissolve and chelate with salicylate b. LIFE (Kerr): Catalyst Paste = CH, ... Base = 83% Methyl Salicylate Oligomers, 15% Methyl Salicylate Polymer,... Reaction = Moisture dissolves CH and Ca+2 ions crosslink the oligomers c. Light Cured DYCAL
CAVITY VARNISH
A solution of natural gum, synthetic resins, or resins dissolved in a volatile solvent, such as acetone, ether or chloroform.
Varnishes
Indications for use*
Seal
the dentinal tubules. Reduce leakage around a restoration. Act as a barrier to protect the tooth from highly acidic cements such as zinc phosphate.
* This material is contraindicated in its use under composite resins and glass ionomer restorations.
Applications
Reduces microleakage around newly placed amalgam Reduces passage of irritants into dentinal tubules Prevents penetration of corrosion products. Can be used as surface coating over certain restorations As a temporary protection from galvanic shock In cases where electrosurgery is to be done adjacent to metallic restorations.
Composition
Natural gums
Copal Rosin Chlorbutanol Thymol Eugenol flouride
Medicinal agents
Properties
Do not possess mechanical or Thermal insulation Film thickness ranges from 2-40 microns Solubility is low- virtually insoluble in distilled water.
Precautions
Bottle should be tightly capped immediately Should be applied in thin consistency Excess varnish should not be left on the margins of the restorations as it prevents proper finishing of the margin of the restorations. Should be confined to dentin when using silicate or silicophosphate restoration.
Contraindications
Composite resins Glass ionomer When therapeutic action is expected from the overlying cement. Eg. ZOE, calcium hydroxide.
Varnishes-cont d
Application process
Applied
with either a small disposable applicator or a cotton pellet. Thin coating of the varnish on the walls, floor, and margin of the cavity preparation. Air dry and reapply the varnish Air dry again to see a shiny hard surface which is ready to receive the gold or amalgam restoration.
Commercial Examples:
Solvent: Film Formers: a. Solution Liners: Copalite = Mixture Copal Resin Hydroxyline = Mixture PMMA Resin, CH Chembar = Chloroform PS Resin, CH, ZnO Tubilitec = Chloroform PS Resin, CH, ZnO, F, Dithymol-I2 b. Suspension Liners: Pulpdent = Water Methyl Cellulose, CH Hypocal = Water Ethyl Cellulose, CH
Dental bases
Types
High
strength
Thermal as well as mechanical protection Eg. Zinc phosphate, polycarboxylate, glass ionomer, and reinforced ZOE.
Low
strength minimum strength and rigidity act as barrier and provide therapeutic benefit eg. Calcium hydroxide and ZOE
Properties
Protection against chemical insults Should
serve against barrier against irritating constituents. Ca Hydroxide and ZOE are the most effective.
conductivity should be similar to tooth structure For effective protection a minimum of 0.75 mm thickness required
Therapeutic effect
Some
Strength Should
withstand the forces of condensation Withstand fracture or distortion under masticatory stresses Also it should harden rapidly Minimum strength req- 0.5 to 1.2 MPa
ZOE
Interference with setting reaction
any polymer
discoloration
polymeric
Non polymeric
Unmodified ZOE insufficient for amalgam direct gold and cast alloy restoration
Calcium hydroxide
Interference with setting reaction discoloration Interaction with other IBMs
Only in methyl cellulose form
No effect Thin transluscent tooth colored fillings-chalky patch Organic solvents of varnishes and some monomers of resins could dissolve it For cast and direct goldneeds protection from Zn phosphate
Zinc phosphate
Interference with setting reaction discoloration Interaction with other IBMs Physical and mechanical compatibility
Completely compatible
Polycarboxylate cement
Interference with setting reaction discoloration Interaction with other IBMs Physical and mechanical compatibility
Does not discolor Does not interfere Only if RM is thin transluscent All but ZOE & film forming resinous material Durable enough to withstand the manipulative forces
Do not interfere
THANK YOU
1. PHILLIPS SCIENCE OF DENTAL MATERIALS, 11TH EDITION 2. CRAIGS RESTORATIVE DENTAL MATERIAL, 12TH EDITION 3. OPERATIVE DENTISTRY, MODERN THEORY AND PRACTICE BY M.A.MARZOUK 4. LINERS VARNISHES AND BASES, LECTURE BY 20072008, Stephen C. Bayne, Ann Arbor, MI 48109 5. LINERS BASES AND CEMENTS, AN IN DEPTH REVIEW, BY RANDY WEINER 6. INTERNET