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(9) Liners and Bases-2

(9) Liners and Bases-2

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Published by Mishi Munawar

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Published by: Mishi Munawar on Feb 29, 2012
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02/29/2012

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LINERS & BASES  

Materials placed between the dentine and sometimes pulp and the restoration that provides pulp protection. When we excavate caries, we remove part of the enamel and dentine; sometimes we need to put a material before we place the restoration over the remaining part of dentine. Sometimes we reach the pulp, but we don’t do endodontic treatment in some cases, you will know later on the indications in the fourth year. Even if we reach the pulp a little bit or we are very close to the pulp , you protect the pulp we use a material right? Some restorative materials that we use for restoration release some irritants. To cover the pulp or remaining dentine therefore we use Liners or Base. This is an example (refer to the slides) a tooth section, have remaining dentine after we prepare the teeth, and there is composite, the materials placed between the composite and remaining dentine is liners.

CAUSES OF PULPAL INFLAMMATION?  
§ Pulpal invasion by bacteria and endotoxin. If you remember we mentioned once in the amalgam lecture that amalgam is the only material that can cause closing of microleakage between restoration and tooth. After we prepare the cavity preparation and place the restoration there will be a microgap between them.

!: Microgap cannot be seen by naked eye.
This microgap can be invaded by bacteria. This can reach the pulp and cause irritation and inflammation to it.

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inflammation by We always say that we have to use a water coolant with the high speed hand piece to prevent it from sending heat to the pulp. We wont need any type of liner or base. As I said. We need to stop every once in a while (intermittent pressure) to protect the pulp especially with diamond bur. the protection to the pulp will be less. § Instrumentation may cause pulp traumatic irritation. minimum of 2mm of dentine is enough to provide protection of the pulp. § Pressure during preparation and continuous hard brush of the tooth create pressure of the tooth. dental materials may have irritants the go through the dentinal tubules to the pulp. Therefore root canal treatment will be needed. so invasion of dental material is easier to get to the pulp. Everytime we make the dentine smaller. The remaining dentinal thickness is the best protector for the pulp. In operative dentistry we have carbide bur another type of burs is diamond bur which cause more irritation than carbide bur MINIMAL DENTINE THICKNESS   Do you remember the photo we just saw? (Refer to the slides sorry L) this dentine that’s between the pulp and the restoration is called the remaining dentinal thickness. by keep a hard remaining dentinal thickness.   § Reaction of dental material. and sometimes if we don’t use a water coolant with the high speed hand piece the heat will cause pulp necrosis and pulpal death. So use of liners and base is more important if the dentine is closer to the pulp. 2 . also by heat.

Its thinness = 2 – 5 micrometer There are 2 types of varnishes: 1. gum like copal varnish or a synthetic resin that is dissolved in an organic solvent that evaporates leaving behind a protective film. Varnish.Natural varnish: like copal gum 2. It’s a very thin layer. So I cant just take a lot of tooth structure and say its ok I will use a liner or a base! (little if any pulpal reaction occurs when there is remaining dentine thickness of 2mm and more) TYPES OF LINERS & BASES   They differ between use and their thickness. it’s a sealer. Conservation of structure is more important than having lost tooth structure with cavity liners or base. therefore we will use another type of protection to the pulp. Two types of sealers: ⊗ Resin we use it for composite. an adhesive bonding. it looks like a nail polish → When you apply the varnish over the tooth the solvent 3 . or block them to protect the pulp.But sometimes we cant because we have to remove excess dentine due to lesion or caries.Synthetic: resin Varnishes. Provide a protective coat to the walls of a prepared cavity. There are three of them 1-cavity sealers 2-cavity liners 3-cavity bases Cavity sealers. which blocks tubules. it’s a thin layer over the protective layer of surface of the dentine. It seals the dentinal tubules.

Under composite restoration to bind it to enamel and dentin. Applied only to dentin on cavity walls that are near the pulp. we only put the liner on the pulpal floor. Meaning we don’t put the liner on all the walls.5 mm. Adhesive sealers now are used more than varnishes. Class two. Copal varnishes have been used for many years under amalgam but now its use has decreased in the late 1990s and now we use other types of sealers. Sometimes we use it under amalgam restoration.will evaporate leaving the active material (Resin) blocking the tubules. Like the ones used in resin composite. and five on axial walls       Figure (1): Class 5. Its thickness is less than 0. Class 2. For sealing under amalgam to improve bonding NOT retention. three. Class 1 Liners are mostly used with metalic resotration in *amalgam *cast gold 4 . you can see it with naked eye. ⊗ For example class one.     Cavity liners. pulpal or axial.

Glass ionomer liners !: vitrebond we use it more now.Liners under resin composite restorations are used only if the tooth preparation is extremely close to the pulp –within 0. another name is reactionary dentin it is formed as a result of irritation if you remember from histology tertiary dentine happens as a result from insult. Now Calcium hydroxide is used as a liner because of its pulpal compatibility and ability to stimulate reparative dentin with direct pulp contact. It’s chemically reactive. a base and a catalyst.5 mm to pulpWe have to types of liners: 1. we will use it in the lab this term by the end of it.5 mm on the pulpal or axial wall. Disadvantages of conventional calcium hydroxide: ✗ Poor physical properties. ✔ Antibacterial effect Now conventional calcium hydroxide. its advantages: ✔ Compatibility ✔ Able to stimulate formation of reparative dentine. We use it in even thickness. so we have to put it before it sets. it’s a modified glass ionomer used as a liner. so it starts the reaction so fast. it’s a two paste.Calcium hydroxide liners 2. › High solubility › Brittleness 5 . should be less than 0. We will put equal amounts of both and mix them together on a mixing pad.

So if we want to use liner under composite we can add vitrebond then itch it. ✗ Under amalgam it might break. Resin modified (vitrebond). Glass ionomer (vitrebond). we can put it. We can use glass ionomer base as a liner. After some time it will melt away. Therefore it will increase the gap between the restoration and the tooth structure. so it decreases the biocompatibility of calcium hydroxide. but also less anti bacterial effect. its used more now. then do etching. Conventional b. ? To overcome these problems now they added resin to calcium hydroxide. which has less brittleness and solubility. which is now more in use. and then put the restoration. that it can be itched. So when we have pulp exposure we put calcium hydroxide over the pulp in a procedure called direct pulp capping. for example if we put it on the bucal wall. Its advantages are: ✔ chemically bonded to tooth structure ✔ fluoride release ✔ initial low PH There are 2 types of GI liners : a. unless in some situations. Its advantages for composite restoration. as it is resin modified. Must be light cured. 6 . Calcium hydroxide as liner has restricted use. because when you condense amalgam you apply force and it cant stand it.✗ Solubility: we shouldn’t put it on mesial or distal wall.

§ Block undercuts for indirect restorations as in crowns we make them outside the oral cavity (undercut occurs when taking impression material) then we cement them on tooth so we do not need undercut Before when we used to have class 1 cavity for example we had 4 mm space. There are 2 types of cavity bases: 1. 1 – 2 mm. They are used as dentin replacement material (when bulk of dentin is removed) ⊗ They are used for: § Bulk build ups for indirect restorations. they add 2 mm base instead to dentine and then the rest is for amalgam. 7 . for example when we are preparing a crown. They are thicker than a liner. because as we said the best insulator is the remaining dentin so you should be as conservative as possible. We only put a thin layer of a liner to protect the pulp then add restoration.DON’T remove sound tooth structure to provide space for a base. But we don’t use this now. 2-glass ionomer is what we use nowadays GUIDELINES FOR BASING.Cavity bases.zinc oxide –eugenol and zinc phosphate cements. we stopped using them in recent years. SEALING   1. LINING.

3. Done by: Nadine AL Homoud 8 .Use bases as indicated. so if we have a deep cavity we place a liner then we place the restorative material. Just for build up materials and block –out for cemented indirect restorations.Use the minimum thickness of liner necessary to achieve the desired results it must not exceed 0.5mm.2. it is NOT used under direct restorations.

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