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Cavity sealers -Liners and Bases

Pulp Capping Materials

DR UMER DAOOD
Learning Outcomes
By the end of this lecture you will be able to :-
1. Define liners, bases , and sealers.
2. Identify the indications for using each material and the rationale
behind using each material.
Sealers, Liners, Bases
Sealers, liners and bases are intermediary
materials that may be placed beneath
definitive restorations to protect the pulp.

(Fundamentals of Operative Dentistry: A


Contemporary Approach by Schwartz, R. S.,
Summit, J. B. and Robbins, J. W. (2006).
Applied to cavities to protect the pulp

from irritation and injury by :-


1.Caries ( Toxins )
2.Cavity preparation ( Heat and depth )

3.Restorative material (Metallic , acid

containing , sealing between tooth and

restorative material)
Sealers Liners Bases
Provide a protective Provide A barrier to Defined as dentin
coating to the walls irritants like sealers but replacement material
and floors of the also have a therapeutic to allow less bulk of
prepared cavities as effects. definitive restorative
well as barrier to •Materials placed material ( Amalgam )
leakage. between dentin (and •Materials used as
sometimes pulp) and the bases
1. Varnish. restoration to provide 1.Glass ionomer/
2. Dentin bonding pulpal protection or Resin modified glass
agents. pulpal response. ionomer
(2-5 micron 2.Zinc phosphate
thickness ) (Applied in thickness 3.Polycarboxylate
less than 0.5 mm)
Pulp Capping Materials
Remaining Dentinal Thickness (RDT)
No material that can be in a tooth provides better
protection for the pulp than dentin

The RDT from the depth of the cavity preparation


to the pulp is the single important factor in
protecting the pulp.

-0.5 mm reduces the effect of toxins by 75%

-1 mm reduces the effect of toxins by 90%

-2 mm reduces or more led to a little pulpal


reaction.
Bacterial infection is the most common cause of
pulpal and periradiucular disease ( Moller at al
1981)

Removal of caries is one of the most basic activities in


dentistry. When caries is deep, every restorative dentist is
faced with the question of the best way to proceed: is it
better to remove all caries regardless of pulpal
consequences, or stop and not expose the pulp?
Several studies showed that restored teeth
with partial caries removal have equal
success compared to restored teeth with
complete caries removal.( Foley et al ,
2004. Riberio et al 1999, Mertz-Fairhurst E
1998)
Direct Pulp Cap
The procedure in which a material is placed directly over the exposed pulp tissue, has been
suggested as a way to promote pulp healing and generate reparative dentin and is called Direct
pulp capping.
The lesion after unsupported enamel removal.
Carious Zones

A. Infected Dentine

B. Affected
demineralised
dentine

C. Translucent
zone

D. Reactionary
dentine

E. Pulpitis
Zinc Oxide Eugenol ( ZOE)
ZOE formulations have been used in dentistry for many years as bases, liners, cements and
temporary restorative materials.
-Its use for direct pulp capping is questionable.
-Eugenol is highly cytotoxic. ( Chong Y, et al ;2000 , Ho Y, et al ;2006)
-It is known that ZOE releases Eugenol in concentrations that are cytotoxic. (Koulaouzidou E,
et al ; 2004)

-ZOE also demonstrates high interfacial leakage. Although it has been noted that this leakage

is not important since ZOE can provide a biologic seal due to the Eugenol release, it must be

kept in mind that Eugenol release drops dramatically with time,(Hume W. 1984) and it is

anticipated that the effectiveness of ZOE in excluding bacteria is reduced the longer it is in

place in the mouth


Glass ionomer / Resin modifed GI
quartz, alumina, cryolite, fluorite, aluminum
trifluoride, and aluminum phosphate

H-

H-
Negatively charged polyacid chains of the ionomer matrix and the
Positively charged calcium on the tooth surface

H-
H-
Water
65% polyacrylic acid
Maleic Acid

Ion exchange in the collagen and inorganic components


Classification of GI
Glassionomer luting cements
Glassionomer Restoratives
Glass-ionomer metal mixtures
Cermets containing metal fused to glass (autocured)
Glassionomer liners (light cured)
Glassionomer bases
Glassionomer sealants
Resin-modified
Adhesive Systems

Classification of contemporary adhesives following adhesion strategy and number of clinical steps. GI = Glassionomer; PAA = polyalkenoic acid. (Reproduced from De Munck J, Van Landuyt K,
Peumans M. A critical review of the durability of adhesion to tooth tissue: methods and results. J Dent Res 2005; 84: 118-132)
Nakabayashi el a1 (1982)

hydrophilic resins infiltrated a surface layer of collagen


fibers in demineralized dentin to form a hybrid layer consisting
Demineralization of resin-infiltrated
Calcium Hydroxide
Antiseptic agent
– Broad spectrum
• Stimulates hard tissue repair
– Cementum
– Bone
Mode of action
• Releases OH- ion high pH: 12.3
– Local coagulation necrosis
– Passive, irregular calcification
Disadvantages of CaOH

The self-cure formulations are highly soluble and are subject to dissolution over time. (Prosser H
et al , 1982) although it has been noted that, by the time the calcium hydroxide is lost due to
dissolution, dentin bridging has occurred.(Accorinte M et al, 2006)
No inherent adhesive qualities and provides a poor seal.(Ferracane, J. 2001)
Presence of Tunnel defects ( What are tunnel defects and how crucial they are in the
performance of CaOH)
Disadvantages of CaOH
Thank You