Intermediary liners and bases

Intermediary Liners and Bases

Definition:

Cavity liners and insulating bases are materials placed between dentin
(sometimes pulp) and restorative material to provide pulpal protection
or pulpal response

Pulpal protection:

1- Chemical protection: against ions that leach out form the

restoration, and enter the dentinal tubules, causing pulpal irritation,
for example: ions leaching out from amalgam during its setting, and
monomer of cements and composite

2- Electrical protection: against galvanic shock

3- Mechanical protection: may rise form the condensation forces

during application of amalgam

4- Biological protection: through direct and indirect pulp capping

5- Thermal protection: temp. may reach the pulp through metallic

restorations (amalgam or gold)

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Intermediary liners and bases

Ideal requirements for intermediary materials:

1- It should provide no further irritation, be biocompatible with pulp-

dentin organ and stimulate reparative dentin formation.

2- The material should provide a sedative and palliative action to the

pulp.

3- It should improve the marginal sealing and the adaptation to the

cavity walls.

4- The material should possess thermal and electrical insulating

capacity

5- The material should have sufficient strength to resist fracture or

distortion under the forces of condensation of the permanent
restoration and subsequent masticatory forces (under metallic
restoration to avoid distortion or fracture).

6- It should be compatible with overlying restorative material and

other intermediary base materials (for example zinc oxide and eugenol
is not used with composite as it interferes with its polymerization
reaction)

7- The material should resist degradation in the oral fluids.

8- It should have adequate workability and be easy to apply.

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Intermediary liners and bases

Types Of Intermediary Materials:

Intermediary
materials

Varnish, Dentin
Base Liner
sealer & DBAs

Reinforced ZO Calcium
&E hydroxide

Tri-Calcium
Zinc phosphate
Silicate

GICs

Z-
Polycarboxylate

RMGICs

Tri-Calcium
Silicate

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Intermediary liners and bases

Cavity Varnish:

Definition:

- A material of thin thickness, applied on the cavity walls on both

enamel and dentin

Form of supply

- It is supplied in the form of a liquid composed of 10% natural gum

or synthetic resin dissolved in 90% organic solvent such as ether,
acetone or chloroform.

Indication:

- Metallic restorations (especially amalgam)

Functions:

1. Sealing against chemical irritation

2. Blocks micro-mechanical irregularities to increase the adaptation
of amalgam
3. Acts as a semi permeable membrane (by blocking the dentinal
tubules)

Contraindications:

- With glass ionomer or ceramic restorations

NB. It’s applied in 2-3 layers to get the required function, increase in
the number of layers leads to: micro-leakage or irregularities.

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Intermediary liners and bases

Dentin sealer and Dentin bonding agents (DBAs):

They are used as desensitizers in case of gingival recession in which

the roots are exposed leading to their sensitivity

Example for dentin sealers: Gluma desensitizer

Liners:

Definition:

Thicker than varnish, but only applied on dentin.

Function:

Biological, chemical and thermal protection.

Example:

Calcium hydroxide:

- Forms of supply:
o Powder & liquid.
Not used nowadays
o Suspension.
o Paste-paste system: the material is mixed outside on a
paper sheet, and applies to the area of exposure (pulp
shallow area) by calcium hydroxide applicator.
o One paste system: the material is mixed inside the tube as
we press it, and applied directly, then light curing.

- Function: induce the formation of reparative dentin

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Intermediary liners and bases

Bases:

1. Zinc phosphate cement:

Provide mechanical protection, so it’s used below amalgam
restoration.
Its main disadvantages are:
1) The liquid used is phosphoric acid which is very irritant to the
pulp
2) High mixing temperature causes thermal irritation

2. Reinforced ZnO & E:

Advantages:
1) Multiple pharmacological actions.
2) Eugenol produces palliative, sedative and obtundant action on
the pulp when used in very low concentrations.
3) ZOE also has an antiseptic and anti-inflammatory effect.
4) ZOE can be placed in moderately deep cavities, when remaining
dentin thickness is as low as 1mm.
5) It is an excellent thermal insulator in a film thickness as low as
0.25mm.
6) It is an excellent electrical insulator and has a good sealing
ability.
7) Low strength properties and not rigid enough to be used as a
base. Despite improved strength properties of RZOE, it is still
inferior to that of other cements.

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Intermediary liners and bases

Indications:

1) as a liner in moderately deep cavities to enhance pulpal healing.

2) As a temporary filling material and for temporary cementation.

3) As a base material, when biological consideration is more

important than mechanical one.

Contraindications:
1) Very deep cavities (dentin bridge ≤ 0.5mm) or as a direct pulp
capping material.
2) With resinous tooth colored restoratives (composite resin), as
eugenol interferes with the setting reaction of any polymer and
can even depolymerize already set polymeric materials.
3) With glass ionomer cements as well as polycarboxylate cement,
where it would deprive the bonding capabilities of these
materials.

3. Glass ionomer cements (GIC and RMGI):

Glass ionomer:
- It has an excellent sealing ability due to chemical adhesion to
tooth structure through carboxylate ions released from PAA
liquid.
- It has an anticariogenic property due to fluoride release from
the powder glass component.

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Intermediary liners and bases

- it is biocompatible with P-D organ and all permanent restorative

materials. However, if remaining dentin thickness is less than 1mm
protection of the pulp by a layer of Ca(OH) liner is needed.
- It provides adequate thermal, chemical and mechanical protection
as well as proper sealing of dentinal tubules. It is thus an
excellent material to be used as dentin substitute.

Indications:

1- sandwich technique
2- liner/base

Advantages of RMGI over conv. GIC:

 Flexible working time.

 Improved strength and wear properties.

 Ease of handling.

However, conv. GIC has higher fluoride release especially during the
first 24 hours (initial fluoride burst).

4. Zinc polycarboxylate cement:

Consists of:
 White powder:
zinc oxide with up to 10% and magnesium oxide
 Clear Liquid
30-40% aqueous solution of polyacrylic acid

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Intermediary liners and bases

indication:
- with amalgam and ceramic restoration

properties and function:

1) It bonds chemically to tooth structure, which leads to proper
chemical protection as well as decreased microleakage.
2) The pH of the cement liquid is 1.7. In spite of its initial acidic
nature, it produces minimal irritation to P-D organ.
3) High biocompatibility.. Due to:
 The pH of the mixed setting cement rises rapidly to 3.4
after two minutes from the start of mixing.
 Polyacrylic acid is weaker than phosphoric acid.
 Polyacrylic acid has low diffusion mobility into the
underlying dentin due to its large molecular size and because
of immediate complexing with fluoride and calcium of tooth
structure which would hinder further penetration of the
acid.
4) lower compressive strength than ZPC, but significantly higher
tensile strength. It provides proper mechanical protection.
5) It is a good thermal insulator in thickness not less than 1.5 mm. It
is also an electrical insulator.
6) It is compatible with all permanent restorative materials.

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Intermediary liners and bases

5. Biodentine:
Dentine Substitute

Composition:

1. Powder:
 Tricalcium silicate, dicalcium silicate (core), calcium
carbonate, oxide (filler), iron oxide (shade), and zirconium
oxide (radiopacifier).
2. Liquid:
 calcium chloride (accelerator) and hydrosoluble polymer
(water reducing agent) and water.

- Setting Reaction:

 CSH gel acts as a matrix of the cement with the crystals of

CaCO3 are filling the spaces between the gel forming
particles of the matrix.
 Calcite (CaCO3 ) acts as an active agent implicated in the
reaction and as a filler (improves the prop. Of the cement).
 Final Hydration Reaction includes unreacted CS particles,
CSH gel and Ca(OH)2
 The reaction:
C3S + H2O CSH + Ca(OH)2
{Mixing time 30 sec. in amalgamator}

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Intermediary liners and bases

- Properties:

1. Setting Time:
45 in. (9-12 min initial setting).
2. Adhesion:
 Crystal growth within dentinal tubules …….. Long lasting seal.
 Ion exchange with dentine.
3. Density and porosity:
Hydrosol polymers: decrease amount of water, Improve density,
Better mechanical prop.
4. Radiopacity:
Due to zirconium oxide: Better to be identified in radiographs.
5. Compressive strength:
- More than 200 Mpa at first 24 Hrs.
- Improves up to 300 Mpa within one month approaching that of
natural dentine (297 Mpa).
6. Biodentine – Tooth interface:
- precipitation of apatite like Ca-Phosphate crystals: high acid
erosion and micro-leakage resistance
7. Ion Release:
Ability to release Ca and OH ions.
8. Antibacterial properties:
CaOH ions released: increase pH to 12.
9. Stability in the oral fluids:
- Not as stable as composite restorations
- More stable than other comparable material

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Intermediary liners and bases

Functions:

1. Minimal pulp reaction:

 High biocompatibility
 Low risk of P tissue reaction.
2. Bioactive properties.
- Stimulate 2ry D formation (lasts for 3 months).
3. Pulp healing promotion.
 Deep cavities.
 pulp Capping (Direct/Indirect).
4. Prevention of clinical failures.
 Mineral tags in DT.
 High dimensional stability.

5. Low risk of bacterial percolation.

- Remineralization of interfacial D
6. No conditioning or bonding.
- Natural micro-mechanical anchorage in DT and ion exchange
chemical bonding.
7. Full restoration in one session.

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Intermediary liners and bases

Theracal:

• A light cured, resin modified calcium silicate filled liner.

• Indication:

1. Designed for use in direct and indirect pulp capping, as a

protective base/liner under composites, amalgams, cements,
and other base materials.
2. Performs as an insulator/barrier and protectant of the dental
pulpal complex

 Constituents:

-> Consists of tricalcium silicate particles in a hydrophilic

monomer (significant calcium release making it a uniquely stable
and durable material as a liner or base).

-> Calcium release stimulates hydroxy-apatite and secondary

dentin bridge formation

 May be placed directly on pulpal exposures after hemostasis is

obtained. It is indicated for any pulpal exposures.
 Has the capability to be cured to a depth of 1.7 mm (no risk of
untimely dissolution), Major advantages in direct pulp capping
treatments.

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Intermediary liners and bases

Clinical judgment for the need of a specific liner or base material

depends mainly on:

1- Remaining dentin thickness ‘clinical depth’ (RDT): as the depth

of the cavity increases, the RDT decreases and there is more
need for intermediary materials before inserting the
permanent restoration. (requires thermal, biological, and
chemical protection)
2- Adhesive properties of liner or base; to benefit from its
adhesive potential, an intermediary material should be placed
directly on tooth structure except where pulpal medication is
essential.
3- Type of restorative material; whether is a metallic or adhesive
esthetic restoration, a direct or indirect one.

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