pulp protection agents

Dr. NUHA ELKADIKI BDS MDS

 Pulp

Pulp : is a specialized connective tissue that occupies

the pulp chamber.

Knowledge of the size and contour of the pulp cavity is

essential during cavity preparation.
 Pulp
Pulpal irritation that occurs during or after operative procedures
may result from
(1) Heat generated by rotary instruments,
(2) Some ingredients of various materials,
(3) Thermal changes conducted through restorative materials,
(4) Forces transmitted through materials to the dentin,
(5) Galvanic shock, and
(6) The ingress of noxious products and bacteria through micro-
leakage.
If leakage of chemical irritation from biomaterial or
bacteria occur, it cause irritation to pulp

Various type of irritation occur:

1. Microbial irritation.

2. Mechanical irritation.

3. Thermal irritation

4. Chemical irritation.

5. Radiant irritation.
Microbial irritation

Bacteria that survive drying under the filling material

remain variable for many years. such bacteria remain
active when moisture is reintroduced as result of:

1. Marginal percolation of various materials.

2. Poor marginal seal and .

3. Improper condensation.
• Mechanical and thermal irritation: depend on

1. Speed of rotation.

2. Size and shape of bur.

3. Coolant
• Chemical irritant

1. Various filling material.

2. Various medicaments used for dehydration or

desensitization of dentin

3. Dentin sterilization agent

• Radiant irritant:
X ray radiation ,laser beam causing radiant irritant.
 Pulp Protection
To protect the pulp against those irritant we give :

1. Chemical protection.

2. Electrical protection

3. Thermal protection.

4. Mechanical protection

5. Pulp medication.
In case of pulp exposure we give :

1. Pulp capping.

2. pulpotomy
 BASE AND LINER

placement of liners and bases is not a step in tooth

preparation, in the strict sense of the term, it is a step in
adapting the preparation for receiving the final
restorative material.
 Objective Of Using Base And Liner

1. The reason for using liners or bases is to protect the

pulp or to aid pulpal recovery or both.
 Pulp capping

Direct pulp capping :

Placement of biocompatible material over the exposed pulp to
maintain vitality and promote healing .

1. To maintain the vitality of the remaining pulp tissue.

2. To prevent the root canal treatment.
3. To help to conserve tooth structure.
 Pulp capping

Indirect pulp capping : all caries are removed except the

once that lie adjacent to the pulp , caries near the pulp is
left in place to prevent pulp exposure and preparation is
enclosed with biocompatible material
Indications:
1. Deep carious lesion near the pulp but not involving it.
2. No mobility of tooth.
3. No history of spontaneous toothache.
4. No tender to percussion.
5. No radiographic evidence of pulp pathosis.
6. No root resorption or radicular disease
 Factor affecting response to pulp capping
procedure
 Age of patient
 Factor affecting response to pulp capping
procedure

 Type of exposure : mechanically exposure has greater

prognosis than exposure due to caries.

 Size of exposure :
 Factor affecting response to pulp capping
procedure

 History of pain : tooth with out pain has greater

prognosis
 Liner

• A liner is defined as a material that is applied in a thin layer, usually

0.5 mm thick, to seal the dentin on the floor and walls of a cavity
from the influx of bacteria or irritants from restorative materials and
procedures. Additionally, a liner (other than a varnish) may provide
some therapeutic benefits. Varnish, calcium hydroxide, zinc
phosphate, glass ionomer, and resin can be used as a liner.
• their main function is to provide a barrier against chemical irritation
. they do not function as thermal insulation they are not used to
produce a structural form for the preparation
 varnish
1. The purpose of placing a varnish is to seal the dentinal
tubules, which will reduce the effects of micro leakage.

2. This is accomplished as the solvent portion of the liquid

(which is usually organic in nature and includes acetone,
ether, or chloroform) evaporates after placement. This leaves
the solute, which is a natural gum (resin or copal) to seal the
dentin.
 varnish
 Varnishes are placed in the cavity preparation prior to placement of
an amalgam restoration. Over time, the varnish will be dissolved by
oral fluids and replaced by the corrosive byproducts of the amalgam.

 In addition to sealing the dentin, a varnish may prevent the metal

ions from migrating from the amalgam to the tooth; this is
responsible for the darkening of the tooth adjacent to an amalgam.

 they are contraindicated when the final restoration involves a resin-

based material
 Base

1. Bases are applied in thick layers to provide the pulp with

thermal protection.
2. These materials must be strong enough to support a
restorative material during placement and function.
3. They encourage the recovery of the injured pulp.
4. bases serve as a replacement or substitute for dentin that has
been destroyed by caries or removed during cavity
preparation.
5. Bases can be shaped and contoured to specific forms.
 Zinc oxide eugenol

 used as an alleviate pain (obtandant) at mild to moderate

inflammation of pulp.
 dispensed in powder and liquid .
 PH=7 , which it one of the least irritating of dental cement.
 ZOE is relatively weak(temporary restoration) , so reinforced
or improved, to produce greater tough and long durable
material .
Contraindication : Inhibit polymerization so should not used
under composite
 Calcium hydroxide

Most common agent considerate as the (gold standard) of pulp

capping material.
Advantages :
 Effect on pulp: The cement is alkaline in nature. The high pH
is due to the presence of free Ca(OH)2 in the set cement. The
pH ranges from 9.2 to 11.7.
 Formation of secondary dentin: The high alkalinity and its
consequent antibacterial and protein lysing effect helps in the
formation of reparative dentin.
 biocompatible.
 Calcium hydroxide

LIGHT ACTIVATED CALCIUM HYDROXIDE

CEMENT:
Light activated cements have a long working time and is
less brittle than the conventional two paste system. They
are radiopaque. They are supplied in syringe form and is
expressed directly on to the tooth through a replaceable
nozzle.
Dycal is a well known brand of calcium
hydroxide pulp capping agent.

Light cured calcium Calcium hydroxide root canal pastes. The

hydroxide. syringe form (top) allows the material to b
conveniently applied into the narrow root
 Flowable composite

 Composite with low amount of filler

more fluid consistency less strength .
Advantage Disadvantage
Better adaptation to the Technique sensitive
wall

Ease of manipulation Polymerization shrinkage lead to

gap formation

More esthetic
 Glass ionomer cements

Renewable source of fluoride

under restoration biological kindness and
potentiality of adherence to
tooth structure(chelating
with calcium of tooth
structure).

Reduce incidence of caries

 Zinc phosphate cements

• Is harder and stronger , but irritant to pulp.

• Supplied in powder liquid form.

• Used to cement cast restoration to the teeth ,and used as

base when high compressive strength is required.

• Initial cement mixture is highly acidic (phosphoric acid)

,the PH approaches neutrality in short period of time .So,
have to use base or varnish below this type of cement
 Zinc polycarboxylate cements

 One of the recent cement , which is supplied in powder liquid form.

 Has potentiality to chemical bond to tooth structure (calcium ions in

enamel and dentin)

 PH is initially compared to zinc phosphate , but pulp response is

comparable to that zinc oxide ,possible explanation of low level of
irritation is the large size of poly-acrylic acid molecules ,which
restrict penetration through dentin, so low incidence of
postoperative hypersensitivity and favorable biological acceptance
Pulp protection according to depth of tooth
preparation
 Bio dentin :
calcium silicate based material
Advantage
1. Biocompatible.
2. Used under composite.
3. Has sealing ability.
4. Create faster dentin bridge.
5. High compressive strength.
MTA (mineral Trioxide aggregate)
Tricalcium silicate ,Tricalcium aluminate, Tricalcium
oxide and silicate oxide.
Advantage
non toxic material.
Stimulate reparative dentin formation.
Minimal inflammation at early healing stage.
MTA (mineral Trioxide aggregate)
Manipulation
MTA (mineral Trioxide aggregate)
How does it work
Thercal
light cured ,resin modified calcium silicate
Mechanism
Calcium release stimulate hydroxyapatite and secondary
dentin formation.