Step 6 : PULP PROTECTION

• Pulp protection refers to protection of pulp from

external irritants.

• The choice of pulp protection agent is based on:

1.Extent of tooth destruction and proximity of
preparation to the pulp
2.Type of restorative material to be used.
Common Causes Of Pulp Injury

 Presence of bacteria-dentin pulp

complex
 Exposure of patent dentinal
tubules
 Depth of tooth preparation
 Dentin dehydration
 Heat generation
 Thermal changes,galvanic
shock,forces transmitted
through restorative materials
 IMPORTANCE OF REMAINING DENTIN
THICKNESS

Dentin –BEST INSULATOR FOR PULP

Conserve Tooth Structure Rather
Than
Replace Lost Tooth Structure With Artificial Material

RDT , Most Imp Factor In Deciding Best Method Of Pulp Protection

 Role Of Effect of toxic
Remaining substances on
Dentin Thickness pulp

O.5mm 25%

1mm 10%

2mm nil
 Objectives of pulpal protection

 Sealing the smear layer

 Thermal insulation
 Pulpal Medication
 Mechanical Protection
PULP PROTECTION MATERIALS CLASSIFIED
(Basis of their film thickness)

Liners
Thin film liners(1-50µ)
Solution liners(2-5µ)
Suspension liners(20-25µ)
Thicker Cement liners(200-1000µ)

Bases
LINERS
 Liners are relatively thin layers of material used
primarily to provide a BARRIER, to protect from
residual reactants diffusing out of a restoration or from
oral fluids ( Or both ) .

 Initial electrical insulation

 Some thermal protection

 In some, Pulpal medication
 Liners
According to basis of film thickness:

Thin film ●
Solution liners(Varnish,2-5µm)

liners(1-50µm) Suspension liners(typically,20-25µm)

●

Cement Liners ●
(Thicker liners-200-1000µm )
 VARNISHES (Solution Liners)

 Any liner based on non aqueous solvent –rely on

evaporation for hardening is designated as solution liner

 Copalite -10% copal resin

90%ether,alcohol,acetone

VARNISH-PROVIDES
 Reduce postoperative sensitivity DOESN’T
 Semipermeable membrane  No sedative effect on pulp
 Reduce microleakage of fluid  No thermal insulation
Varnishes are replaced??
 High Solubility
 Poor sealing ability

Sealers & Dentin adhesives

GLUMA De-sensitizer
 Suspension liner( 20-25µm)

 Liners based on water have many of constituents

suspended instead of dissolved
 Dry more slowly& produce thicker films
 Pulpodent-methyl cellulose,CH
 Hypocal-ethyl cellulose,CH
 CEMENT LINER (200-1000µm)
 Thicker Liners
 Selected primarily for pulpal medication &thermal protection
Concept
 In deepest portion or microscopic pulp exposure

Dentinal bridging- calcium hydroxide

•Recommend Ca(OH)2 liner –over laid with RMGI base

 Clinical Tips
• Liners & Base applied without pressure

• For Composites
if pulp exposure/0.5mm RDT
Ca(OH)2 Liner+ RMGIC (Prevent etchant
dissolutions)
 Bases
 Relatively thick layers

 Thermal protection for pulp

 Supplement mechanical support for restoration
- by distributing local stresses from restoration
across underlying dentinal surface

 Internal buildups to block undercuts in preparations for

indirect inlays & onlays
GIC-IS USUALLY USED AS BASE NEEDS?

Effectively bond to tooth

Fluoride
Chemical & microchemical bond tooth-
retentive preparation features –not reqd
Sufficient strength as base under Amalgam, gold,cearamic
BASE OR VARNISH –I st

 MICOLEAKAGE nor ACID penetration -prevented by base

 Base governs- “Order of APPLICATION”

If ZnPO4----VARNISH BASE

If CaOH2
ZnOE Hardened Varnish
P.C.C
G.I.C
RDT “after tooth preparation”
 Step 7: Secondary Retention and
Resistance Forms
When the external walls of the preparation converge
toward each other, as they approach the external surface of
the tooth, then no additional or “secondary”retention is
required.

The secondary retention and resistance forms are of

two types:
(1) mechanical preparation features and
(2) Treatments of the preparation walls with etching,
priming, and adhesive materials.
Mechanical features:

These include the following:

•Retention grooves and coves

•Groove extensions
•Beveled enamel margins
•Pins, slots, steps and amalgam pin.
Retention grooves and coves:

•provide extra retention for Class

II preparations by reducing
proximal displacement of the
restoration.

Retention grooves are placed for

•Class II amalgam preparations
•Class II cast metal restorations.
•for some Class I and Class V
amalgams
•for certain gold foil restorations.
Groove extensions:
•Added retention is provided by
extension into facial or lingual
grooves.
•This is done for cast metal
restorations when indicated.

Skirts:
•These are features provided for cast
metal restorations wherein the
preparation envelopes the tooth
around some line angles.
•These enhance both retention and
resistance forms.
Beveled enamel margins:
•This feature is provided for cast metals and composite
restorations to produce better marginal adaptation between the
restoration and the tooth.
•bevels also increase the surface areas for etching and thus
greatly improve the bonding between the restoration and the
tooth
Pins, slots, steps, amalgapins:

These are primarily used with amalgam restorations when

the need for improving retention and resistance is very
high such as for capping cusps, building up of a grossly
destroyed tooth, etc
Conditioning procedures:

•These include etching and sanding.

•These are employed for bonded restorations
like glass ionomers, composite or ceramic
restorations.
•They may also an employed to bond amalgam
or cast metal restorations to tooth structure
where indicated.