PULP PROTECTIVE MATERIALS

Cavity Liners, Bases, Varnishes.

Liners and bases are materials placed between dentin and

the restoration to provide pulpal protection

Liners are relatively thin layers of materials used primarily

to provide a barrier to protect the dentin from residual

reactants diffusing out of a restoration and or oral fluids

that may penetrate leaky teeth.

They can be classified as:
Thin film liners (1-50um)

Thick Liners (200 –1000um)

- Primarily selected for pulpal medication and thermal
protection.
- Bases.(1-2mm) – used to provide thermal insulation
Cavity Varnish:

Cavity varnish is a solution of one or more resins which

when applied onto the cavity walls, evaporates leaving a

thin resin film, that serves as a barrier between the

restoration and dentinal tubules

Applications:

1) It reduces microleakage around the margins of newly placed

amalgam restorations, thereby reducing post-operative
sensitivity

2) It reduces passage of irritants into the dentinal tubules from

the overlying restoration or base.

3) In case of amalgam restorations, they prevent penetration of

corrosion products into the dentinal tubules thus minimising
tooth discolouration
4) It may be used as a reinforce coating over certain

restorations to protect them from dehydration or contact

with oral fluids.

5) May be applied on the surface of metallic restorations as

temp. protection in case of galvanic shock.

Composition:

It is a natural gum such as copal, rosin or synthetic resin

dissolved in an organic solvent such as alcohol ,acetone or

ether. Medicinal agents such as chlorbutanol, thymol and

eugenol may be added. Some varnishes also contain fluoride.

Properties:

The film thickness ranges between 2-4m. They neither

possess mechanical strength nor provide thermal insulation

because of thin film thickness

The solubility of dental varnish is low. They are virtually

insoluble in distilled H2O

Manipulation:

The varnish can be applied using a brush, wire loop or a

small pledget of cotton. Several thin layers are applied. Each

layer is allowed to dry before applying the next, when the 1 st

layer dries, small pin holes develop. There voids are filled in

the succeeding varnish applications to attain a uniform and

continuous coating.
Precautions:

1. Varnish solutions should be tightly capped immediately

after use to prevent loss of solvent by evaporation.

2. It should be applied in thin consistency. Viscous varnish

does not wet the cavity walls properly. It should be
thinned with an appropriate solvent.

3. Excess varnish should not be left on the margin of the

restorations [prevents proper finishing of the margins of
the restoration.
Contra Indications:

a) Composite Resin: The solvents in the varnish may react with or

soften the resin

b) GIC – varnish eliminates the potential for adhesion and

biocompatibility of the cement

c) When therapeutic action is expected from the overlying cement

Eg: (ZnOE & Ca(OH)2

Cavity Liner:

A cavity liner is used like a cavity varnish to provide a

barrier against the passage of irritants form cements or other
restorative materials and to reduces the sensitivity of freshly
cut dentin.

They are usually suspensions of Ca(OH)2 in a volatile

solvent on evaporation of the volatile solvent, the liner

forms a thin film on the prepared tooth surface.
Composition:

Suspension of Ca(OH)2 in an organic liquid such as methyl ethyl

ketone or ethyl alcohol.

Properties:

Like varnishes, cavity liners neither possess mechanical

strength nor provide significant thermal insulation.

Ca(OH)2 are soluble and should not be used at the margins of

the restoration

Fluoride compounds have been added to some liners to

reduce the possibility of sec. caries around permanent
restoration.
Cement Base:

A base is a layer of cement placed under the permanent

restoration to encourage recovery of the injured pulp and
to protect it against numerous types of insult to which it
may be subjected.

It serves as replacement or substitute for the protective

dentin, that has been destroyed by caries or cavity
preparation.
Types:

A variety of materials may be employed in general they

belong to 2 categories

Low strength Bases

High strength Bases

High Strength bases:

Are used to provide thermal protection for the pulp, as well as

mechanical support for the restoration.

Eg: Zn PO4, Zn polycarboxylate, GIC & reinforced ZOE.

Properties:

Thermal Properties:

The base must provide thermal protection to the pulp.

The thermal conductivity of bases is similar to tooth structure and

is in the range of recognized insulators such as asbestos For
effective thermal protection the base should have minimal
thickness of .75mm
Protection against chemical insults.

The cement base also serves as a barrier against penetration of

irritating constituents (acids, monomer etc) from restorative

materials Ca(OH)2 and ZnOE are most effective for this.

Therapeutic effect:

Ca(OH)2 acts as a pulp capping agent and promotes the formation

of secondary dentin. ZOE has an obtundant effect on pulp

strength.

The base should have sufficient strength to withstand the forces

of condensation without fracture under masticatory stresses.

Clinical Considerations:

Clinical Judgements about the need for specific liners and

bases are linked to the amount of remaining dentin thickness

(RDT), considerations of adhesive materials, and the type of

restorative material being used.

In a shallow tooth excavation, which includes 1.5 to 2mm or

more of RDT, there is no need for pulpal protection other than

in terms of chemical protection.

How ever, in a composite tooth preparation, eugenol has the

potential to inhibit polymerization of layers of bonding agent

or composite in contact with it.

Therefore calcium hydroxide is normally used, if a liner is

indicated. If the RDT is very small or if pulp exposure is a

potential problem, then calcium hydroxide is used to stimulate

reparative dentin for any restorative material.

CALCIUM HYDROXIDE CEMENT
Available as powder or 2 paste cements

It is available as dry powder or two paste system.

Mixed either with distilled water or saline to form a paste as

it can also be suspended in chloroform and conveyed to the

required area with the help of a syringe

When available as 2 paste cements.

One paste

– monomer of methyl cellulose as initiator and CaOH

Other paste:

Calcium hydroxide and catalyst, when they are brought in

contact methyl cellulose undergoes polymerization and
porous matrix is formed

pH:11
Mechanism of action:

Uses:

1. Cavity liner

2. Pulp capping agents

PIT AND FISSURE SEALANTS
32
 INTRODUCTION

Occlusal surface -- 12.5% OF TOTAL tooth SURFACES

NEARLY FOR 80% OF CARIES ATTACK.

PF caries 8 times > smooth surface caries

33
PIT AND FISSURES
 DEFINITION:
 Pits are small pin point depressions located at the junction
of developmental grooves or at the terminals of the
grooves.
 Fissure is a deep, very narrow channel, cleft, ditch or
crevice which may be sometimes deep. It is formed at the
depth of developmental grooves during the development of
the tooth.
 PIT AND FISSURE SEALANTS

DEFINITION:
Fissure sealants are materials which are designed to
prevent pit and fissure caries when they are applied to
the occlusal surface of the teeth in order to obturate
occlusal fissures and to remove sheltered environment in
which caries may thrive.
-
Roide House
 CLASSIFICATION

BASED ON TYPES CHARACTERSITICS

1. First Generation Activated by UV light

Sealants. No more used, as a UV light
is harmful to the body

2. Second Generation Chemical curing resins,

I. GENERATIONS Sealants. based on catalyst-
accelerator system. e.g.
Concise(3M)
3. Third Generation Activated by visible light
Sealants. e.g. Fissurit (Voco) Delton
(Johnson and Johnson)
4.Fluoride containing Double protection
Sealants
II. FILLERS 1. Free of fillers Flow is better.
2. Semifilled More resistant to
wear.
1. Clear Esthetic but difficult
to identify at recall
examination.

2. Tinted Can be easily

III. COLOUR OF identified.
THE SEALANTS

3. Opaque Can be easily

identified.
 Non-toxic and non irritating .

 Adhere to the tooth .

 The consistency and viscosity.

 Mechanical, Compressive and Tensile

properties.
 Resistance.

 Able to be seen .

 Low solubility in oral fluids.

 Cariostatic action.

39
TYPES OF SEALANTS:
• Alkyl Cyanoacrylates
• Polyurethanes Eg. Elmex protector
Epoxylate
• BIS-GMA
 MATERIALS USED AS PIT AND FISSURE SEALANTS
1. CYANOACRYLATES:
 Disadvantages:
-Bond to unetched enamel is poor
-Material sticks to skin
-Mechanical durability poor
-Biodegradable
-Hydrolysis of cyanoacrylates to toxic
materials
 Recent cyanoacrylates – butyl and isobutyl esters
 Cyanoacrylates with fluoride -also available

41
2. POLYURETHANES :

 Adhesion to enamel is not satisfactory

 Disadvantages:
-Poor mechanical properties
-Low oral durability ( 2-3 months).

3. BOWEN 1972 : BIS-GMA

 Addition of BIS-PHENOL A and GLYCIDYL

METHACRYLATE (BIS-GMA)

 In 1972, Nuva-Seal
 Hydroxyl group in BIS-GMA is responsible for viscosity
 The fillers make the sealant more resistant to abrasion

42
4, GIC, RMGIC
5, FLOWABLE COMP
6, FLOW COMPOMERS

43
44
why pit and fissures are more prone to DC ?

MORPHOLOGY

Niche for microorganism

Inaccessible ( brush & saliva)

Thickness of enamel

Less effectiveness of fluoride

Salivary pellicle (newly erupted teeth)

More porous enamel (newly erupted teeth)

45
Morphology of fissures

WIDTH OF OPENING OF FISSURE = 0.1 mm

CROSS SECTION OF OCCLUSAL FISSURE

Diameter of Dental Probe = 0.2 mm
Diameter of Bristles = 0.2 mm
46
Diameter of Fissure = 0.1 mm
 Types of fissures

Two main type of pits and fissures are usually described

1)Shallow, wide v-shaped fissures-self cleansing and

CARIES RESISTANT

2)Deep, narrow I-shaped fissures-constricted and

resemble bottle neck. May have different branches-
CARIES SUSCEPTIBLE

47
 Types of fissures
NANGO , 1960 : FIVE TYPES.

V – TYPE
34%

U – TYPE
48 14%
 Types of fissures

K – TYPE
26%, hourglass

INVERTED Y – TYPE
7%

I – TYPE
16% 49
 MICROFLORA OF PIT AND FISSURES —
 Cocci constitute – 75% to 95% of microorganisms

S.Sanguis – Predominant viable microorganisms

S.Mutans and Lactobacilli –

low in newly formed plaque in fissures
over time

Fusiforms, Spirillae and Spirochaetes are

absent

50
 How do sealants
work ???

 Keep substrates out of pits, fissures and grooves.

 Create an anaerobic environment. 

51
 Effectiveness of sealants
 Conservative preventive measure.

 Conjunction with water fluoridation .

 100% effective .

 Retention varies for sealant coverage:

96% after 1 yr.
82% after 5 yrs.
57% after 10 yrs.
52% after 15 yrs.

52
INDICATIONS :
 Presence of deep pit and fissures on occlusal
surfaces of teeth.
 In cases of suspected/ initial occlusal caries in
children and young adults.
 In children who are susceptible to occlusal
caries.
 Children coming from non fluoridated areas
with increase caries experience.
 In teeth especially palatal aspects of upper
lateral incisors. Sometimes deep palatal grooves
of upper molars and buccal grooves of lower
molars.
3-4yrs : Primary molar sealant application.
6-7yrs : First permanent molar .
11-13yrs : Second permanent molars and the premolar.

Simonsen 1983.

Group 1 – Caries free patients judged at no risk to decay.

Group 2 – Patients judged to be at moderate risk to decay.
Group 3 – Patients with rampant caries at a high risk to decay.

Sealing of teeth in group 2 patients is done but not in

group 1 and 3.
55
 CONTRA INDICATIONS:

 Shallow pit and fissures

 Well established carious lesions- cavitations
 Those teeth which are partially erupted or not
completely erupted- such teeth are difficult from point
of isolation.
 PROCEDURE OF APPLICATION:

Selection of patient

Cleaning and prophylaxis of fissure

system

Isolate and dry the tooth surface

 Acid etching

Use phosphoric acid 37%

 Wash the surface with running water [1/2

min]

 Isolate and dry the tooth surface

 Apply the bonding agent.

 Sealant application.
 Evaluate the sealant.
 Check the occlusion.
 Check retention and periodic
maintenance.
 It is advisable to apply topical
fluorides on the occlusal surface as
it is acid etched.
SEALANT RETENTION DEPENDS ON:

• Type of sealant used.

• Position of teeth in the mouth

• Clinical skill of the operator.

• Age of the child.

• Eruption status of teeth.

 DECISION MAKING:

CATCH No Yes Yes Yes

DISCOLORATION No No Yes Yes

SOFTNESS No No No Yes

STATUS OF Sound
TOOTH
TREATMENT Nil Sealant Sealant PRR
 PREVENTIVE RESIN RESTORATION

 Introduced by
Simenson and Stallard, 1978

 Indicated when open carious lesion

in the pit or fissures
 STEPS IN PRR:
1. Limited excavation to remove carious tissue
2. Restoration of the excavated area with a
composite resin
3. Application of a sealant over the surface of the
restoration and remaining, sound, contiguous
pits and fissures.
COST EFFECTIVENESS:

Use of sealants will preserve sound tooth structure.

 More tooth tissue will be lost later when

amalgam restoration will be replaced at a later
stage.
REFERENCES:
Soben Peter: Essentials of preventive and community dentistry
Glucks G M: Jongs community dental health
Pine C M. Community oral health
Blanaid D. Essential dental public health
Norman Harris. Primary preventive dentistry
Thank You