sealers / cavity liners / pulp management Flashcards
when do we need liners
1) deep carious lesions
2) liner or base should be placed
3) dentin provides best best protection for pulp
- no material compares
4) little pulpal reaction occurs beneath the restoration when remaining dentin thickness is greater than 2 mm
sealers
1) dentinal adhesives
- deals dentinal tubules
- creates oxygen inhibited layer
- ex. scotchbond
2) sealer/ desensitizer
- ex. Gluma
- reduce post op sensitivity (with 4 and 5th gen adhesives)
- cross links tubular proteins and occludes dentinal tubules
Gluma
1) 5% gluteraldehyde
2) 35% HEMA
cavity liner
1) thin layer of intermediate material covering deepest dentin surface
2) some are fluoride releasing
3) used for direct or near pulp exposures
4) provide a barrier to protect pulp from bacteria and residual reactants of restoration
5) electrical and thermal insulation
6) some stimulate tertiary dentin
base
1) intermediate material replacing missing dentin
2) for metal restorations and over some liners
3) thermal and electrical insulation (especially amalgam and gold)
4) distributes local stress across all underlying dentin
indirect pulp cap
1) intermediate material placed against demin dentin at deepest portion of cavity prep
- approaching the pulp
2) to prevent RCT
activa
1) rubber ram isolation2
2) clean periphery
3) insert tip on cartridge and dispense 0.5 mm thick layer
- leave at least 1 mm of distance from liner to the prep cavosurface
4) light cure for 20 seconds
5) etch, bond, restore
direct pulp cap
1) place over exposed pulp tissue
2) the smaller the exposure the BETTER
liner for direct pulp capping at pacific
1) MTA (mineral trioxide aggregate)
- sets in 3-4 hours
2) pro root MTA (dentsply)
3) small mechanical or pinpoint exposures that bleed after caries removal
- vital, asymptomatic teeth
- must be covered with liner after material has set
4) calcium silicate
mechanical exposure
1) iatrogenic damage
pathological or carious exposure
1) pulp is breached by carious lesion
cannot use activa for
1) pulp exposure
2) it is cytotoxic in nature
remaining dentin thickness
1) thickness of dentin after prep is complete
2) estimating RDT helps decide whether to use liner or and base
3) 0.5 mm of dentin reduces the effect of toxic substances of the pulp by 75%
- 1 mm is 90%
- 2 mm is nearly no pulpal reaction
RDT amalgam
1) >2 mm sealer
2) 0.5-2mm base, sealer
3) <0.5 mm liner, base, sealer
composite
1) >=0.5 mm bond
2) <0.5 mm liner, bond
pulp protextion
1) to protect the pulp or aid pulpal recover
2) deep excavation approximating the pulp => indirect pulp cap
2) < 1 mm diameter (exposure and asymptomatic) => direct pulp cap
3) > 1mm diameter (exposure and symptomatic) => RCT
dycal
1) calcium hydroxide
2) one of first liners
3) direct and direct pulp cap
4) alkaline (Antibacterial)
5) stimulates reparative dentin
6) water soluble
ZOE
1) zinc oxide eugenol
2) IRM (intermediate restorative material)
3) not used under composite
4) soothing agent
5) poor compressive strength
6) inhibits resin polymerization
7) used under AMALGAM
glass ionomer
1) ketac
- bioactive (fluoride release)
- good seal (ionic bond)
- slow set
- difficult to manipulate
RMGI
1) vitrebond
2) activa
- indirect pulp cap
- dual cure
- easy to manipulate
calcium silicate
1) direct pulp cap
2) Mineral trioxide aggregate MTA
- bioactive
- direct and indirect pulp cap
- slow set 3-4 hours
- expensive
- difficult to manipulate
3) biodentine
- bioactive
- indirect and direct pulp cat
- setting time is 5 mins
RM calcium silicate
1) theracal LC
- bioactive
- direct and indirect
- similar to MTA and biodentine
- light cured (better controlled than MTA)
more about activa (pulpdent)
1) bioactive
2) ionic resin matrix with shock absorbing resin
3) bioactive fillers that mimic natural teeth
4) smart material which released and recharges with
- Ca, PO4, and F ions in response to pH
5) mineral apatite formation stimulation
- no BPA, Bis GMA
bioactive materials
1) releases fluoride
2) elicits specific biologic response at the interface of the material and the tissue
3) display one or more of the following
- remineralizer through fluoride or other mineral release
- apatite like material on its surface when immersed in body fluid over time
- revitalize live tissue to promote vitality
