sealers / cavity liners / pulp management

Question 1

when do we need liners

Answer 1

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

Question 2

sealers

Answer 2

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

Question 3

Gluma

Answer 3

1) 5% gluteraldehyde
2) 35% HEMA

Question 4

cavity liner

Answer 4

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

Question 5

base

Answer 5

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

Question 6

indirect pulp cap

Answer 6

1) intermediate material placed against demin dentin at deepest portion of cavity prep
- approaching the pulp
2) to prevent RCT

Question 7

activa

Answer 7

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

Question 8

direct pulp cap

Answer 8

1) place over exposed pulp tissue
2) the smaller the exposure the BETTER

Question 9

liner for direct pulp capping at pacific

Answer 9

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

Question 10

mechanical exposure

Answer 10

1) iatrogenic damage

Question 11

pathological or carious exposure

Answer 11

1) pulp is breached by carious lesion

Question 12

cannot use activa for

Answer 12

1) pulp exposure
2) it is cytotoxic in nature

Question 13

remaining dentin thickness

Answer 13

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

Question 14

RDT amalgam

Answer 14

1) >2 mm sealer
2) 0.5-2mm base, sealer
3) <0.5 mm liner, base, sealer

Question 15

composite

Answer 15

1) >=0.5 mm bond
2) <0.5 mm liner, bond

Question 16

pulp protextion

Answer 16

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

Question 17

dycal

Answer 17

1) calcium hydroxide
2) one of first liners
3) direct and direct pulp cap
4) alkaline (Antibacterial)
5) stimulates reparative dentin
6) water soluble

Question 18

ZOE

Answer 18

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

Question 19

glass ionomer

Answer 19

1) ketac
- bioactive (fluoride release)
- good seal (ionic bond)
- slow set
- difficult to manipulate

Question 20

RMGI

Answer 20

1) vitrebond
2) activa
- indirect pulp cap
- dual cure
- easy to manipulate

Question 21

calcium silicate

Answer 21

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

Question 22

RM calcium silicate

Answer 22

1) theracal LC
- bioactive
- direct and indirect
- similar to MTA and biodentine
- light cured (better controlled than MTA)

Question 23

more about activa (pulpdent)

Answer 23

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

Question 24

bioactive materials

Answer 24

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