INTRODUCTION
Pulp protection refers to protection of pulp from external irritants. Restorative dental materials provide
excellent properties for bulk of dental restoration . But do not protect pulp or preserve its health
Considerations include :
Chemical protection
Electrical protection
Thermal protection
Pulp medication
Mechanical protection
OBJECTIVES FOR PULP PROTECTION :
1) Mild and strong chemical or mechanical insults
2) If insult produces fluid flow, in or out of dentinal tubules, pressure change is sensed by
mechanoreceptors within pulp and patient experiences sensitivity.
3) Leakage of chemical irritants from bacteria or dental materials- pulp becomes inflamed
4) Smear layer
1. It is 25 % to 30 % porous
2. Produce dentinal tubule sealing
3. Long term diffusion can occur so necessitates sealing of smear layer for chemical protection
CLASSIFICATION OF PULP PROTECTIVE AGENTS
1. Cavity sealers
Cavity Varnish
Resin bonding agents
2. Cavity Liners
3. Cavity base
CAVITY VARNISH
In shallow cavity : For amalgam restorations , cavity varnish used
Help reduce postoperative sensitivity due to micro leakage
Contraindicated under :
GIC interferes with adhesion
Composite interferes with polymerization
Composition
Components
1.Solid 10% copal resin
2.Solvent 90% ether,acetone,alcohol
3.Setting reaction Physical-by solvent evaporation
Structure
1.Arrangement Amorphous film
2.Bonding Covalently bonded organic
material
3.Composition Single phase
4.Defects Pores & cracks
Physical properties
1.Thermal & electrical Insulator
2. .Wetting Poor on hydrophilic surfaces
Chemical properties
1.Solubility Low
Mechanial properties
1.Tensile <1
strength(Mpa)
2.Elongation <0.1%
Biologic properties
1.Toxicity None,if solvent eliminated safely
RESIN BONDING AGENTS
- Dentin bonding agents
- For adhesion and seal prepared tooth
- Bonding for amalgam restorations to reduce micro leakage
- For indirect restorations : Ceramic inlays, veneers, cast restorations
CAVITY LINERS
Liners placed between dentin and restoration to provide pulpal protection
Use depends on extent and location of preparation and restorative material to be used.
CALCIUM HYDROXIDE
It can be used in deep cavity
Advantages :
Pulpal biocompatibility
Stimulate reparative dentin
Antibacterial activity
- To prevent loss, a base is placed over it
Disadvantages :
Low strength
high solubility
Loss or softening under poorly sealed restorations
GLASS IONOMER CEMENT
Used for moderate to deep cavities
- As liner under amalgam, cast gold, composite restorations
Advantages :
Good biocompatibility
Good strength
Fluoride release
Chemical adhesion to tooth structure
CAVITY BASES
Used to replace missing dentin or block undercuts in preparations for indirect restorations
Thickness : 1 2 mm
Provide thermal protection and adequate strength
Applied on pulpal and axial walls of cavity preparations
Eg. Zinc phosphate cement, zinc polycarboxylate cement, glass ionomer cement type (III)
Zinc phosphate cement
Excellent thermal insulation
Zinc polycarboxylate cement
Biocompatible
Adhesion to tooth structure
Glass ionomer cement
Mild to pulp
Good adhesion to tooth structure
Fluoride release
Adequate strength as base
Compatible with all restorative materials
- Used under amalgam, composite resin, cast gold, ceramic restorations
Zinc phosphate Polycarboxylate Glass ionomer
cement(modern cement cement(KETAC-
TENACIN) (DURELON) CEM)
Components
1.Component 1 ZnO powder ZnO powder H2O F-Al-Si glass
powder
2.Component 2 H3PO4/H2O Polyacrylic Polyacrylic
acd/H2O acid/H2o
3.P/L ratio High High High
4.Setting reaction Acid-base Acid-base reaction Acid-base reaction
reaction
Structure
1.Arransgement Crystalline matrix Amorphous Amorphous
& fillers matrix,crystalline matrix,crystalline
fillers fillers
2.Bonding Ionic Covalent,ionic Covalent,ionic
3.Composition Multiphase Multiphase Multiphase
4.Defects Pores & cracks
Physical properties
1.Thermal & Insulator Insulator Insulator
electrical
Chemical
properties
2.Solubility 0.10 (low) Low 0.10(low0
Mechanical
properties
1.Compressive 77 100 120
strength(Mpa)
2.Diametral - 17 -
tensile strength
(Mpa)
Biologic properties
1.Safety Acceptable acceptable Acceptable
METHOD OF PULPAL PROTECTION
Materials Shallow Moderate excavation Deep excavation
excavation (RDT<0.5mm)
(RDT 0.5-2mm)
(RDT>2mm)
Amalgam no/no/sealer No/base/sealer CH/base/sealer
Composite No/no/DBS No/no/DBS CH/No/BDBS
Gold inlays No/No/cement No/Base/cement CH/Base/Cement
and onlays
Ceramic, No/No/DBS,CC No/No/DBS,CC CH/No/DBS,CC
PR,FRP
PULP CAPPING
INDIRECT PULP CAPPING
Retention of soft dentin near pulp and medication of remaining dentin with calcium hydroxide
Reinforced GIC / reinforced zinc oxide eugenol over calcium hydroxide liner
Criteria :
No history of spontaneous pulpal pain
Normal response to vitality tests
No periapical involvement
Procedure
Administer LA. Isolate tooth with rubber dam
Remove all undermined enamel high speed handpiece with air water spray
Excavate carious dentin
Apply calcium hydroxide liner over demineralised dentin
Place reinforced GIC or reinforced Zinc oxide eugenol over liner
Place permanent restoration after 6 to 8 weeks after evaluating patients response
DIRECT PULP CAPPING
To seal exposed pulp with material that promotes reparative dentin formation
Calcium hydroxide is choice for direct pulp capping
Criteria :
Asymptomatic tooth no spontaneous pain, no abnormal response to thermal stimuli
Size of exposure less than 0.5mm diameter
Hemorrhage easy to control
Area of exposure must be uncontaminated by saliva or gingival fluids
Procedure :
Administer LA . Isolate tooth with rubber dam
Control hemorrhage with cotton pellet
Place calcium hydroxide over exposed pulp
Place base/ liner
Place reinforced GIC/ reinforced zinc oxide eugenol
Place permanent restoration after 6 to 8 weeks
Substitutes for liners
DENTIN BONDING SYSTEMS
Involve unfilled, liquid acrylic monomer mixture placed onto an acid etched and primed dentin surface
Hydrophilic monomers (2-HEMA)
Dissolve hydroxyapatite crystals
Forms interpenetrating network around dentin collagen
Hybrid zone : 0.1 5 m deep
Micromechanical bonding is formed
Two component system :
Etching with priming or
Bonding or etching or
Priming with bonding self etching primers
One component system :
Latest dentin bonding system
Combination of all three stages into single component
AMALGAM BONDING SYSTEMS
To seal underlying tooth structure and bond amalgam to enamel and dentin
4- methyloxy ethyl trimellitic anhydride (4-META) is used
No chemical bonding
Thick layers (10 50m)
Forces fluid components of amalgam into unset bonding layer
Produce micromechanical laminations
Advantage:
Dentin sealing
Improved resistance form
CONCLUSION
Survival of liners and bases has never been well understood
During restoration removal , difficult to completely remove restoration and assess liners and
bases
Solution liners provide only chemical protection for days or weeks,thin and brittle
Bonding agents may survive years
Traditional calcium hydroxide liners dissolve, lose 10% to 30% volume over 10 or more years
Long term changes in both cement liners and bases not well characterized
Under these circumstances it is judicious to remove most liners and bases during rerestoration
procedure.
REFERENCES
Sturdevants - Art and science of operative dentistry
Remya raghu - Clinical operative dentistry
