DENTAL LINERS, BASES AND VARNISHES

By dr. siddharth suthar part I endo PG

Department of Conservative dentistry, endodontics and esthetics

Why do we need them?

MECHANICAL THERMAL CHEMICAL

Pulp protection

ELECTRICAL

BIOLOGICAL

Importance of remaining dentin thickness

Remaining dentin thickness Effect of toxic substances

0.5mm 1 mm 2 mm

25% 10% Minimal or nil

Some important points to consider

1.

2.

3.

Knowledge about pulp dentin complex, its defensive mechanism as a function of the intensity and duration of irritants. Clinical signs of pulpal irritation and its healing capacity The irritating capabilities of the diseases affecting the tooth, operative procedures and the materials used.

Proper understanding of the nature of diffusability and the factors affecting it. The functions of the intermediary bases.

Factors governing dentin permeability

1.

Type of dentin

The types and nature of penetrants depending upon Compatibility and reactivity with dentinal constituents Their valencies Degree of ionization Molecular size Molecular mobility Wetting ability Driving forces
Plaque acids-penetrate quickly and extensively Salivary ions-depends on molecular size and reaction potential Corrosion products readily penetrate dentin

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

The degree of mineralization of dentin Dentin exposed during tooth preparation Effective depth (dentinal bridge) Induced stresses Hydraulic pressure Deficient resistance and retention form Microleakage Cracks and microcracks in the dentin and enamel Type of intermediary base or restorative material Dessication of dentin

Why do we need liners and bases

Because the dentine is sensitive Hydrodynamic theory of pain transmission When we cut or prepare a cavity we are cutting fresh dentinal tubule we have to maintain a good seal between the filling and the cavity

Ideal requirements for intermediary base materials

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Should be capable of creating an impervious layer on cut vital dentin Biocompatible Chemically compatible Should be thermal, chemical and electrical insulator. Should not discolour Should harden quickly Should withstand condensation forces Should stabilize or diminish dentin permeability. Should be easily manipulated Should impart sedative action Should promote repair and healing

Materials used for intermediary bases and basing

1. 2. 3. 4. 5. 6.

Zinc oxide eugenol Calcium hydroxide Zinc phosphate cement Polycarboxylate cement Varnishes and film forming resinous materials Glass ionomer cements

Principles of intermediary basing

Layer of the intermediary base< the microleakage space

R.M.- no chemical &/or physical adhesion

No therapeutic effect

Are applied to change only certain properties

are not concerned with retention and resistance form of restoration.

Apply all over the preparation

But if it is not so, then

Do not apply on margins or surrounding walls, confine to axial and pulpal walls only Confine to deepest parts of the pulpal and/or axial walls so that restoration will be seated on two opposite areas in dentin. Apply minimal thickness to fulfill the objectives Therapeutic bases-always weak-either carry with reinforcing carrier or use as subbase Should be securely retained in the dentin to avoid displacement.

Determination of effective depth

From the radiograph Effective depth in the radiograph Enamel thickness in the radiograph Actual effective depth Actual enamel thickness

Using sonic probes By correlating the items recognizable in the preoperative radiograph. E.g., sclerotic dentin, dead tract etc.

CAVITY LINER
Thin layer of cement such as calcium hydroxide suspension in an aqueous or resin carrier (after evaporation), used for protection of pulp: certain glass ionomer cements that are used as an intermediate layer between tooth structure and composite restorative material are also considered liners.

Liners are aqueous or volatile organic suspensions or solutions. They leave a thin film and shining surface on the cavity, the thickness of this film very minimal not exceeding 0.5 mm. Their solvents evaporate quickly, leaving behind a film residue.

Composition
Suspension of calcium hydroxide in an organic solvent such as methyl ethyl ketone or ethyl alcohol Other liners include
Type

III GIC Type IV ZOE

Properties
Do not possess mechanical strength Very less thermal protection Calcium hydroxide-soluble-should not be applied at the margins Flouride added to some liners to reduce secondary caries

Types of liners
Solution liners Suspension liners

Calcium Hydroxide
Indications for use
Protects

the pulp from chemical irritation by its sealing ability. Stimulates the production of reparative or secondary dentin. Compatible with all types of restorative materials.

Calcium Hydroxidecontd
Application process
Placed

only on dentin. Placed directly over the deepest portion of the preparation.

Commercial Examples:
a. DYCAL (LD Caulk): Catalyst Paste= 51% CH, 39.7% Ethyl Toluene Sulfonamide, 9% ZnO, 0.3% Zn Stearate Base Paste= 39% Glycol Salicylate, 45% TiO2, 15% Ca Tungstate, 0.6% CH Reaction= Moisture allows Ca+2 ions to dissolve and chelate with salicylate b. LIFE (Kerr): Catalyst Paste = CH, ... Base = 83% Methyl Salicylate Oligomers, 15% Methyl Salicylate Polymer,... Reaction = Moisture dissolves CH and Ca+2 ions crosslink the oligomers c. Light Cured DYCAL

Fig. 44-1 Location for placement of calcium hydroxide.

CAVITY VARNISH
A solution of natural gum, synthetic resins, or resins dissolved in a volatile solvent, such as acetone, ether or chloroform.

Varnishes
Indications for use*
Seal

the dentinal tubules. Reduce leakage around a restoration. Act as a barrier to protect the tooth from highly acidic cements such as zinc phosphate.

* This material is contraindicated in its use under composite resins and glass ionomer restorations.

Applications
Reduces microleakage around newly placed amalgam Reduces passage of irritants into dentinal tubules Prevents penetration of corrosion products. Can be used as surface coating over certain restorations As a temporary protection from galvanic shock In cases where electrosurgery is to be done adjacent to metallic restorations.

Composition
Natural gums
Copal Rosin Chlorbutanol Thymol Eugenol flouride

Synthetic resins Organic solvents

Alcohol Acetone ether

Medicinal agents

Properties
Do not possess mechanical or Thermal insulation Film thickness ranges from 2-40 microns Solubility is low- virtually insoluble in distilled water.

Precautions
Bottle should be tightly capped immediately Should be applied in thin consistency Excess varnish should not be left on the margins of the restorations as it prevents proper finishing of the margin of the restorations. Should be confined to dentin when using silicate or silicophosphate restoration.

Contraindications
Composite resins Glass ionomer When therapeutic action is expected from the overlying cement. Eg. ZOE, calcium hydroxide.

Varnishes-cont d
Application process
Applied

with either a small disposable applicator or a cotton pellet. Thin coating of the varnish on the walls, floor, and margin of the cavity preparation. Air dry and reapply the varnish Air dry again to see a shiny hard surface which is ready to receive the gold or amalgam restoration.

Commercial Examples:
Solvent: Film Formers: a. Solution Liners: Copalite = Mixture Copal Resin Hydroxyline = Mixture PMMA Resin, CH Chembar = Chloroform PS Resin, CH, ZnO Tubilitec = Chloroform PS Resin, CH, ZnO, F, Dithymol-I2 b. Suspension Liners: Pulpdent = Water Methyl Cellulose, CH Hypocal = Water Ethyl Cellulose, CH

Fig. 44-5 Location for placement of cavity varnish.

Dental bases
Types
High


strength

Thermal as well as mechanical protection  Eg. Zinc phosphate, polycarboxylate, glass ionomer, and reinforced ZOE.
Low

strength minimum strength and rigidity act as barrier and provide therapeutic benefit eg. Calcium hydroxide and ZOE

Properties
Protection against chemical insults Should

serve against barrier against irritating constituents. Ca Hydroxide and ZOE are the most effective.

Thermal properties Thermal

conductivity should be similar to tooth structure For effective protection a minimum of 0.75 mm thickness required

Therapeutic effect
Some

bases are used for their therapeutic effects.

Strength Should

withstand the forces of condensation Withstand fracture or distortion under masticatory stresses Also it should harden rapidly Minimum strength req- 0.5 to 1.2 MPa

Compatibility of intermediary base materials with restorative materials and techniques

Interference with the setting reaction and properties of the permanent restorative material Discoloration of permanent restorative material Combination of different intermediary base materials.

ZOE
Interference with setting reaction
any polymer

discoloration

Interaction with other IBMs

Polycarboxylate , GIC,

Physical and mechanical compatibility

polymeric

can depolymerize the set polymer

Non polymeric

methyl cellulose carried calcium hydroxide

Unmodified ZOE insufficient for amalgam direct gold and cast alloy restoration

Calcium hydroxide
Interference with setting reaction discoloration Interaction with other IBMs
Only in methyl cellulose form

Physical and mechanical compatibility

For amalgamin methyl cellulose or alkyl salicylate chelate

Does not discolor

No effect Thin transluscent tooth colored fillings-chalky patch Organic solvents of varnishes and some monomers of resins could dissolve it For cast and direct goldneeds protection from Zn phosphate

Zinc phosphate
Interference with setting reaction discoloration Interaction with other IBMs Physical and mechanical compatibility

Does not interfere

If used in colors other than yellow

Completely compatible

Most rigid, durable, and tough

Polycarboxylate cement
Interference with setting reaction discoloration Interaction with other IBMs Physical and mechanical compatibility

Does not discolor Does not interfere Only if RM is thin transluscent All but ZOE & film forming resinous material Durable enough to withstand the manipulative forces

Film forming resinous materials

Interference with setting reaction discoloration Interaction with other IBMs
Organic solvents can dissolve Ca hydroxide Can form dark line around resin restoration Can be dissolved by monomers Can be dissolved by polycarboxylate and GIC Are nor affected by manipulative forces

Physical and mechanical compatibility

Do not interfere

THANK YOU

1. PHILLIPS SCIENCE OF DENTAL MATERIALS, 11TH EDITION 2. CRAIGS RESTORATIVE DENTAL MATERIAL, 12TH EDITION 3. OPERATIVE DENTISTRY, MODERN THEORY AND PRACTICE BY M.A.MARZOUK 4. LINERS VARNISHES AND BASES, LECTURE BY 20072008, Stephen C. Bayne, Ann Arbor, MI 48109 5. LINERS BASES AND CEMENTS, AN IN DEPTH REVIEW, BY RANDY WEINER 6. INTERNET