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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