Pulp Protection-Liners and Bases

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Presentation Transcript

Slide 1: 

Pulp Protection -Liners and Bases Bandar Al-Abdulwahhab Department of Operative Dentistry Riyadh Colleges of Dentistry and Pharmacy

Introduction : 

Introduction Caries is a bacterial infection. All restorative procedures cause pulpal irritation.

Physiologic Considerations : 

Physiologic Considerations 1-Remaining Dentinal Thickness: No material that can be placed in a tooth provides better protection for the pulp than dentin. The RDT from the depth of cavity preparation to the pulp is the single important factor in protecting the pulp. A 0.5-mm thickness reduces the effect of toxins by 75%. A 1.0-mm thickness reduces the effect of toxins by 90%. A 2.0-mm thickness or more lead to a little pulpal reaction.

Physiologic Considerations : 

Physiologic Considerations 2-Causes of Pulpal Inflammation: Pulpal invasion by bacteria or their toxins. Toxic effects of dental materials. Heat effects of rotary instruments. The keys to minimizing adverse pulpal reaction from rotary instrumentation are: Adequate air-water spry. Light pressure. Sharp rotary cutting instruments Preservation of tooth structure.

Physiologic Considerations : 

Physiologic Considerations 2-Causes of Pulpal Pain: Increased intrapulpal pressure on nerve endings due to inflammatory response as a result of bacterial invasion. Or (in the absence of inflammation) Rapid movement of fluid outward through dentinal tubules lead to a deform in nerve endings in the pulp causing a pain (Hydrodynamic theory).

Cavity Liners and Bases : 

Cavity Liners and Bases Cavity Sealers, Liners and bases are: Materials placed between dentin (and sometimes pulp) and the restoration to provide pulpal protection or pulpal response. Pulpal protection: 1- Chemical protection. 2- Thermal protection. 3- Electrical protection. 4- Mechanical protection. 5- Pulpal Medication.

Cavity Liners and Bases : 

Cavity Liners and Bases Terminology and classification: 1- Cavity sealers: Materials provide protective coating to the walls of prepared cavity and a barrier to leakage at the interface of the restorative material and the walls. The sealers thickness (1 to 50 µm) can be subdivided into solution sealer and suspension sealer .

Cavity Liners and Bases : 

Cavity Liners and Bases Terminology and classification: 1- Cavity sealers: Any sealer based on nonaqueous solvents that rely on evaporation for hardening is designated as a solution sealer (or varnish). Sealers based on water have many of the constituents suspended instead of dissolved and are called suspension sealers.

Cavity Liners and Bases : 

Cavity Liners and Bases Two forms of cavity sealers: 1-Varnishes: A natural gum (such as copal) or a rosin, or a synthetic resin dissolved in an organic solvent(acetone, chloroform, or ether)that evaporates, leaving behind a protective film. It is used as : a barrier against bacteria and their by-products into dentinal tubules and reduces the penetration of the oral fluid at the restoration-tooth interface.

Cavity Liners and Bases : 

Cavity Liners and Bases Cont’ 1-Varnishes: The film thickness 2-5 µm. Two application have been shown to be more effective than a single coat. It has been used under amalgam and before cementation of indirect restorations with zinc phosphate cement.

Cavity Liners and Bases : 

Cavity Liners and Bases 1- Cavity sealers: 2-Adhesive sealers: A materials provide sealing as well as bonding at the interface between cavity preparation walls and restoration. Examples include: Adhesive bonding systems, resin luting cements and glass-ionomer luting cement. The film thickness 20-50 µm.

Cavity Liners and Bases : 

Cavity Liners and Bases 2-Cavity Liners: A material of minimal thickness (0.2 to 1mm) to achieve a physical barrier to bacteria and their products and restoration and /or provide a therapeutic effect and applied only to dentin cavity walls that are near to the pulp.

Cavity Liners and Bases : 

Cavity Liners and Bases 2-Cavity Liners: Example of cavity liners: Calcium hydroxide, zinc Oxide-eugenol (old), and glass ionomer. 1-Calcium Hydroxide: Pulpal compatibility. Ability to stimulate reparative dentin formation. Antibacterial action, PH >11. Recent research has indicated that calcium hydroxide release growth factors from dentin that assist in pulp healing. Poor physical properties, restrict their use over the smallest area. To start the reaction, some calcium hydroxide must be dissociated by moisture from air or from moist dental surfaces.

Cavity Liners and Bases : 

Cavity Liners and Bases 2-Cavity Bases: A material of minimal thickness (1 to 2mm) to replace missing dentin, used for : 1-Bulk buildup and/or , 2-Blocking out undercuts in preparations for indirect restorations and/or, 3-Provide thermal protection and/or, 4-Supplement mechanical support for the restoration.

Cavity Liners and Bases : 

Cavity Liners and Bases 2-Cavity Bases: Examples of bases: Glass ionomer, Resin-modified glass-ionomers, (zinc phosphate cements and Polycarboxylate cement, Zinc-oxide Eugenol)old. 1-Glass Ionomer: Fluoride release. Chemical bond to tooth structure. Good physical properties. Low PH, i.e. acidic. Some people use GIC as liner.

Cavity Liners and Bases : 

Cavity Liners and Bases Clinical Considerations: Clinical judgments about the need for specific liners and bases are linked to: 1- Amount of remaining dentin thickness (RDT). 2-Considerations of adhesive materials. 3-The type of restorative material being used.

Cavity Liners and Bases : 

Cavity Liners and Bases Clinical Considerations:

Slide 18: 

COMMERCIAL EXAMPLES of Sealers, Liners, and Bases

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Pulp capping: an endodontic treatment designed to maintain the vitality of endodontium. Several conditions must be consider before pulp capping: 1-The is no history of spontaneous pulp pain. 2-Pulp vitality has been confirmed. 3- There is no history of pain lingers after application of thermal stimulus. 4-No evidence of periradicular lesion of endodontic origin.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Direct Pulp Capping: The placement of biocompatible agent on healthy pulp tissue that has been exposed. Treatment objective: is to seal the pulp against the bacterial leakage, encourage the pulp to wall off the exposure site by initiating a dentin bridge and maintain the vitality of the underlying pulp tissue region.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Factors affect the success rate of DPC: 1-Coronal and radicular pulp free from bacterial invasion. 2-Size of exposure(pinpoint, less than 1 mm). 3-Age of the Patient (good blood supply). 4-Tooth type and site. 5-Hemorrhage from the pulp(Slight hemorrhage with bright red in color). Direct pulp capping should be attempted only when a small mechanical exposure of healthy pulp occurs.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping DPC Procedure: 1- Isolation: isolate the tooth with a rubber dam. 2- Prepare the tooth for final restoration, in case of traumatic pulp exposure, 3- Adequate hemostasis must be achieved to the pinpoint exposure. 4-The exposure should be covered with calcium hydroxide with slight extension to dentin. 5- Restore the tooth with a well-sealed restoration.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Indirect Pulp Capping: The placement of biocompatible agent over a thin layer of reaming carious dentin, after deep caries excavation, from the pulp tissue with no exposure of the pulp. Treatment objective: is to avoid the pulp exposure and the necessity of more invasive measures of pulp therapy by stimulating the pulp to generate reparative dentin and maintain the vitality of the underlying pulp tissue region. We should be considered IPC when there is a radiographically evident, deep caries lesion encroaching on the pulp and the pulp is vital.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Advantages of IPC: 1-The remaining dentin thickness is directly related to odontoblast. 2- The remaining dentin thickness avoiding pulp exposure, means that: There is less chance for infected debris to be introduced into the pulp. There is no concern to hemorrhage from the pulp.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping IPC Procedure: 1- Isolation: isolate the tooth with a rubber dam. 2- Prepare the tooth for final restoration. 3-In deep part , a spoon excavator or /and large round bur, in low-speed handpiece with gentle stroke should be used to excavate the caries- dentin (the wet (soft, amorphous) ) . 4- As the pulp is approached, the dry, fibrous, demineralized dentin that give moderate resistance to gentle scrapping should be remained (Affected dentin).

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Con’ IPC Procedure: 5- Place a calcium hydroxide liner over the remaining mineralized dentin. Two choices: 6- One -Appointment Technique: Put a suitable base and then restore the tooth with a well-sealed final restoration.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Con’ IPC Procedure: The idea behind one Appointment Technique that: The placement of calcium hydroxide over the dentin has been shown eliminate all remaining bacteria. The well-sealed restoration should isolate the bacteria from life-sustaining substrate. Prevent further traumatic to the pulp.

Direct and Indirect Pulp Capping : 

Direct and Indirect Pulp Capping Con’ IPC Procedure: 6-Two-Appointment Technique: Put a suitable base and then restore the tooth with a well-sealed temporary restoration. 7-After 6-8 weeks, take Bitewing x-ray and Carefully remove all temporary filling and calcium hydroxide. 8- Remove the remaining affected dentin and confirm the reparative dentin formation. 9-Again apply suitable liner and base then your final restoration. Always monitor the signs and symptoms of the tooth prior to, during and after treatment.

The end : 

The end