PULP

PROTECTION
PRESENTED BY
Varun prasad R
 CONTENTS
 INTRODUCTION
 DENTIN
 PULP
 PULP-DENTIN COMPLEX
 IRRITANTS TO PULP-DENTIN COMPLEX
 REACTION OF PULP DENTIN ORGAN TO STIMULATION OR IRRITATION
 SMEAR LAYER
 PULP PROTECTION
 FACTORS DETERMINING TYPE OF PULP PROTECTION
 REMAINING DENTIN THICKNESS
 CLASSIFICATION
 SEALERS
 LINERS
 BASES
 PULP CAPPING
 CONCLUSION
 REFERENCES
 INTRODUCTION
Embryology and physiology of P-D complex.

mesenchyme Vitality &

Dental papilla protection

Clinical implications:

Pulp - highly responsive to external stimuli

Microleakage of the restorative materials - penetration of oral fluids &

bacteria – principle cause of pulpal response.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 DENTIN
Provides both color and elastic foundation for
enamel.

Forms the bulk of the tooth and protective encasement

for the pulp

Vital tissue without vascular supply or innervation-able

to respond thermal, chemical or tactile external stimuli

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 STRUCTURE:
Composed of small
apatite crystals embedded
in cross-linked organic PERITUBULA
R DENTIN
matrix of collagen fibrils
INTERTUBULA
R DENTIN
2 types of dentin:
a) Intertubular dentin
b) Peritubular dentin DENTINA
L TUBULE

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
Primary dentin:
-formed until root formation is completed

Secondary dentin:
-slowly formed dentin that continues to constrict the
dimensions of pulp chamber

Tertiary dentin:
-localized to the affected area of pulp-dentin complex

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 Relation between the diameter and the number of tubules and the
proximity of the pulpal chamber. a Superficial dentin with less tubules; b
D.H.deep
Pashley , dentin with
Department of more
Oral Biology, tubules
School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
Dentin permeability
 PULP
75% Water, 25% Organic

Connective tissue of collagen fibres and ground

substance supporting vital cellular, vascular and
nerve structures of teeth.

Sensitive and resilient tissue with a great potential

for healing.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 STRUCTURE:
Histologically,
-distinct concentric
zones:
a)pulp core
b)cell-rich zone
c)cell-free zone
d)odontoblastic layer

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
CELLS:
a)Formative cells

b)Defense cells

c)Reserve cells

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 PULP-DENTIN COMPLEX
Dentin-type I collagen

Pulp-type I, III and V collagen

PULP

FORMATIVE NUTRITIVE SENSORY PROTECTIV

E

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 IRRITANTS TO PULP DENTIN COMPLEX
Mechanical: Biological:
 Operative procedures  Caries

 Traumatic occlusion Microleakage

Chemical:

 Restorative materials

 Fluid flow – osmotic flow and dehydration

Physical:

 Thermal changes conducted through restorations

 Galvanic shock

 Forces transmitted through materials to dentin

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
 INSULTS TO PULP DENTIN ORGAN
MILD OR LONG TERM • Recession of odontoblastic process towards
CHEMICAL/MECHANICAL pulp and occlusion of dentinal tubules by
INSULT deposition of hydroxyapatite crystals

• Rapid recession of odontoblastic process

STRONG INSULT CLOSER
and formation of thin bridge of
TO PULP hydroxyapatite across dentinal tubules.

FLUID FLOW WITHIN • Inwards or Outwards, Pulpal pressure

DENTINAL TUBULES changes sensed by MECHANO
BECAUSE OF INSULT RECEPTORS-SENSITIVITY

LEAKAGE OF CHEMICALS • Pulpal Inflammation

FROM DENTAL MATERIALS
OR BACTERIA

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
 REACTION OF PULP DENTIN ORGAN TO
STIMULATION OR IRRITATION
DENTIN SCLEROSIS:
-Mild irritation

-Odontoblasts are vital

-Stimulation of Tome’s fibres – formation of intratubular dentin

-local tubular sclerosis underlying region to the carious lesions - highly calcified

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
DEAD TRACT:
-Severe irritation

-Complete degeneration of odontoblasts

-the odontoblasts die and the corresponding tubules are referred as dead
tracts.

-Highly permeable to chemicals and toxins

-Considered destructive for pulp dentin organ

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
HEALTHY REPARATIVE DENTIN:
-Most favorable response

-Stimulation of pulp dentin organ to form sclerotic

dentin or calcific barrier

-Formation of secondary dentin (has misangulated tubules)

-No disturbance to pulp

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
UNHEALTHY REPARATIVE DENTIN:
-Fairly favorable response

-Degeneration of odontoblasts

-Dead tract formation

-Mild pathological reversible changes in pulp tissue

-Formation of tertiary dentin – indicates recuperative capacity of pulp

-TERTIARY DENTIN – not completely impervious; Ages the pulp and reduces capacity for
further repair

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
DESTRUCTIVE REACTION:

-Most unfavorable pulpal response

-Insult exceeding recuperative capacity of pulp

-Inflammation of pulp, odontoblast destruction, pulp necrosis

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of
the pulpo dentin complex; Critical Reviews in Oral Biology & Medicine
 SMEAR LAYER
Any debris calcific in nature, formed by
the reduction of enamel, dentin or
cementum

Cut dentine debris into the dentinal

tubules-SMEAR PLUG

First identified by Leeuwenhoek

Importance in dentistry identified by

EICK

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
It reduces permeability

Aids in maintaining a drier field

Reduces infiltration of noxious agents into the

tubules and perhaps the pulp.

Hindrance to dentin bonding procedures, hence

removed or modified by some form of acid
conditioning.

Acid etching or conditioning allows for removal

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 PULP PROTECTION
No perfect replacement for missing enamel and dentin

• CHEMICAL PROTECTION

• THERMAL PROTECTION

• MECHANICAL PROTECTION

• PULPAL MEDICATION

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 CHEMICAL PROTECTION
Amalgam restorations can leak along cavity margins. Seal smear layer to produce chemical
protection.

Composite resins undergo polymerization shrinkage – leakage along margins. Dentin bonding
agents serve a dual purpose – adhesion and cavity sealing

 Thin film liners – liner ingredients dissolved in volatile non aqueous solvent

Liners based on non aqueous solvents – depending on evaporation for hardening – SOLUTION
LINERS OR VARNISHES

Liners based on water – constituents suspended in water

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
THERMAL PROTECTION
Intraoral HEAT FLOW:
-Through restoration or around microleakage
-113 F – Pulpal infammation
-130 F – Permanent pulp damage

 Pulpal response – Time, temperature and dentin thickness

THROUGH RESTORATION AROUND RESTORATION
Thermal Conductivity Thermal expansion
Amalgam Dentin Pulp

Thermal Diffusivity
T3 +Q
+DT T2
T1
-Q
T0 T0

Amalgam Dentin Pulp

T3 T3
T2
+Q
+Dt T1
T0

Amalgam

Tooth

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 MECHANICAL PROTECTION
Offered by cement base: ideal thickness: 0.5 – 0.75 mm (MINIMUM
BASING CONCEPT)

Materials used – Zinc phosphate, Resin reinforced zinc oxide eugenol

cement, zinc polycarboxylate, glass ionomer cement, resin modified glass
ionomer cement (RMGIC)

 Important requisites – compressive strength and modulus of elasticity

compatible with restorative material – Mismatch can cause tensile stress at
cement – restoration interface

General recommendation – Zinc phosphate for amalgam and Zinc

phosphate, GIC or zinc polycarboxylate for composite resin
Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 PULPAL MEDICATION
Two important aspects of pulpal medication:
Relief of pulpal inflammation
Facilitation of dentinal bridging for physiological protection

Materials commonly used

 Eugenol (Palliative liner)
Calcium hydroxide (Stimulating liner)

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 FACTORS DETERMINING TYPE OF
PROTECTION

 Extent and location of preparation (Remaining dentin thickness)

Type of restorative material used

Metallic restorations that are NOT bonded to tooth and are not
insulating (amalgam and cast metal) – greatest need for pulp
protection

Tooth colored materials – bonded to tooth structure and

insulating; seal by bonding agents – pulp protection generally not
needed unless preparation is extremely close to pulp
James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
REMAINING DENTIN THICKNESS

Thickness of dentin bridge between the pulpal floor of the preparation and the
pulp

 Most important factor in determining pulp protection agent

Also termed EFECTIVE DENTIN THICKNESS (EDT) / Effective Dentin

Depth (EDD)

 Ideal RDT: 2 mm

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 REMAINING DENTIN EFFECT OF TOXIC
THICKNESS SUBSTANCES
ON PULP

0.5mm 25%

1mm 10%

2mm minimal or nil

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 RDT AND PULP DENTIN ORGAN RESPONSES
• 2.5 mm or more – healthy reparative dentin
• 1 – 2 mm – unhealthy reparative dentin
• < 1 mm – Destructive reaction

PULP RESPONSES MEDIATED BY RDT

• Odontoblast survival
• Reactionary dentin formation
• Pulp inflammation

ALTERING FACTORS
• Degree of cellular injury to odontoblast
• Buffering capacity of dentin

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 RDT ODONTOBLA REACTIONARY
PULP

ST DENTIN INFLAMMATIO
FORMATION N
SURVIVAL
>1mm 100% Slight Minimal

0.5-1mm 88% Slight Minimal

0.25- 82% Increased

0.5mm Significant
68% Slight Most
<0.25mm Severe

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 CLASSIFICATION
According to Schwartz
1)CAVITY SEALERS
a)Cavity Varnish
b)Resin bonding agents

2)CAVITY LINERS

3)CAVITY BASES

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 According to Sturdevant
1) LINERS
a)Thin
-Solution liners (varnish 2-5 µm)
-Suspension liners (20-25 µm)
b)Thick
-cement liners
2) BASES

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 CAVITY SEALERS

 CAVITY VARNISH:
• Solutions of one or more resins from natural
gums, synthetic resins or rosin, dissolved in
volatile solvents like chloroform, alcohol,
acetone, benzene, toluene, ethyl acetate and
amyl acetate.

• May also contain medicinal agents like thymol,

chlorobutanol and eugenol.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
Eg: COPALITE
• 90% solvent (ether + alcohol + acetone) + 10% copal resin

• Low resin content – thin film on drying.

• Thin films – flexible and dries rapidly.

• Thick films - trap solvent during superficial drying and become brittle

• Completely dries in 8 – 10 seconds

• Hydrophobic and does not wet dentin wall

• Requires 2 applications for 85% coverage

• 2-5 mm film produced

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 MANIPULATION:

-The varnish may be applied by using a brush, wire loop or a small pledget of cotton.

-Multiple layer are applied .

-Each layer is allowed to dry before applying the next one.

-The main objective is to attain a uniform and continuous coating

 PRECAUTIONS:

-Varnish solution should be tightly capped immediately after use to prevent loss of solvent by
evaporation.

-It should be applied in thin consistency. Viscous varnish doesn't wet the cavity walls properly.

-Excess varnish should not be left on the margins of the restorations as it prevents proper finishing
of the margins of the restorations

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 PHYSICAL PROPERTIES
Thermal Insulator
Electrical Insulator
LCTE(ppm/0C) High
Wetting Poor
CHEMICAL
PROPERTIES

Solubility(% in water) Low

MECHANICAL
PROPERTIES
Tensile strength(Mpa) <1
Elongation(%) <0.1%
BIOLOGIC
PROPERTIES

Toxicity None if solvent eliminated

safely
CONTRAINDICATIONS:

 Composite resin: the solvent in the varnish may react with or soften the resin

 Glass ionomer: varnish eliminate the potential for adhesion and the
biocompatibility of the cement

 In a silicate or silicophosphate restoration-varnish confined to the dentin.

 Varnish applied on the enamel- inhibit the uptake of fluoride by enamel.

 When therapeutic action is expected from the overlying cement. e.g. zinc oxide
eugenol and calcium hydroxide

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

RESIN BONDING AGENTS:
-Apart from adhesion recommended for sealing
-In Indirect restorations to seal the prepared tooth
structure

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 Dentin bonding systems involve an unfilled, liquid acrylic monomer
mixture placed onto an acid-etched and primed dentin surface.

 The bonding primer depends on hydrophilic monomers, such as 2-

hydroxyethyl methacrylate (HEMA).

 Primer and/or bonding agent may flow into dentinal tubules, the bond
strength is primarily achieved by micromechanical bonding to the
intertubular dentin along the cut dentin surface.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

IDEAL REQUIREMENTS:

• Acceptable bond strength to dentin similar to the bond strength of composite resin to
enamel

• Be biocompatible and non-irritating to the pulp.

• Prevent microleakage.

• Be easy to apply and not be technique sensitive.

• Provide long term stability in the oral environment.

• Attain high bond strength early so as to resist degradation during finishing and
polishing.

• Have a reasonable shelf-life.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 • The immediate application of a dentin-bonding agent after
preparation (IMMEDIATE DENTIN SEALING [IDS]) has been
suggested to provide several advantages concerning bacterial
microleakage, hypersensitivity, and bonding quality.

• Polymer film is very similar to that of varnish, much better wetting

characteristics and produces a completely impervious layer.

• Decrease in marginal microleakage using dentin bonding agents

when compared to varnish

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 CAVITY LINERS

• According to Ferracane a liner is a material which is applied

in a thin layer used for sealing the dentinal surface and
walls of the cavity, contrary to the invasion of microbial
overload or nuisances from restorative procedures.

• The main function is to provide electrical insulation and

thermal protection to the pulp.

• The thickness of cavity liner is 0.5 mm.

• And it is applied in a thin layer on the prepared cavity

surface.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 CALCIUM HYDROXIDE:
-Bacteriostatic properties.
-High pH (9.5 to 11).
-Due to their alkaline nature they also serve as a
protective barrier against irritants from certain
restorations.
APPLICATIONS:
-For direct and indirect pulp capping.
- As low strength bases beneath and composite
restoration for pulp protection.
MODE OF SUPPLY:
-Two paste system
-Light cure system.

COMMERCIAL NAMES:
Dycal, Life, Care( Self cured), Prisma VLC Dycal.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 COMPOSITION:
Base paste:
Glycol salicylate 40% Reacts with Ca(OH)2 and ZnO
Calcium Sulphate
Titanium dioxide Inert fillers,pigments
Calcium tungstate Provides radiopacity
or
Barium sulphate

Catalyst paste:

Calcium 50% Principal reactive ingredient

hydroxide
Zinc oxide 10%
Zinc stearate 0.5% Accelerator
Ethylene toluene
Sulfonamide Oily compound, acts as carrier
39.5%
Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition
  SETTING REACTION:
 Calcium hydroxide reacts with the salicylate ester to form a chelate
Amorphous calcium disalicylate.
 Zinc oxide takes part in the reaction.
 The reaction is greatly accelerated by moisture and accelerators.
 SETTING TIME: 2.5 – 5.5 minutes.
 PROPERTIES:
Compressive strength: 10 to 27Mpa.
Tensile strength: 1.0Mpa.
Modulus of elasticity: 0.37Gpa/m².
Thermal properties: Thick layer provide some thermal
insulation
Solubility and Disintegration: High solubility in water
0.4 to 7.8%

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

  BIOLOGICAL PROPERTIES
-The cement is alkaline in nature.
-The high pH is due to the presence of free Ca(OH) 2 in the set cement.
-The pH ranges from 9.2 to 11.7
-The high alkalinity and it consequent antibacterial and protein-lysing effect
helps in the formation of reparative dentin.
 MANIPULATION:
-Equal length of the two paste are dispended on a paper and mixed to uniform
color.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 GLASS IONOMER CEMENT:
Water –based material that hardens following an acid-base reaction between
fluoroaluminosilicate glass powder and an aqueous solution of polyacid

AVAILABLE AS:
 Powder /liquid in bottles
 Pre-proportioned powder/liquid in capsules
 Light cure system
 Powder / distilled water (water settable type)

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 COMPOSITION- Powder:
Silica (SiO2) 41.9%
Alumina(Al2O3) 28.6%
Aluminium fluoride (AlF3) 1.6%
Calcium fluoride(CaF2) 15.7%
Sodium fluoride (NaF) 9.3%
Aluminum phosphate (AlPO4) 3.8%
Liquid :
Polyacrylic acid Increases the reactivity of the liquid

Increases working time and shortens setting time

Tartaric acid
Reaction medium initially and then slowly hydrates the
Water cross-linked matrix there by increasing the strength

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 SANDWICH and BONDED BASETECHNIQUE:
-Glass ionomer cement used as an intermediate layer between the dentin
and a resin based composite
- can be closed or open.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 ZINC OXIDE EUGENOL CEMENT:
- Excellent thermal insulation
- Exhibit poor physical properties
- Inhibit composite polymerization
- Increase micro leakage under
amalgam restorations

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

  Type I – For temporary cementation.
 Type II - Permanent cementation.
 Type III - Temporary restoration
and thermal insulation
 Type IV – Cavity liners

MODE OF SUPPLY:
Powder and liquid.
Two paste system.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 COMPOSITION:
POWDER

Zinc oxide 69.0% , principal ingredient

White rosin 29.3%, to reduce brittleness of set cement
Zinc stearate 1.0% accelerator, plasticizer
Zinc acetate 0.7%, accelerator, improves strength
Magnesium oxide Action is same like zinc oxide

LIQUID
Eugenol 85.0% , reacts with zinc oxide
Olive oil 15.0% , plasticizer

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 CALCIUM TRADITIONAL GI REINFORCED ZOE
HYDROXIDE
PHYSICAL
PROPERTIES
LCTE(ppm/0C) Low Low Low
Thermal Conductivity Insulator Insulator Insulator
Electrical Conductivity Insulator Insulator Insulator
CHEMICAL
PROPERTIES
Solubility(% in water) 0.3-0.5(high) 0.08(low) Moderate
Shrinkage on setting _ 24(low) _
MECHANICAL
PROPERTIES
Elastic modulus(Mpa) 588 1820 _
Compressive strength 138 128 71
Diametral tensile _ 24 _
strength

Flexural strength _ 46 _

Dentin Shear bond _ 5.8 _

BIOLOGIC
PROPERTIES
Biocompatability [Acceptable] [Acceptable] [Acceptable]
 CAVITY BASES
 Thicker dimensions beneath permanent restorations
 Mechanical, chemical and thermal protection of the pulp
 Substitute for lost dentin.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

ZINC PHOSPHATE CEMENT:
-Base under metallic restorations
-Superior physical properties
-Excellent thermal insulation
-Not adhesive to dentin
-Not recommended under tooth colored restorations

MODE OF SUPPLY:
-Powder and liquid system,
-Capsules of preproportioned powder and liquid.
-Variety of shades are available like yellow,
golden brown, grey, pink and white

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 COMPOSITION:
POWDER
Zinc oxide 90.2%- principal constituent
Magnesium oxide 8.2%- aids in sintering
Other oxides like bismuth or barium oxides 0.2%- improves smoothness of mix
Silica 1.4% - filler; aids in sintering.

LIQUID

Phosphoric acid 38.2%-reacts with zinc oxide

Water 36.0%- controls rate of reaction
Aluminium phosphate or zinc phosphate 16.2%- buffers, to reduce rate of reaction.
Aluminium 2.5%.need for the cement forming reaction.
Zinc 7.1%

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 SETTING REACTION:
-When the powder is mixed with the liquid, the phosphoric
acid attacks the surface of the particles, dissolving the zinc
oxide forming acid zinc phosphate.
- The aluminium of the liquid is essential for cement
formation.
-The aluminium complexes with the phosphoric acid to form
a zinc aluminophosphate gel.
-The reaction is acid- base and also exothermic.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 The set cement is cored structure consisting primarily of unreacted
zinc oxide particles embedded in a cohesive amorphous matrix of
zinc alumino phosphate

SETTING TIME: 5 to 9 minutes.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 ZINC POLYCARBOXYLATE CEMENT:
• with potential for adhesion to tooth structure.
• Application: as bases and liners.
• Available as:
a)powder and liquid in bottles.
b)water settable cements.
c)precapsulated powder/liquid system

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 COMPOSITION:
POWDER
Zinc oxide 90%wt. basic ingredient
Magnesium oxide 8.2%wt. principal modifier and also aids
in sintering.
Oxide of bismuth and aluminium Small amounts
Stannous fluoride Increases strength, modifies setting time
and imparts anti-cariogenic properties.

LIQUID
Aqueous solution of ployacrylic acid or 32 – 42%
Copolymer of acrylic acid with other
unsaturated carboxylic acids, i.e.
iticonic, maleic, or tricarboxyllic acid.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 SETTING REACTION:

When the powder and liquid are mixed, the surface of powder
particles are attacked by the acid, releasing zinc, magnesium and
tin ions. These ions bind to the polymer chain via the carboxyl
groups. They also react with carboxyl groups of adjacent polyacid
chains to form cross-linked salts. The structure of set cement
consist of an amorphous gel matrix of zincpolyacrylate in which
unreacted powder particles are dispersed.

SETTING TIME: 7 to 9 minutes

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 RESIN MODIFIED GLASS IONOMER CEMENT:

• An effort to improve the physical properties of conventional glass

ionomer cement.

• Some polymerizable functional groups have been added to the

GIC to impart an additional curing processes that can overcome
the inherent drawbacks.(moisture sensitivity & low early strength)

• It is probably best described as glass ionomer to which resin has

been added.

• An acid-base reaction, similar to conventional GIC.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 SUPPLIED AS:
-Chemically cured
-Light cured
-Dual cured (all are usually
supplied as powder and liquid)

COMPOSITION

POWDER LIQUID

Ion leachable glass Polyacrylic acid, water

Photo initiators or chemical initiators or both Methacrylate monomer

Polymerizable resin Hydroxyethyl methacrylate monomers

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 Properties RMGIC GIC
Compressive strength 105Mpa 150Mpa
Tensile strength 20Mpa 6.6Mpa
Adhesion Similar to GIC Chemical
Microleakage Greater than GIC High solubility
Anticariogenic Significant Significant
Pulpal response Mild similar to GIC mild
Esthetics Less translucent Lack translucent and
rough surface texture

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 SETTING REACTION:

-The initial setting reaction of the material occurs by

polymerization of methacrylate groups. The slow acid base reaction
will ultimately be responsible for maturing process and the final
strength . The overall water content is less for this type of materials.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 -Excellent bases and liners, they are multifunctional because can
adhere both tooth and resin

-Seal the tooth and provide a strong

antibacterial action

-Don’t induce sensitivity

-Easiest materials to place

-Prevent bacterial microleakage and

pulp injury from inflammatory activity

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 COMPOMER:
 Indications:
I) One paste system
- Restorative for low stress bearing areas
- class III & class V cavities
- used as a base under composite restoration

II) 2 component system

- Cementation of prosthesis

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 PROPERTIES:
• Compressive strength – 100 MPa
• Elastic modulus – 3.6 GPa
• Bond strength – 11-24 MPa
• Solubility – low
• Setting time – 3 min
• Fluoride release – less compared to GIC

Composition:
A)One paste system
- silicate glass particles
- sodium fluoride
- polyacid modified monomer without water
Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition
 B)2 component material
Powder
• strontium aluminium fluorosilicate

• metallic oxides

• chemical or light activated initiator

Liquid
• polymerizable methacrylate/carboxylic acid monomers

• multifunctional acrylate monomers

• water

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 LIGHT ACTIVATED CALCIUM HYDROXIDE:
-Light activated cements consists of calcium
hydroxide and barium sulphate dispersed in a urethane
dimethacrylate resin.
-It also contains HEMA and polymerization
activators.
-It has long working time and is less brittle than the
conventional two paste system
-Potential disadvantage: when used as a base beneath
composite restoration, subsequent withdrawal from the
base of the cavity during polymerization.

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition

 Zinc phosphate Polycarboxylat Glass-Ionomer Resin modified
e GIC
PHYSICAL
PROPERTIES

Thermal Insulator Insulator Insulator Insulator

Electrical Insulator Insulator Insulator Insulator
LCTE(ppm/0C) Low Low 10(Low) Low
CHEMICAL
PROPERTIES

0.10(low) low 0.70(low) 0.2(low)

Solubility(%in
water)
MECHANICAL
PROPERTIES

Compressive 77 100 120 200

strength
Diametral _ 17 _ 35
tensile
strength
BIOLOGIC
PROPERTIES

[Acceptable] [Acceptable] [Acceptable]

Safety [Acceptable]
Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 Restoration Shallow Moderately Deep cavity
cavity deep (RDT
(RDT >2mm) cavity(RDT 0.5 <0.5mm)
-2)
Amalgam Varnish/dentin Base / Sealer Calcium
bonding agent hydroxide liner
and
base/Sealer
Composite Dentin bonding Dentin bonding Ca(OH)2liner
agent agent and dentin
bonding agents
Cast gold Luting cement Base and luting Ca(OH)2liner,
inlay and cement base and
onlay luting cement
Ceramic, fiber Dentin bonding Dentin bonding Ca(OH)2liner,
reinforced agent and resin agent and resin GIC
prosthesis; cement cement base,Dentin
bonding agent
and resin
cement
Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and Science of Operative dentistry,Fifth edition
 PULP CAPPING
DIRECT PULP CAPPING:

-Indicated when there is a small mechanical exposure of the pulp due to

caries, trauma or during operative procedures.

-Materials of choice – Calcium hydroxide and Mineral Trioxide Aggregate

-AIM is to form a calcific bridge.

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 • Calcium hydroxide – gold standard

• MTA – showing superiority to CaOH

• Zinc oxide eugenol – Cytotoxic, chronic inflammation

and a lack of

• dentin bridging and pulpal healing 12 weeks after pulp

capping.

• GIC/RMGIC – similar

• Adhesive systems – similar, poor bonding, heat from

light cure

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 PULP CAPPING
INDIRECT PULP CAPPING:
-Radiographic evidence of caries close to the pulp. Pulp exposure should
be avoided.
-Materials of choice – Calcium hydroxide lined by glass ionomer cement

James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative dentistry-a contemporary approach
 CONCLUSION
No artificial material placed into a tooth provides
better protection for the pulp than dentin, which has
excellent buffering capacity to neutralize the effect of
cariogenic acid.
Preserving sound dentin and taking steps for
conserving and protecting freshly cut dentin (IDS)
could aid in pulp protection.
 Alternative use of natural substance to reduce the
cytotoxic effects on pulp.
“THE RESPECT THE OPERATOR SHOWS
FOR THE DENTIN IS DIRECTLY
REFLECTED IN THE HEALTH OF THE
PULP”
- MANLEY
 REFERENCES
James B Summit, J.William Robbins, Richard S. Schwartz;Fundamentals of Operative
dentistry-A contemporary approach,2nd edition

D.H. Pashley , Department of Oral Biology, School of Dentistry, Medical College of

Georgia, Augusta, Georgia 30912-1129, USA; Dynamics of the pulpo dentin complex;
Critical Reviews in Oral Biology & Medicine

Theodore m. Roberson, Harald 0. Heymann, Edward j. Swift ; Sturdevant’s Art and

Science of Operative dentistry,Fifth edition

Marzouk M.A,,SimontonA.L,Gross R.D:Operative dentistry-morden theory and practice

1st indian edition- All India Publisher and Distributors,Regd,1997

Kenneth J.Anusavice, Philips’ Science of DENTAL MATERIALS ,Eleventh Edition.

Ronald L.Sakaguchi. John M.Powers,Craig’s Restorative Dental materials, Thirteenth

Edition.
 REFERENCES
Samartzi TK, Papalexopoulos D, Sarafianou A, Kourtis S. Immediate Dentin Sealing: A
Literature Review. Clin Cosmet Investig Dent. 2021 Jun 21;13:233-256.

Torres. Modern Operative Dentistry. Springer International Publishing; 2020.

AkarshBolenwar, Aditya Patel, Anjali G Bhoyar, Recent advances in pulp capping

materials, J Res Med Dent Sci, 2022,10 (7): 092-097.

Kunert M, Lukomska-Szymanska M. Bio-Inductive Materials in Direct and Indirect

Pulp Capping—A Review Article. Materials. 2020 Mar 7;13(5):1204.

Harshinee Chandrasekhar et al /J. Pharm. Sci. & Res. Vol. 8(11), 2016, 1308-1311

Chandak MS, Chandak M, Nikhade PP, et al. Role of liners in restorative dentistry. J.
Evolution Med. Dent. Sci. 2020;9(25):1881- 1886,

Myrna M. Elwaseef. Pulp capping materials. Biomat. J., 1 (5),19 – 27 (2022).