Pulpal Considerations Liners & Bases Dr.

Ghada Maghaireh

Liners and Bases Liners and bases are materials placed between the dentin (and some time pulp) and the restoration to provide pulpal protection. Causes of Pulpal Inflammation Pulpal invasion by bacteria & their toxins. Reaction to dental material. Instrumentation techniques (rotary instruments in high and low speed handpieces). - Adequate air/water spray coolant - Light pressure during preparation.

Remaining Dentin Thickness The remaining dentinal thickness, from the depth of the cavity preparation to the pulp, is the single most important factor in protecting the pulp from insult. Little if any Pulpal reaction occurs when there is a remaining dentinal thickness of 2 mm or more. Conservation of tooth structure is more important than the replacement of lost tooth structure with a cavity liner or base.

Cavity Sealers Cavity sealers provide a protective coating to the walls of a prepared cavity and a barrier to leakage at the interface of the of the restorative material and the walls. a. Varnishes. b. Resin bonding systems.

Varnishes It is a natural gum like copal varnish or a synthetic resin that dissolved in an organic solvent that evaporates leaving behind a protective film. Varnishes film is very thin (2 to 5 m). Copal varnishes have been used for many years under amalgam restorations. Use of varnishes has decrease considerably in the late 1990s.

Adhesive Sealers Adhesive bonding systems for resin composite restorations are well documented. There are some concerns about the use of adhesive resins under amalgam restorations. Cavity Liners Cavity liner thickness is usually less than 0.5 mm. Liners are usually applied only to dentin cavity walls that are near the pulp (i.e. pulpal or axial walls). Liners are used more with metallic restorations (e.g. amalgam and cast gold). Liners under resin composite restorations are used only if the tooth preparation is extremely close to the pulp. Calcium hydroxide liners. Glass inomer liners. Calcium Hydroxide Liners Calcium hydroxide [Ca(OH)2] has long been used as a liner because of its pulpal compatibility and ability to stimulate reparative dentin with direct pulp contact. Calcium hydroxide has antibacreterial action. Conventional calcium hydroxide liners have poor physical properties (High solubility and brittleness). Its use is restricted to application over known or suspected pulp exposure (direct pulp capping).

Glass Inomer Liners Chemical bond to tooth structure. Fluoride release. Initial low pH. Conventional Vs resin-Modified glass inomer liners (vitrebond). Resin-modified glass inomer liners are more desirable for use with resin composite restorations. Cavity Bases Typically 1 to 2 mm. Cavity bases are used as dentin replacement material. They are used for bulk build ups and to block undercuts for indirect restorations. Zink oxide-Eugenol and Zink Phosphate cements has dimensioned in recent years. Glass inomer bases.

Guidelines for Basing, Lining, and Sealing Do not remove sound tooth structure to provide space for a base. Use bases as indicated for build-up materials and block-out for cemented indirect restorations. Use the minimum thickness of liner necessary to achieve the desired results.

References: Chapter #5 of the Fundamentals of Operative Dentistry