LINERS & BASES

Materials placed between the dentine and sometimes pulp and the restoration that provides pulp protection. When we excavate caries, we remove part of the enamel and dentine; sometimes we need to put a material before we place the restoration over the remaining part of dentine. Sometimes we reach the pulp, but we dont do endodontic treatment in some cases, you will know later on the indications in the fourth year. Even if we reach the pulp a little bit or we are very close to the pulp , you protect the pulp we use a material right? Some restorative materials that we use for restoration release some irritants. To cover the pulp or remaining dentine therefore we use Liners or Base. This is an example (refer to the slides) a tooth section, have remaining dentine after we prepare the teeth, and there is composite, the materials placed between the composite and remaining dentine is liners.

CAUSES OF PULPAL INFLAMMATION?

Pulpal invasion by bacteria and endotoxin. If you remember we mentioned once in the amalgam lecture that amalgam is the only material that can cause closing of microleakage between restoration and tooth. After we prepare the cavity preparation and place the restoration there will be a microgap between them.

!: Microgap cannot be seen by naked eye.

This microgap can be invaded by bacteria. This can reach the pulp and cause irritation and inflammation to it.

Reaction of dental material. As I said, dental materials may have irritants the go through the dentinal tubules to the pulp. Everytime we make the dentine smaller, the protection to the pulp will be less, so invasion of dental material is easier to get to the pulp. So use of liners and base is more important if the dentine is closer to the pulp. Instrumentation may cause pulp traumatic irritation, also by heat. inflammation by

We always say that we have to use a water coolant with the high speed hand piece to prevent it from sending heat to the pulp, and sometimes if we dont use a water coolant with the high speed hand piece the heat will cause pulp necrosis and pulpal death. Therefore root canal treatment will be needed. Pressure during preparation and continuous hard brush of the tooth create pressure of the tooth. We need to stop every once in a while (intermittent pressure) to protect the pulp especially with diamond bur. In operative dentistry we have carbide bur another type of burs is diamond bur which cause more irritation than carbide bur

MINIMAL DENTINE THICKNESS

Do you remember the photo we just saw? (Refer to the slides sorry L) this dentine thats between the pulp and the restoration is called the remaining dentinal thickness. The remaining dentinal thickness is the best protector for the pulp, by keep a hard remaining dentinal thickness, minimum of 2mm of dentine is enough to provide protection of the pulp. We wont need any type of liner or base.

But sometimes we cant because we have to remove excess dentine due to lesion or caries; therefore we will use another type of protection to the pulp. Conservation of structure is more important than having lost tooth structure with cavity liners or base. So I cant just take a lot of tooth structure and say its ok I will use a liner or a base! (little if any pulpal reaction occurs when there is remaining dentine thickness of 2mm and more)

TYPES OF LINERS & BASES

They differ between use and their thickness. There are three of them 1-cavity sealers 2-cavity liners 3-cavity bases Cavity sealers. Provide a protective coat to the walls of a prepared cavity. Its a very thin layer, It seals the dentinal tubules, or block them to protect the pulp. Two types of sealers:

Resin we use it for composite, its a sealer, an adhesive bonding, which blocks tubules. Varnish, its a thin layer over the protective layer of surface of the dentine. Its thinness = 2 5 micrometer There are 2 types of varnishes: 1- Natural varnish: like copal gum 2- Synthetic: resin Varnishes; gum like copal varnish or a synthetic resin that is dissolved in an organic solvent that evaporates leaving behind a protective film, it looks like a nail polish When you apply the varnish over the tooth the solvent

will evaporate leaving the active material (Resin) blocking the tubules. Copal varnishes have been used for many years under amalgam but now its use has decreased in the late 1990s and now we use other types of sealers. Adhesive sealers now are used more than varnishes. Like the ones used in resin composite. Under composite restoration to bind it to enamel and dentin. Sometimes we use it under amalgam restoration. For sealing under amalgam to improve bonding NOT retention.

Cavity liners. Its thickness is less than 0.5 mm, you can see it with naked eye. Applied only to dentin on cavity walls that are near the pulp, pulpal or axial. Meaning we dont put the liner on all the walls.

For example class one; we only put the liner on the pulpal floor. Class two, three, and five on axial walls

Figure (1): Class 5, Class 2, Class 1

Liners are mostly used with metalic resotration in *amalgam *cast gold

Liners under resin composite restorations are used only if the tooth preparation is extremely close to the pulp within 0.5 mm to pulpWe have to types of liners: 1- Calcium hydroxide liners 2- Glass ionomer liners

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vitrebond we use it more now, its a modified glass ionomer used as a liner. Now Calcium hydroxide is used as a liner because of its pulpal compatibility and ability to stimulate reparative dentin with direct pulp contact, its advantages:

Compatibility
Able to stimulate formation of reparative dentine, another name is reactionary dentin it is formed as a result of irritation if you remember from histology tertiary dentine happens as a result from insult.

Antibacterial effect
Now conventional calcium hydroxide, its a two paste, a base and a catalyst, we will use it in the lab this term by the end of it. We will put equal amounts of both and mix them together on a mixing pad. We use it in even thickness, should be less than 0.5 mm on the pulpal or axial wall. Its chemically reactive, so it starts the reaction so fast, so we have to put it before it sets. Disadvantages of conventional calcium hydroxide:

Poor physical properties;

High solubility Brittleness

 Solubility: we shouldnt put it on mesial or distal wall, for

example if we put it on the bucal wall, and then put the restoration. After some time it will melt away. Therefore it will increase the gap between the restoration and the tooth structure.

Under amalgam it might break, because when you condense

amalgam you apply force and it cant stand it.

To overcome these problems now they added resin to calcium hydroxide, which has less brittleness and solubility, but also less anti bacterial effect, so it decreases the biocompatibility of calcium hydroxide. Calcium hydroxide as liner has restricted use, unless in some situations. So when we have pulp exposure we put calcium hydroxide over the pulp in a procedure called direct pulp capping. We can use glass ionomer base as a liner, its used more now. Glass ionomer (vitrebond). Must be light cured, as it is resin modified. Its advantages are:

chemically bonded to tooth structure fluoride release initial low PH

There are 2 types of GI liners : a. Conventional b. Resin modified (vitrebond); which is now more in use. Its advantages for composite restoration, that it can be itched; we can put it, then do etching. So if we want to use liner under composite we can add vitrebond then itch it.

Cavity bases. They are thicker than a liner, 1 2 mm. They are used as dentin replacement material (when bulk of dentin is removed)

They are used for: Bulk build ups for indirect restorations, for example when we are preparing a crown. Block undercuts for indirect restorations as in crowns we make them outside the oral cavity (undercut occurs when taking impression material) then we cement them on tooth so we do not need undercut

Before when we used to have class 1 cavity for example we had 4 mm space, they add 2 mm base instead to dentine and then the rest is for amalgam. But we dont use this now. We only put a thin layer of a liner to protect the pulp then add restoration. There are 2 types of cavity bases: 1- zinc oxide eugenol and zinc phosphate cements, we stopped using them in recent years. 2-glass ionomer is what we use nowadays

GUIDELINES FOR BASING, LINING, SEALING

1- DONT remove sound tooth structure to provide space for a base, because as we said the best insulator is the remaining dentin so you should be as conservative as possible.

2- Use bases as indicated, it is NOT used under direct restorations. Just for build up materials and block out for cemented indirect restorations, so if we have a deep cavity we place a liner then we place the restorative material. 3- Use the minimum thickness of liner necessary to achieve the desired results it must not exceed 0.5mm.

Done by: Nadine AL Homoud