L9

Cement Bases and Liners

Cavity preparation in most situations

involve the dentin which mostly has
: been irritated by
.Caries. 1
.Mechanical process of cavity preparation. 2
.Restorative materials. 3
Ass.Prof.Dr.Mohamed ALsakkaf

After removing the affected tissues and

completion of cavity preparation, it
: is important to
.Try to prevent further irritation. 1
Improve the defense capabilities of
.2
. dentin pulp organ

And this can be accomplished by application

.of intermediary base material
Sound dentin is the best barriers between
.restorative material and pulp
The greater the thickness of overlying dentin
the lesser the irritation reaching Bridge
.the underlying pulp

Conservation of sound dentin during cavity

.preparation well be beneficial
3

The purpose of pulp insulation is to

:protect the pulp against
.Thermal shocks

Chemical constituents from restorative

. material
.Galvanic shocks

.Microleakage of bacteria and debris

Penetration of mercury and other metallic

. ions

.
4

Ideal requirements of base materials

It should have adhesive potential to
tooth structure (marginal sealing
. and adaptation to cavity walls)

.1

.Non-irritant to vital pulp tissues. 2

5

Provide thermal insulation against

. conductive metallic restorations

.3

Reduce galvanic action of metallic

. restorations

.4

Enhance formation of reparative

. dentin

.5
6

It must be strong enough to withstand . 6

condensation forces and future
.masticatory forces
Compatible with overlying restorative . 7
materials and other intermediary
base material (not react with the
material or interfere with its setting
.reaction)
It should resist degradation in oral
.8
.fluids
.Easy to apply. 9
7

These ideal requirements should be

met to provide the protective and
medicating effects on pulp-dentin
.organ
No available material provides all these
properties so; by combining materials
. all ideal requirements can be achieved

.
.
8

Types and Classifications

I Cavity Liners
A-Cavity Varnishes

Organic copal resin or synthetic resin

gum dissolved in solution of ether
. chloroform or acetone

.
9

These solutions evaporate rapidly after

placement on tooth surface, leaving
. a thin semi-permeable membrane
Thickness 5-25 depending on the
: following
.Type of solvent. 1
.No. of applications. 2

.
.

10

Applications
Applied with small cotton placed in
solution (only once to avoid
. contamination of varnish bottle)
Varnish should be kept in tightly bottle
. to prevent evaporation of the solvent

.
.
11

The solvent evaporates leaving small

pits in the film, so 2 or more layers
. are indicated
Remove the excess varnish from external
. tooth surface by using solvents
Varnish is insoluble in the oral fluid, so
. its applied to D + E

.
.
.
12

Uses
Leakage of oral fluids around the margins . 1
. and walls at restoration tooth interface
.Reduce postoperative pain and sensitivity

In case of amalgam. 2
Retard ion migration into dentin wall result
. in tooth discoloration
13

Dental cement. 3

The semi-permeable nature of varnish

film decrease penetration of phosphoric
acid from dental cements (Zn / ph and
.silicate cement) into dentin

14

:Remember
As mentioned varnish applied to E + D
walls including cavosurface margins,
except at enamel, in silicate cement as
it will block the transfer of fluoride
from silicate cement [ main reason
.for selecting this material ]
Contraindicated with G.I as it block
the transfer of fluoride and prevent
.chemical adhesion to tooth structure

.
15

Insoluble in dist.water but not used

with restorative resins because the
. gum dissolve in monomer
Restorative resins containing organic
solvents as tooth colored material,
destroy the integrity of varnish film
.rendering it void of value to be used

.
.

16

B- Cavity Liners
Ca (OH)2 applied in thin coatings and
. must be removed from cavity margins
Ca (OH)2 can neutralize acidity of
. dental cement

.
.
17

Remember

Pt, with recently restored. Complain of

pain and discomfort with cold drinks lasts
.for few seconds (Till takes temp. of mouth)
It lasts for several weeks (not less than 2
and may extend to 2 ms) until the
effective barrier of reparative dentin is
.formed

18

Pain sensation in dentin is the result

of the movement of fluid in d. ts by
capillary attraction or by change of
osmotic pressure (heating or cooling
.of dentin)

19

II Bases
Zinc Phosphate Cement-1
The acidity is quite high at time they are
inserted in tooth (PH 3.5), then PH
rapidly approaching neutrality during
24 48 hrs, any damage occurs to pulp
from Zn / Ph will occur during first
.few hrs, after insertion

20

PH is lower and remains lower for long

. time if thin mixes are employed
The consistency of the cement is related
high
high powder. ( to Liq.P ratio
). thickness of the mix

.
.

21

Z.PH. mixes are Prepared

a. Luting mix (thin mix) for seating inlays
. or crowns
.b. Base mix (viscous mix)

If luting mix is viscous from the start, it

will not permit the flow of the cement
. beneath casting
22

Indications.
Replacement of dentin lost by extensive
.1
:caries to act as
a. Thermal insulating base under metallic
.restoration
.b. Chemical barrier under silicate cements
Aid in mechanical retention of gold and . 2
.porcelain inlays
Formation of temporary cement
.3
.dressing
23

Mixing and insertion

:Mix on a Cool Slap. 1
Reaction between powder and liquid is
.
: exothermic, cool slap to
.a. Absorb the heat of the reaction
b. Permits incorporation of a great amount
. of powder to the desired mix
Leaving the mixed cement on this cool slap
during insertion into the cavity, benefits
.the working time slowing the reaction
24

:Dispense a Correct P / L Ratio. 2

By powder dispenser 1 large and 1
.
small cup of powder are dispensed onto
.the middle of the slap

In upper corner additional 2 large cups

.are dispensed to be used later
P. of initial large cup divided into 6
.equal parts

Liquid (6-7 drops) dispensed to the side

.of the divided portions

.
25

Mix Over a Large Area. 3

By long thin bladed steel spatula the
first 1\6 portion of powder is mixed
with liquid covering at least 1\2 of the
.slap for 15 sec
Each portion is spatulated for another
15 sec till inlay consistency is achieved
(may require 6 portions) total
.spatulation time = 90 sec

.
.
26

:Inlay consistency
when the mass is gathered together and
spatula is laid into it and withdrawn
cement will string up for 1 1 1\2
inches before breaking. Then mix to
.heavy putting like consistency

27

Insertion
To prevent sticking of cement to instrument, .
immerse tapered plugger in the remaining
.dry powder
Inlay consistency is used first for better seal .
+ initial retention. Then the heavy
consistency mix is placed in area requiring
.protection
The cement base is then burnished to place .
. and carved into the desire contour
28

ZPC (when properly mixed), carried

without delay with plastic instrument
.to the cavity
Cavity must be dry but not desiccated by
alcohol, this increase the chance for
phosphoric acid in the cement to be
absorbed into dentin, and this lead to
.pulp irritation
Cavity varnish can be applied before the
cement to minimize acid penetration into
.pulp

29

Minimal pressure is applied to spread

the cement into place-over pulpal +
. axial walls only
Restorative areas + margins of cavity
. must be free from cement
Excess cement is removed by sharp
excavators and floor is smoothed
. carefully with inverted cone bur

.
.
.
30

It has low thermal conductivity, which

means good thermal isolator for pulp
. protection, under metallic fillings
Phosphate cement increases dentin
. permeability due to etching by acids
ZPC is a good base material except for
its irritation qualities related to its
: acid content so

.
.
.
31

Cavity varnish is applied first on the . 1

floor of moderately deep cavities to
. minimize the potential harm
Ca(OH)2 as sub-base under Zn / Ph if . 2
cavity is deep, because the liner will
. neutralize the acidity of the cement
32

Zinc oxide Eugenol Cement 2

Used as temporary filling material to

seal up cavities between visits to bland
. the dentin and pulp
It has the Following Pharmacological
Actions

33

.Antiseptic action. 1
.Anti-inflammatory action. 2
.Counter irritant. 3
.Sedative action. 4
It has a perfect initial seal ability,
so the prevent ingress of saliva,
. bacteria and debris into dentin

.
34

Remember
Through the action of eugenol ring, it
will prevent polymerization and
Harding of resin material, for this case
ZOEC contraindicated as I.B.M if in
.contact with filled or unfilled materials
Capable of blocking the penetration of
. ions from R.M

.
35

When used as temporary material, a

stiff mix is made on the slap in which
small cotton strands are forced into
: the mix for
.a. Reinforcing the mix
.b. Easy handling
The surface is smoothened with
moistened, and occlusal relationship
. are tested and adjusted

.
36

Calcium Hydroxide. 3
Used to cover dentin, forming the floor of
. deep and moderately deep cavities

.
.

The compounds are alkaline in nature, to

enhance secondary dentin formation
over pulp (calcific bridge) that seals off
.the vital tissues against irritation
37

.
It is the material of choice in deep cavities .
.Used as capping agent (direct or indirect)

with subsequent pulp exposure (in this

case, the material must be applied
.without pressure)

Not strong enough to provide reliable

support for a restoration under heavy
.occlousal stresses
38

Strong base of ZPC is used to cover the

. capping material (Ca(OH)2)
.High thermal insulation capacity

.Effective against penetration of acids

:It provided in different forms
.Powder form. 1
.Paste. 2
.Suspension. 3

.
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Polycarboxylate Cement. 4
:Powder
.Zno and some Mgo

It may also contain small amounts of

. Ca(OH)2, fluoride and other salts

.
40

:Liquid
.Solution of polyacrylic acid and co-polymers
More adhesion to tooth structure than any
. other dental cement

Produce minimal pulp irritation, despite

. their initial acidity

.Twice as soluble as Zinc Phosphate cement .

.Tensile strength higher than Zn \ Ph .
41

Glass Ionomer Cement. 5

.Based on polyacrylic acid formulation

.
.

Extension of Zinc polycarboxylate

. cements
Powder
Aluminosilicate glass with fluoride salts
which provide the leached out fluorides
responsible for its anticariogenic
.properties

42

Liquid
Polyacrylic acid which has the potential for
chelation with ca++ in tooth structure
responsible for adhesive properties of the
.cement

43

Uses

Because of its biologic kindness and

. potentials for adherence to Ca of tooth
Used primarily as R.M. for treatment
.1
. of eroded lesions
.Luting agent. 2
Base material (even though the material . 3
is very sensitive to water and a dry
. field is imperative)
44

The powder and liquid are mixed

on a paper pad or glass slap using
.plastic spatula
G.I.C used in sandwich technique
. in treatment of caries

.
.

45