PULPAL

CONSIDERATIONS
LINERS & BASES
Today we are gonna talk about liners and bases there definitions , where we use them , why we use them , and the guide lines . So what is the liner and what is the base ?? They are materials placed between the dentin ( or the pulp sometimes ) and the restoration to provide pulpal protection .. it will be on the pulpal or axial wall ( toward the pulp ) bcz we use it to protect the pulp

Some times we put liners or bases directly on the pulp >> u will take them later on Why do we need to do pulpal protection ?? Bcz there are a lot of irritants to the pulp when we do cavity preparation we open the enamel but it's not porous as dentin so when we reach the dentin , the dentinal tubule will opened and the dentin communicate to the pulp and as much as we go farther in the dentine we become closer to the pulp and the diameter of the dentinal tubule increase so the irritation can go directly to the pulp .. so that's why we need to but a liner or a base to protect the pulp What are the irritants ?? 1) Bacteria and its' toxins from caries >> so we do cavity preparation to remove the caries and bacteria 2) Action of dental materials >> some times can cause irritation by producing some products and if a gap remain between the restorative material and the dentin that will allow for bacteria and its' products to go inside the dentinal tubule and even the pressure it self from the materials can cause moving of water

inside the dentinal tubules and cause irritation , pain and sensitivity to the patient 3) The instrumentation technique >> when we use a rotary instrument either high speed or slow speed the rotary instruments will produce evaporation will produce heat and this also may cause irritation to the pulp so we should make a work efforts to minimize this irritation by using light pressure when we preparing the cavity , do not make the cavity in one time u must work and stop then continue and always use water coolant specially with the high speed >> NEVER EVER use a high speed hand piece without water coolant Remaining dentin thickness : it's the dentin remain between the floor of the cavity and the pulp >> and it's the most effective protector and insulator to the pulp from any irritation So we use the liners or bases as a second choice >> so if we can conserve the dentin we never remove it

Now we can classify the liners and bases into three categories : cavity sealers , cavity liners and cavity bases Cavity sealers , cavity liners and cavity bases ..

SEALERS
Cavity

sealers : provide protective coating to the wall of the prepared cavity , it is like a nail polish It is a natural gum like cobalt varnish >> It is usually solute in a volatile solvent ( like alcohol ) >> so when we apply it the volatile material will evaporate and leaving the material inside the dentinal tubules
They

divided into varnishes and resin bonding system ( adhesive sealers )

The

main difference between them is that the sealers is like the sealant to the dentinal tubule from here came its' name it occlude the dentinal tubule ( decrease the sensitivity which come from the micro gap ) and the liner is thicker than the sealer it's about 0.5 mm and when we come to the base it is thicker than the liner 2-3 mm

 Sealers

very thin ( 2-5 micron ) we almost can't see them bcz it is usually goes into the dentinal tubule and block them
Nowadays

they found that the varnish has minimal effect not as much as they were thought >> so we don't use it usually
Resin

bonding system ( adhesive sealers ) >> the bonding agent which we use it now in the lab ( it will go into the dentinal tubule and block it ) >> we use it usually And now they are talking about bonding under amalgam as a kind of sealers >> but it doesn't have a remarkable success

LINERS
Liner

: is a thicker material and it's max thickness is 0.5 mm and we apply it on the dentin to protect the pulp
Liners

usually applied on the cavity wall which near the pulp ( pulpal or axial walls )
When

u will do natural tooth exercise in the lab not necessary to have class1 it's maybe class2 or class5 , so after remove the caries u will put a liner on the dentin , where u will put

the liner ?? if u did class1 u will put it on the pulpal floor .. if class2 u should put it on the pulpal floor and the axial walls and if it class5 u will put it on the axial again .. why ?? bcz these walls close to the pulp and the aim of the liner is protecting the pulp Liners are used with amalgam and cast gold >> so when the depth of the cavity more than the optimum thickness of amalgam ( 1.5-2.0 mm ) then we put the liner then we put the amalgam in a thickness of 1.5-2.0 mm .. we can't put a liner and leave a thickness less than 1.5 mm to the amalgam
The

insulting nature of esthetic restorative materials and the sealing effect of the bonding agent preclude the need for liners or bases unless the cavity preparation is extremely close to the pulp NOTE > in composite >> I put a liner then acid etch then put the bonding .. >> we never etch then put the bonding then put the liner ( and that's what some students in the 3rd or 4th year do )
Do

u remember what the name of the resin modified glass inomer liner ??

1) it's the veterbond >> we use it usually under composite I do not use the conventional glass inomer why ? bcz the modified GI liner can be acid etched .. 2) it comes as powder and liquid 1:1 ratio and it needs light to cure and I ( the Dr ) use it widely
liners

could be :

1) Calcium hydroxide liner >> based on calcium hydroxide

More

used as a liner bcz a) Has antibacterial action (high pH ) b) its' pulpal compatibility c) stimulate the dentin formation so even u put it in direct contact to the pulp it can stimulate formation of reparative dentin ( tertiary dentin )
The

conventional calcium hydroxide ( which u will use in the lab ) come into two pasts base and catalyst 1:1 ratio and it's chemically set so u should work with it quickly It is high soluble >> so that it's very important to do not put it on the cavity walls bcz in the oral environment it's soluble it will leave a gap between the tooth and the restoration >> accumulation of bacteria and debris >> sensitivity and recurrent dentin

now we use it in direct pulp capping more than as a liner under restoration 2) GI liners >> we said in the pre lec that one use of the GI is as a liner

BASES
Thicker They

than liners ( 1-2 mm )

thought that we can use bases as dentin replacement material >> but actually it is not >> in the past >> they prepare class1 cavity for example and it's 3 mm thickness they put 1.5 mm base and 1.5 mm amalgam >> now we don't do that we put a liner for ex and fill the 2.5 mm depth by amalgam
Now

we use the base usually in indirect restoration when we have under cuts
Now we don't use the bases in operative dentistry usually

Main

cavity bases are : ZOE , zinc phosphate cement and GI base ( conventional or resin modified
Now

the guide lines :

1) do not remove sound dentin to provide a space for a base > they where do that

2) use bases is indicated as build up material and in indirect restoration 3) put a minimal thickness of a liner to achieve good results

Done By ::: HaNaa JadAllah