Podcast
Questions and Answers
What are the five materials that can be used to protect a tooth during a preparation?
What are the five materials that can be used to protect a tooth during a preparation?
Liner, Varnish, Desensitizer, Base, Bonding agent
What are two ways that decay can progress?
What are two ways that decay can progress?
Through the enamel and into the dentin. Through the dentin and into the pulp.
What are the four types of stimulus that can cause pulpal responses?
What are the four types of stimulus that can cause pulpal responses?
Physical, Mechanical, Chemical, Biologic
What does a dental liner do?
What does a dental liner do?
Liners are materials that are laid down in a thin layer of
Liners are materials that are laid down in a thin layer of
Liners are strong materials that can be placed in thick amounts.
Liners are strong materials that can be placed in thick amounts.
Calcium hydroxide is only available in a light-cured form.
Calcium hydroxide is only available in a light-cured form.
Dycal is a type of zinc phosphate.
Dycal is a type of zinc phosphate.
What are the indications for use of calcium hydroxide?
What are the indications for use of calcium hydroxide?
What are the advantages and disadvantages of calcium hydroxide?
What are the advantages and disadvantages of calcium hydroxide?
Explain how to prepare a calcium hydroxide mixture from two pastes.
Explain how to prepare a calcium hydroxide mixture from two pastes.
Where should a dental liner be placed?
Where should a dental liner be placed?
What does cavity varnish do?
What does cavity varnish do?
Cavity varnish should be applied before a liner.
Cavity varnish should be applied before a liner.
What is the application process for cavity varnish?
What is the application process for cavity varnish?
What does a desensitizer do?
What does a desensitizer do?
Desensitizers can be used instead of a varnish.
Desensitizers can be used instead of a varnish.
What are the three types of dental bases?
What are the three types of dental bases?
What does a protective base do?
What does a protective base do?
What does an insulating base do?
What does an insulating base do?
What does a sedative base do?
What does a sedative base do?
What are the three major classifications of dental cements?
What are the three major classifications of dental cements?
What is a luting agent?
What is a luting agent?
What properties are required for a good luting agent?
What properties are required for a good luting agent?
When are temporary cements used?
When are temporary cements used?
A good luting cement should be mixed until it becomes an extremely viscous consistency
A good luting cement should be mixed until it becomes an extremely viscous consistency
A permanent cement is used in the placement of provisional coverage
A permanent cement is used in the placement of provisional coverage
Why is it important to use a fulcrum when removing cement?
Why is it important to use a fulcrum when removing cement?
Why should a base for a temporary restorative be thick and putty-like?
Why should a base for a temporary restorative be thick and putty-like?
What are some of the main variables that can affect cementation?
What are some of the main variables that can affect cementation?
What is the main ingredient in zinc-oxide eugenol (ZOE)?
What is the main ingredient in zinc-oxide eugenol (ZOE)?
ZOE is considered to be more acidic than most other cements.
ZOE is considered to be more acidic than most other cements.
ZOE can be used under all types of restorations.
ZOE can be used under all types of restorations.
What are the three types of ZOE cements?
What are the three types of ZOE cements?
What kind of ZOE cement is used for short-term restorations, sedative dressing or insulating/sedative base?
What kind of ZOE cement is used for short-term restorations, sedative dressing or insulating/sedative base?
ZOE cements are always supplied as a liquid and a powder.
ZOE cements are always supplied as a liquid and a powder.
Why are IRM cements used?
Why are IRM cements used?
What are the main two components in zinc phosphate cements?
What are the main two components in zinc phosphate cements?
Zinc phosphate cements are always supplied as a powder and a liquid.
Zinc phosphate cements are always supplied as a powder and a liquid.
Why is it important to use a cold, dry, thick slab to spatulate zinc phosphate cements?
Why is it important to use a cold, dry, thick slab to spatulate zinc phosphate cements?
A dental liner or desensitizer should be placed on top of zinc phosphate
A dental liner or desensitizer should be placed on top of zinc phosphate
What type of zinc phosphate cement is recommended for deep cavity preparations?
What type of zinc phosphate cement is recommended for deep cavity preparations?
What are polycarboxylate cements mainly composed of?
What are polycarboxylate cements mainly composed of?
What are the advantages and disadvantages of polycarboxylate cements?
What are the advantages and disadvantages of polycarboxylate cements?
In what situations are polycarboxylate cements used?
In what situations are polycarboxylate cements used?
Polycarboxylate cement is supplied as a two-paste system.
Polycarboxylate cement is supplied as a two-paste system.
Glass ionomer cements are discussed in this lesson
Glass ionomer cements are discussed in this lesson
Composite resins will be discussed in this lesson
Composite resins will be discussed in this lesson
Powders should be dispensed before liquids
Powders should be dispensed before liquids
You should touch the bottle to the slab before dispensing liquid
You should touch the bottle to the slab before dispensing liquid
Zinc Oxide Eugenol (ZOE) cements can be used as an insulating and sedative base
Zinc Oxide Eugenol (ZOE) cements can be used as an insulating and sedative base
What type of cement is a good choice for thermal insulation, but needs to be placed over a liner because it is slightly irritating to the pulp?
What type of cement is a good choice for thermal insulation, but needs to be placed over a liner because it is slightly irritating to the pulp?
Why is polycaroxyate a good option for cementing restorations?
Why is polycaroxyate a good option for cementing restorations?
Why is glass ionomer a good option for deep restorations?
Why is glass ionomer a good option for deep restorations?
Flashcards
Dental Liners
Dental Liners
Thin layers (less than 0.5mm) of material placed in the deepest part of a tooth preparation to protect the pulp from irritants.
Dental Bases
Dental Bases
Material placed in deep preparations to protect the tooth from thermal shock or to provide pulpal protection.
Calcium Hydroxide
Calcium Hydroxide
A common dental liner that protects the pulp and stimulates the production of new dentin. Available in light and self-curing forms.
Cavity Varnish
Cavity Varnish
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Desensitizer/Primer
Desensitizer/Primer
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Pulpal Responses
Pulpal Responses
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Cavity Preparation
Cavity Preparation
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Liner Application
Liner Application
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Varnish Application
Varnish Application
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Desensitizer Application
Desensitizer Application
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Protective Base
Protective Base
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Insulating Base
Insulating Base
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Sedative Base
Sedative Base
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Physical Stimulus
Physical Stimulus
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Mechanical Stimulus
Mechanical Stimulus
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Chemical Stimulus
Chemical Stimulus
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Biologic Stimulus
Biologic Stimulus
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Pulp Protection
Pulp Protection
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Micro leakage
Micro leakage
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Study Notes
Dental Cements
- Dental cements are supplementary materials used in restorative and esthetic procedures to maintain tooth health.
- Different types of cements are used based on the depth of the tooth preparation.
- Common types include liners, varnishes, desensitizers, bases, and bonding agents.
Pulpal Responses
- If decay reaches the dentin, patients may experience sensitivity and discomfort after restoration.
- The dentist might decide to add additional materials to address pulpal responses, providing medication and protection.
Tooth Cross-Section with Decay
- Displays tooth structure with decay, highlighting smooth surface cavity, pit and fissure cavity, and root cavity.
Bitewing X-Ray
- Shows various stages of dental caries (decay) in a bitewing X-ray.
Cavity Preparation (Prep)
- Cavity preparation involves removing decaying parts and shaping the tooth for restoring it.
Pulpal Responses - Stimuli
- Types of Stimuli: Physical, Mechanical, Chemical, Biological
- Examples of Stimuli: Thermal, Electrical, Handpiece, Occlusion, Acid from dental materials, Bacteria from saliva or caries
Dental (Cavity) Liners
- Liners are applied to the deepest part of the dental preparation.
- They seal the exposed surfaces and dentinal tubules of the tooth to prevent irritation
- Protect the pulpal tissues from physical, mechanical, chemical, and biological elements.
- Regenerate reparative or secondary dentin production.
Liners
- Thin-layered materials (less than 0.5 mm).
- Protect the pulp from chemical irritation.
- Not strong enough to resist condensation when placed in thick layers.
- Compatible with all restorative materials.
Calcium Hydroxide
- Available in light-cured and self-curing forms.
- Used as a pulp protector when pulp exposure is anticipated.
- Placed beneath any restorative material.
- Considered as a very soluble material.
Indications for Use - Liners
- Protect the pulp from chemical irritation.
- Stimulate production of reparative or secondary dentin.
- Are compatible with all types of restorative materials.
Liners - Advantages and Disadvantages
- Advantage: Biocompatibility and ability to stimulate reparative dentin.
- Disadvantages: Low compressive strength and very soluble.
Calcium Hydroxide (Dycal) - Preparation
- Usually comes in a two-paste system (base and catalyst).
- Equal amounts of base and catalyst are dispensed.
- Mixed in a circular motion until uniform in color.
- Mixing time: 10-15 seconds.
- Setting time: 2-3 minutes.
Liner - Application Process
- Placed only on the deepest dentin surfaces of the preparation.
- Not placed on enamel or in retentive grooves.
Cavity Varnish
- Used to seal dentinal tubules.
- Reduces microleakage around restorations.
- Protects the tooth from acidic cements like zinc phosphate (not to be used under composite resins or glass ionomer restorations).
Cavity Varnish - Application Process
- Applied after the liner and/or insulating base (except for zinc phosphate).
- Thin coating is applied to walls, floor, and margins of the cavity preparation.
- Usually a second coat is applied.
Desensitizer (aka Primer)
- Used to treat or prevent hypersensitivity.
- Alternative to varnish.
- Seals dentinal tubules to prevent oral fluids from entering and causing sensitivity.
- Can be used under all types of restorations.
Desensitizer (Primer) - Application Process
- May contain HEMA and glutaraldehyde (use sparingly).
- Avoid contact with soft tissues.
- Apply with a cotton-tipped applicator.
- Apply over all exposed dentin areas.
Dental Bases
- Provide pulpal protection during restorative procedures.
- Included in specific applications: protective, insulating, or sedative.
Dental Base Types
- Protective base: Protects pulp before restoration, reduces post-operative sensitivity, and minimizes pulp damage.
- Insulating base: Placed in deep preparations to safeguard the tooth from thermal shock.
- Sedative base: Used on pulps affected by decay or during mechanical decay removal to soothe them.
Dental Cements - Classification
- Luting Agents: Adhering material for restorations (temporary/permanent).
- Restorative Material (IRM): Intermediate restoration material.
- Liners & Bases: Materials to protect the pulp.
Dental Cements - Uses
- Permanent, intermediate, and temporary restorations.
- Luting agents for indirect restorations and orthodontic bands.
- Thermal insulators under metallic restorations (bases).
- Pulp capping agents and cavity liners.
- Root canal sealants.
- Periodontal packs.
Luting Agent
- Adhesive to hold castings to tooth structure.
- Intended for temporary or permanent cementation.
Luting Agent Consistency
- Permanent cements: Long-term cementation of cast restorations, similar to syrup consistency.
- Temporary cements: Used when removal is anticipated, similar to syrup consistency.
- Luting mix should string up then break approximately 1 inch from the slab.
Cementation
- Permanent cement: Long-term cementation of inlays, onlays, crowns, bridges, laminate veneers, and orthodontic appliances.
- Temporary cement: Used for provisional coverage.
Cement Removal
- Requires proper operator preparedness and knowledge of selected instruments (explorer, mouth mirror, scaler).
- Uses a fulcrum (finger rest).
- Floss used in embrasure areas.
Base/Temporary Restoration Consistency
- Should be thick and putty-like, with a slightly tacky texture that can be rolled into a ball, similar to playdough.
Variables Affecting Cementation
- Mixing time
- Humidity
- Powder-to-liquid ratio
- Temperature
Types of Cements
- Zinc-oxide eugenol (ZOE)
- Zinc phosphate
- Polycarboxylate
- Glass ionomer
- Composite resin
Zinc-oxide Eugenol (ZOE)
- Contains eugenol (soothing effect on the pulp).
- Neutral pH (less acidic than other cements).
- Strong smell, potentially irritating to oral mucosa (eugenol allergy possible).
- Not used under composite resins, glass ionomers, or other resin restorations (eugenol affects resin setting).
- ZOE Type I: Temporary cementation.
- ZOE Type II: Permanent cementation of cast restorations.
- ZOE Type III: Used for short-term restorations, or as a sedative dressing/insulating/sedative base.
Zinc-Oxide Eugenol (ZOE) - Mixing
- Liquid/Powder (e.g., IRM): Mixed on oil-resistant paper pad; mixing time 30-60 seconds, setting time 3-5 minutes in the mouth.
- Paste (e.g., TempBond): Two-paste system as a temporary cement; pastes are dispensed on an oil-resistant paper pad and mixed.
ZOE Type I (TempBond)
- Temporary cement.
- Zinc oxide eugenol base for provisional crown and bridge cementation.
ZOE Type III (IRM)
- Short-term restoration, primarily for primary teeth emergencies or caries management.
Intermediate Restorations
- Reduce sensitivity and discomfort in teeth.
- Preserve tooth function and esthetics until permanent restoration is placed.
- Protect preparation margins and prevent shifting of adjacent/ opposing teeth due to open spaces.
- Durable for up to 6 months.
Zinc Phosphate
- Zinc oxide and phosphoric acid.
- Phosphoric acid can irritate the pulp. A liner or desensitizer is needed beneath.
- Supplied in powder and liquid form.
Zinc Phosphate- Preparation
- Cement is slowly mixed over a large, cool, dry, thick glass slab to dissipate the heat.
- Ensure the slab is dry.
- The powder is added in small increments.
- Mixing is done until a 1-1.5 inch string forms when the spatula is lifted from the mix.
- Mixing time is 1.5-2 minutes.
Zinc Phosphate- Types
- Type I: (Fine grain) - Used in permanent cementation of casts.
- Type II: (Medium grain) - Recommended for insulating base in deep cavity preparations.
Polycarboxylate
- Not as strong as zinc phosphate but less irritating to pulp.
- Commonly found in powder and liquid form.
- Zinc oxide (powder) and polyacrylic acid (liquid).
Polycarboxylate - Use
- Permanent cement for cast restorations (stainless steel crowns & orthodontic bands).
- Nonirritating liner for composite or amalgam restorations.
- Intermediate restorative restoration
Polycarboxylate - Supplies
- Liquid can be measured using a squeeze bottle or calibrated syringe.
- Shelf life is limited due to liquid thickening through water evaporation.
- Mixed on a non-absorbent paper pad.
Other Cements
- Glass ionomer cement
- Composite resin
Dispensing Powders
- Condense powders before dispensing by tapping containers.
- For fluffed powders, gently invert the container several times.
- Immediately replace container caps after dispensing.
- Always dispense powders before liquids.
Dispensing Liquids
- Do not invert droppers.
- Avoid touching bottles to the slab before drop is dispensed.
- Immediately place bottle caps on bottles after dispensing.
- Dispense liquids after powders to prevent evaporation.
Summary of Base Materials
- Zinc Oxide Eugenol (ZOE): Insulating and sedative base.
- Zinc Phosphate: Excellent thermal insulation but can irritate pulp. Place over a liner.
- Polycarboxylate: Protective and insulating, nonirritating to pulp. Usable beneath direct and indirect restorations.
- Glass Ionomer: Fluoride release, good for deep preparations.
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