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Questions and Answers

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?

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?

Physical, Mechanical, Chemical, Biologic

What does a dental liner do?

<p>Lines the deepest portion of the dental preparation, Seals the exposed surfaces of the prepared tooth, protects the pulpal tissue from irritation caused by physical, mechanical, chemical and biologic element, and Regenerates production of reparative or secondary dentin.</p> Signup and view all the answers

Liners are materials that are laid down in a thin layer of

<p>less than 0.5 mm (A)</p> Signup and view all the answers

Liners are strong materials that can be placed in thick amounts.

<p>False (B)</p> Signup and view all the answers

Calcium hydroxide is only available in a light-cured form.

<p>False (B)</p> Signup and view all the answers

Dycal is a type of zinc phosphate.

<p>False (B)</p> Signup and view all the answers

What are the indications for use of calcium hydroxide?

<p>Protects the pulp from chemical irritation. Stimulates production of reparative or secondary dentin. Compatible with all types of restorative materials.</p> Signup and view all the answers

What are the advantages and disadvantages of calcium hydroxide?

<p>Advantages: biocompatibility and its ability to stimulate reparative dentin. Disadvantages: has a low compressive strength and is very soluble.</p> Signup and view all the answers

Explain how to prepare a calcium hydroxide mixture from two pastes.

<p>Dispense equal amounts on a paper pad. Mix quickly with a small spatula or ball applicator until uniform in color. Mixing time is 10-15 seconds. Setting time is 2-3 minutes.</p> Signup and view all the answers

Where should a dental liner be placed?

<p>The deepest dentin surface of the preparation</p> Signup and view all the answers

What does cavity varnish do?

<p>Seal the dentinal tubules, reduce microleakage around a restoration, act as barrier to protect tooth from highly acidic cements.</p> Signup and view all the answers

Cavity varnish should be applied before a liner.

<p>False (B)</p> Signup and view all the answers

What is the application process for cavity varnish?

<p>Apply a thin coating of varnish to the walls, floor and margin of the cavity, and then apply a second coat.</p> Signup and view all the answers

What does a desensitizer do?

<p>Treat or prevents hypersensitivity, seals the dentinal tubules to prevent oral fluids from seeping between the tooth and restoration, ideal for use under all restorations.</p> Signup and view all the answers

Desensitizers can be used instead of a varnish.

<p>True (A)</p> Signup and view all the answers

What are the three types of dental bases?

<p>Protective base, Insulating base, Sedative base</p> Signup and view all the answers

What does a protective base do?

<p>Protect the pulp before the restoration is placed, and reduces postoperative sensitivity and damage to the pulp.</p> Signup and view all the answers

What does an insulating base do?

<p>Placed in deep preparations to protect the tooth from thermal shock.</p> Signup and view all the answers

What does a sedative base do?

<p>Soothe a pulp that has been damaged by decay or irritated during the process of removing the decay</p> Signup and view all the answers

What are the three major classifications of dental cements?

<p>Luting agents, Restorative material, Liners &amp; Bases</p> Signup and view all the answers

What is a luting agent?

<p>A material that acts as an adhesive to hold together a casting to the tooth structure</p> Signup and view all the answers

What properties are required for a good luting agent?

<p>All of the above (E)</p> Signup and view all the answers

When are temporary cements used?

<p>When the dentist needs to remove a restoration at a later time (D)</p> Signup and view all the answers

A good luting cement should be mixed until it becomes an extremely viscous consistency

<p>False (B)</p> Signup and view all the answers

A permanent cement is used in the placement of provisional coverage

<p>False (B)</p> Signup and view all the answers

Why is it important to use a fulcrum when removing cement?

<p>It provides a stable resting point for the instrument, which reduces hand fatigue and makes the procedure more efficient and effective.</p> Signup and view all the answers

Why should a base for a temporary restorative be thick and putty-like?

<p>The base should be tacky so that it adheres to the tooth. However, the base must also be able to roll into a ball so that it can be shaped and placed accurately.</p> Signup and view all the answers

What are some of the main variables that can affect cementation?

<p>Mixing time, Humidity, Powder to liquid ratio, Temperature</p> Signup and view all the answers

What is the main ingredient in zinc-oxide eugenol (ZOE)?

<p>Oil from cloves called eugenol</p> Signup and view all the answers

ZOE is considered to be more acidic than most other cements.

<p>False (B)</p> Signup and view all the answers

ZOE can be used under all types of restorations.

<p>False (B)</p> Signup and view all the answers

What are the three types of ZOE cements?

<p>ZOE type I, ZOE type II, ZOE type III</p> Signup and view all the answers

What kind of ZOE cement is used for short-term restorations, sedative dressing or insulating/sedative base?

<p>ZOE type III</p> Signup and view all the answers

ZOE cements are always supplied as a liquid and a powder.

<p>False (B)</p> Signup and view all the answers

Why are IRM cements used?

<p>They reduce sensitivity and discomfort to tooth, maintain function and esthetics to tooth until permanent restoration can be placed, protect margins of a prepared tooth, prevent shifting of adjacent/opposing teeth because of open spaces, and can last for up to 6 months.</p> Signup and view all the answers

What are the main two components in zinc phosphate cements?

<p>Zinc oxide and Phosphoric acid</p> Signup and view all the answers

Zinc phosphate cements are always supplied as a powder and a liquid.

<p>True (A)</p> Signup and view all the answers

Why is it important to use a cold, dry, thick slab to spatulate zinc phosphate cements?

<p>To dissipate the heat that is created when the phosphoric acid reacts with the zinc oxide</p> Signup and view all the answers

A dental liner or desensitizer should be placed on top of zinc phosphate

<p>False (B)</p> Signup and view all the answers

What type of zinc phosphate cement is recommended for deep cavity preparations?

<p>Type II zinc phosphate (medium grain)</p> Signup and view all the answers

What are polycarboxylate cements mainly composed of?

<p>Powder is mainly zinc oxide and liquid is a viscous solution of polyacrylic acid in water.</p> Signup and view all the answers

What are the advantages and disadvantages of polycarboxylate cements?

<p>They are not as strong as zinc phosphates, but they are less irritating to the pulp and are great for bonding to enamel.</p> Signup and view all the answers

In what situations are polycarboxylate cements used?

<p>They are used as a permanent cement for cast restorations, stainless steel crowns, orthodontic bands, non-irritating liner under both composite or amalgam restorations, and as an intermediate restoration.</p> Signup and view all the answers

Polycarboxylate cement is supplied as a two-paste system.

<p>False (B)</p> Signup and view all the answers

Glass ionomer cements are discussed in this lesson

<p>False (B)</p> Signup and view all the answers

Composite resins will be discussed in this lesson

<p>False (B)</p> Signup and view all the answers

Powders should be dispensed before liquids

<p>True (A)</p> Signup and view all the answers

You should touch the bottle to the slab before dispensing liquid

<p>False (B)</p> Signup and view all the answers

Zinc Oxide Eugenol (ZOE) cements can be used as an insulating and sedative base

<p>True (A)</p> Signup and view all the answers

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?

<p>Zinc phosphate</p> Signup and view all the answers

Why is polycaroxyate a good option for cementing restorations?

<p>Because it is non-irritating to the pulp and can be placed under both amalgam and composite restorations</p> Signup and view all the answers

Why is glass ionomer a good option for deep restorations?

<p>Due to its fluoride release</p> Signup and view all the answers

Flashcards

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

Material placed in deep preparations to protect the tooth from thermal shock or to provide pulpal protection.

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

A thin coating applied after the liner to seal dentinal tubules, reducing microleakage.

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Desensitizer/Primer

Material used to seal dentinal tubules and prevent sensitivity after a restoration is placed.

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Pulpal Responses

Reactions the pulp experiences in response to different stimuli (e.g., thermal, mechanical, chemical).

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Cavity Preparation

Removing decay and shaping the tooth for a restoration.

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Liner Application

Placed on the deepest dentin portion of the preparation, NOT on enamel or grooves.

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Varnish Application

Applied after the liner on the walls, floor and margin of the cavity prep.

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Desensitizer Application

Applied to all exposed dentin surfaces; should not touch soft tissue.

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Protective Base

Reduces post-op sensitivity, protecting the pulp before a restoration is placed.

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Insulating Base

Protects the tooth from thermal shock in deep preparations.

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Sedative Base

Soothes a damaged pulp.

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Physical Stimulus

Examples include thermal or electrical changes.

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Mechanical Stimulus

Examples include handpiece or occlusion.

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Chemical Stimulus

Acid from dental materials.

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Biologic Stimulus

Bacteria from saliva or caries.

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Pulp Protection

Protecting the pulp tissue from irritation.

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Micro leakage

Leakage of oral fluids between the tooth surface and the restoration

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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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