1. PULPAL CONSIDERATIONS
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2. ADHESIVE SEALERS
 e.g: adhesive bonding systems-resin luting
cements-GI luting cement
 Provide chemical bond
 Varnishes reduce but don’t eliminate microleakage
around amalgam
 High copper amalgam
 Comparable in short term(24hrs to 14days)
 Leakage increase: margin on dentin/cementum-
1month to year (long term=caries)
 Drawbacks: pooling of resin(x-ray artifact/perio
prob)-incorporation to amalgam/loss of strength-
more tech sensitive than varnish
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3. PHYSIOLOGIC CONSIDERATIONS
1-RDT:
 No material provides better protection
 Role :Buffering-insulation
 Single most important factor inprotecting pulp
 Conservation better than replacement
2-Causes of pulpal inflammation:
 Bacteria or toxins (dental materials : mild &transitory)
 Early enamel caries ¼ DEJ causes slight reaction
(enamel permeability)
 Outward flow doesn’t prevent bacteria
 Acid etch: tolerable if bacterial invasion in prevented
 Rotary instruments : friction/dessication
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0.5mm=75%
1mm=90%
2mm
0.25-0.3

4. INSTRUMENTATION
 Least effect: high speed-light force(1-3oz)-new bur-
air coolant-water spray-least prep.
 Frictional heat: burn lesions-abscess
 Dessication: tolerable in limited areas- loss of
dentinal fluid
 Temperature rise: enamel vs dentine?/ pressure vs
speed (low speeds)/ diamond vs carbide bur/ depth
of prep.> full coverage:3-22%
 New methods: laser(co2-Er:YAG-Nd:YAG-FEL)/ air
abrasion (water coolant necessary)
 Electrosurgery: intact enamel/ 0.4sec
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5. CAUSES OF PULPAL PAIN
 inflammation>pressure on nerve ends
 No inflammation> changes in outward flow
speed>deformation of nerve ends
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6. CAUSES OF THERMAL SENSITIVITY
 Theory of thermal shock (diffusivity) >base fore
metallic restorations-thickness :0.5-0.75mm-E.M)
 Theory of pulpal hydrodynamics (gap-volume and
flow of outward fluid due to
density/diameter/permeability) > effective sealing-
integrity of interface
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6months max even with no base
50% 24hrs/78% mild
almost always disappears within 30 days

7. CAVITY SEALERS,LINERS AND BASES
Sealer
• prevention of leakage at interface- coating all walls :
a-varnish (natural/synthetic) b-adhesive sealer
(seal&bond)
Liner
• minimal thickness- only near pulp wall- physical
barrier and/or therapeutic effect(fluoride-antibacter)
Base
• replace missing dentin or block out undercuts
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8. CAVITY SEALERS
 Kidd : microleakage= passage of bacteria-fluids-
molecules-ions along the interface
 Leads to : secondary caries-marginal discoloration-
pulpal pathosis
 Causes of clinical failures of restorations : sec.
caries- marginal gap/fracture- discoloration
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9. VARNISHES
 Natural gum (copal) , a rosin or synthetic resin
dissolved in acetone,chloroform,ether
 A thin protective film of 2-5μ
 No thermal insulation
 2applications
 Reducing dentin permeability by 69%
 Reducing microleakage 4-6months
 Under ZPC crown cementation
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10. LINERS
 Ca(OH)2
 Not all formulations have stimulatory effect on
pulpoblasts
 Reparative dentin assisted rather than stimulated
 Antibacterial/anti inflammatory action- release G.F
from dentin>healing
 Conventional: poor physical properties-high
solubility-lower E.M
 Light activated : better properties
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11. LINERS
 Glass ionomer
o Chemical bond-fluoride release
o Decreases interfacial bacterial penetration (fluoride-
low pH- metal cation)
o Acidic for 24hrs
o Conventional : reduced gap-higher E.M-lower
resistance to acid etch
o Bonded base technique (open sandwich provides
better seal due to increased strain capacity
because of delayed set)
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12. BASES
 ZOE-ZPC: excellent thermal insulation-physical
properties but not adhesive
 GI (conventional)
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13. GUIDELINES FOR BASING-LINING-SEALING
 Don’t remove sound tooth structure to provide
space for base
 Bases for buildup materials but for if for amalgam or
composite restorations: minimal extent
 Min. thickness of liner
 Adhesive sealer under amalgam?
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14. PULP CAPPING
 Endodontic treatment designed to maintain the vitality of
the endodontium
 1-vital pulp/no spontaneous pain 2-no lingering pain after
hot/cold stimulus 3-no PA lesion 4-bacteria excluded
 Indirect P.C prefered
 Monitoring for several months
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15. DIRECT PULP CAP
 Ideal condition= bacteria free
 Aged pulps : increased fibrosis and decreased
blood supply
 Type/extent of exposure-bleeding amount
 Only when: small mechanical exposure of healthy
pulp-rubber dam isolation and adequate
hemostasis
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16. INDIRECT PULP CAP
 X-ray deep caries-no spontaneous pain-normal
vitality test
 Spoon excavator or large round bur,low speed
handpiece
 Wet(soft,amorphus) dentin removed- dry, fibrous
demineralized dentin leaved(moderate resistance to
gentle scraping)
 Caries-disclosing dyes: caution for deep dentin
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Delay indirect restorations 4-6months
Do not remove IPC after removing
temporary restoration

17. DENTIN BONDING VS CA(OH)2 AS DPC
 After smear layer removal pulpal tissue and adhesive
resin are compatible for 90days
 Faster dentin bridge with Ca(OH)2
 Toxic components rapid release
 In bacteria free environment>successful capping with
bonding
 Imperfect seal (nanoleakage in hybrid layer-collagen
hydrolysis)
 Lower bond strength to carious dentin
 Less intertubular dentin in deep lesions
 Bond degredation
 Acid etch: increase dentinal fluid flow-foreign body
reaction- increased bleeding
 Resin components inhibit T lymphocytes
 QTH temperature(20sec=25.2˚c)/11.2 irreversible damage
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18. CALCIUM HYDROXIDE SHORTCOMINGS
 Break down in acid etching
 Dissolution under leaking restoration
 Interfacial failure in amalgam condensation
 Tunnel defect in reparative dentin
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19. FUTURE OF DIRECT PULP CAPPING MATERIALS
 Hydroxyapatite as scaffold for dentin formation
 BMP-BSP
 MTA(tricalcium silicate/aluminate/oxide-silicate
oxide) : high pH- compressive strength comparable
to reinforced ZOE-radiopaque-antibacterial-
biocompatible
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20. ANTIBACTERIAL EFFICACY OF RESTORATIVE
MATERIALS
 Amalgam: copper-mercury-zinc-silver-chloride
components/effective against: S mutans, A viscous,
lactobacillus spp
Marginal seal improves with time(acidic
environment/ low oxygen concentration/corrosion
products)
 GI
 Resin composites (some resin
components/Glutaraldehyde)
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