Cavity liners and bases
Liners and bases are materials placed between dentin (sometimes
pulp) and the restoration to provide pulpal protection or pulpal
response.
Pulp protection against:
1. Chemical protection
2. Electrical protection
. !hermal protection
". #echanical protection
$. Pulpal medication
Protective needs %or a restoration varies depending on the e&tent
and location o% the restoration and the type or restorative material
used.
L'(E)*:
+re relatively thin layers o% materials (1",pm) used to
provide a barrier to protect the dentin %rom residual reactants
di%%using out o% a restoration and-or oral %luids. which may
penetrate lea/y tooth0restoration inter%aces.
#ay provide pulpal treatment. some thermal and
electrical insulation.
!he need to liners is greatest with metallic restorations
that are not well bonded to the tooth structure such as
amalgam . while the composite and resin modi%ied 1'C
are bonded to the tooth so it eliminates the need to liners
2(LE** the cavity is very close to the pulp and pulpal
medication is needed.
!ypes o% liners:
1.thin %ilm liners:
A . Solution liners: varnishes. 2 0 $ 3m thic/.
B . Suspension liners: 2,02$ 3m.
2.thic/er liners:
also known as Cement liners: 2,,01,,, 3m (,.201mm) used %or
thermal protection. pulpal medication.
4+*E*:
oCement bases. typically 102 mm.
o2sed to provide thermal protection %or the pulp and
supplement mechanical support %or the
)estoration by the stress distribution on the underlying
dentin sur%ace e.g. %orces o% amalgam condensation.
5b6ectives o% pulpal protection:
)eviewing the anatomy. physiology o% dentin 7 pulp
comple&.
*tructure o% dentin.
)eaction o pulp to di%%erent stimuli:
'% the insult is strong and near to the pulp. the odontoblastic
processes are retracted rapidly and a thin local bridge o%
hydro&yapatite crystals is %ormed at the site.
*mear layer:
8uring cavity preparation with rotary instruments. some o%
the cutting debris is compacted to the sur%ace that material
/nown as smear layer9this layer is very e%%ective barrier so
it is le%t when using a non0bonding restoration li/e amalgam.
:owever. it is partially porous , ;. it can<t prevent slow
long term di%%usion9that<s way the smear layer should be
sealed with a layer o% liner.
:andling o% smear layer (according to rest. mat. used):
=ith amalgam >? leave it.
=ith composite >? must be removed.
!raditional liners (varnishes) could be used with recent amalgam
restorations. but dentin and bonding systems can produce better
e%%ect and replace the liners.
*olution liners (varnish)
Copal or natural resin dissolved in non0a@ueous volatile solvent.
(ether. alcohol and acetone) upon drying it will produce a thin
%ilm layer.
+8A+(!+1E*: %le&ible 7 dry rapidly.
5n the other hand. thic/ %ilms tend to trap solvent during drying
and become brittle.
L+BE)* 5C A+)('*::
*ingle coating covers only $$; o% the sur%ace
because the smear layer is moist and the varnish is
hydrophobic..*5 + *EC5(8 L+BE) '* (EE8E8
*econd coat covers D,0D$;
(.4. use o% varnishes decreased since 1EE, due to using o% 84*.
desensitiFing agents.
*uspension liners:
*ame e%%ect 7 dry slowly 7 give thic/er %ilms.
Constituents are suspended or dissolved in water.
!hermal protection thic/er layer (2,02$ 3m)
Cunctions o% Cavity liners:
1. Primary purpose protective seal o% e&posed dentin
sur%ace.
2. Electrical insulation (with newly placed amalgam restoration)
%rom the electrical circuts with restorations in ad6acent teeth.
. !hermal insulation with metallic restoration
8egree o% insulation depends upon
!hic/ness o% remaining dentin
2mm o% dentin or e@uivalent thic/ness o% insulating
material should e&ist to protect the pulp.
". Pulpal medication (dentin bridging)
0Zno/E liner
Ca (5:)
2
liner
Eugenol is slightly acidic. phenoloic compound that have an
obtundant action on the pulp at low concentrations with mild to
moderate pulpal in%lammation.
(.4. high conc will be irritating to the pulp.
ZnO/E liner. base. cement
Gn5-liner %or moderately deep cavities because it is
released during setting and over several days.
(ow a days resin0modi%ied glass ionomer cement is
used.
Ca (5:)2 very deep cavities or microscopic
E&posure Ca (5:)
2
Caustic (+l/aline. p: 12)
*timulate secondary dentin %ormation
!ypes
0 Ca (5:)
2
suspension
0 Chemically set material
0 Light0cured material
Ca (5:)
2
dissolution or degradation overtime
*etting reaction o% the ZnO/E and calcium hydroxide
accelerated by moisture.
Eugenol and calcium hydro&ide cannot be incorporated is
the same %ormulation because eugenol rapidly chelates
with calcium ions in a strong e&othermic reaction
the choice o% eugenol0based versus
Calcium0hydro&ide0based liner is based on the relative depth o%
the tooth preparation.
:istorical 4ac/ground:
4e%ore 1EH,<s Gn phosphate cement
)ein%orced ZnO/E
1EI, polycarbo&ylate cement
1ED$01EE" 1lC
LC1'C. compomers chemical adhesion.
1ood mechanical properties. %luoride release. command setting
and rapid achievement o% strength.
Previously
8eep cavity:
J Ca (5:)
2
liner
J 4ase %or mechanical support Kstress distribution.
J Aarnish on the base plus walls e&cept when using
Finc phosphate cement the varnish must be
applied be%ore the cement.
J +malgam
Currently
J Light cured Ca (5:)
2
liner
J 1'C base
Cor indirect restoration:
J + base is used to bloc/ undercuts
J Pre%erable to be bondable to dentin to prevent
dislodgement during
temporiFation and impression ta/ing.
0 Composition. structure and properties o% di%%erent
cement bases.
0 Llaniputation
Clinical consideration with liners and bases
Clinical 6udgment depends upon:
1) )emaining dentin thic/ness ()8!)
2) Consideration o% adhesive material
) !ype o% restorative material use
M in amalgam: 1.$ mm depth >? 2 layers o% varnish K
amalgam
M in composite: acid itch 7 primer 7 bonding agent?
!:E +'#: to give chemical protection.
M eugenol can<t be used under
composite because it inhibits
polymeriFation.
M in case o% very thin )8! use spherical amalgam
because it needs less %orces o% condensation.
(ewer liners place less emphasis on pulpal medication and
%ocus more on chemical protection by sealing. adhesion and
mechanical protection.
(ewer compositions rely on mechanically strong acrylic
resin matrices. and that choice ma/es the release o% eugenol
or calcium hydro&ide more di%%icult or impossible..
8r. #osta%a
