Operative dentistry

Lec.9 (Cavity liner and cement base) ‫ شذى‬.‫د‬

Zinc polyacrylate cements (or zinc polycarboxylate) are supplied as a powder and a
liquid or as a powder that is mixed with water. The liquid is a water solution of
polyacrylic acid (32% to 42%). The cement powder is essentially zinc oxide and
magnesium oxide. The cement powder that is mixed with water contains the zinc oxide
particles coated by 15% to 18% polyacrylic acid.
Properties
1- Poly carboxylate cement is one of the dental cement systems which have chemical
adhesion to enamel and dentin, by the ability of the carboxylate groups in the cement
molecule to chelate to calcium in enamel and dentin.
2- The large sizes of the polyacrylic acid molecule, which can't penetrate through
dentinal tubules, make this cement low irritant to the pulp, so this cement is used as a
base or for cementation with sensitive teeth.
3- Short setting time (2-6 minutes).
4- This cement is sensitive to disintegration and solubility more than zinc phosphate
cement.
Uses:
1- As a luting agent.
2- As a base material.
3- In orthodontics for cementation of bands.
Manipulation:
1. Powder/liquid ratio for the base consistency is 2-3 parts of powder to 1 part of liquid
by weight. The powder/liquid ratio becomes (1.5/1) when using poly carboxylate
cement as a luting agent.
2. Dry and cool glass slab are used for mixing, the cooling slows the chemical reaction
and thus provide longer working time.

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3. The liquid should not be dispensed until just prior to the time of mixing, to avoid
evaporation of water which cause increase in the viscosity and this will cause decrease
in strength and higher solubility.
4. The mix should be completed within 30-40 second.
4- Glass ionomer cement:
Glass ionomer cements are supplied as a powder and a liquid or may come as capsules.
The material formulated of glass powder and an ionomeric acid containing COOH
groups and from this formulation it acquires its name. The powder is fluoro-alumino-
silicate glass. The liquid typically is a 47.5% solution of 2:1 polyacrylic acid and
itaconic acid copolymer.
Uses:-
1- As a base material.
2- Luting agent.
3- Also can be used as filling material specially of the modified types of glass ionomer
cements.
Properties:
1. The compressive strength is greater than zinc phosphate cement.
2. Glass ionomer cements are very sensitive to contact with water during setting. The
field must be isolated completely. If glass ionomer is used as filling material, once the
cement has achieved its initial set (about 7 minutes), coat the cement surface with a
coating agent such as a varnish, because the complete setting reaction takes place in 24
hours.
3. Glass ionomer cement bond to tooth structure chemically by ionic interaction with
calcium and/or phosphate ions from the surface of the enamel or dentin. In addition,
when the enamel surface is conditioned (etched with 37% phosphoric acid), the bond
strength of glass ionomer cement become greater, because acid etching of enamel
surface will produce micro porosities on the etched surface that will improve the
mechanical retention.
4. Glass ionomer cement release fluoride, so it has anti cariogenic effect (bacteriostatic
or bactericidal), thus this cement can be used in patient with a high caries index.

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Classification of glass ionomer cement:
The most practical classification of the Glass ionomer cements is on their clinical usage
into:
Type I Glass ionomer cements are the luting cements, characterized by low film
thickness and rapid set.
Type II Glass ionomer cements are restorative cements, with subtypes into two types.
Type II-1 Glass ionomer cements are aesthetic cements (available in both conventional
and resin-modified presentations) and Type II-2 Glass ionomer cements are 'reinforced'
cement which are more wear-resistant.
Type III Glass ionomer cements are the lining cements and fissure sealants,
characterized by low viscosity and rapid set.

5- Resin cements:
Are thin versions of restorative resins (e.g. calibra and panavia resin cements), consist
of a resin matrix with inorganic fillers that are bonded to the matrix with monomers.
The fillers are silica or glass particles, and the fillers level vary from 40%-80% by
weights. The bonding of this cement to enamel is attained by acid etch technique. The
bonding agent is used to provide mechanical adhesion of the cement to etched surface
of the tooth.
Polymerization of resin cements is achieved by chemical reaction (self cure), light
activation (light-cure), or both (dual-cured). The self -cured composite cement are
typically two paste system (base and catalyst), while the light cure cement is a single
component.
Properties:
1- Resin cements are insoluble in oral fluids.
2- Higher filler particles loading result in higher mechanical properties (strength and
stiffness) and reduce polymerization shrinkage, and a lower coefficient of thermal
expansion.
3- In some products fluoride is added to act as anti-cariogenic factor, and reduce the
resin cement sensitivities.

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Uses:
1. As a luting material either for cast or for tooth colored restorations such as esthetic
ceramic and laboratory processed composite restoration.
2. Also resin cement with high filler range can be used as a base material.

Cavity liners:
1- Cavity varnishes:
They are solutions of natural resins or synthetic resins dissolved in a solvent such as
alcohol, chloroform, or acetone. The solvent evaporates, leaving a thin film on the
cavity preparation.
Functions:
1- It is placed on enamel and dentin walls to reduce the penetration of oral fluids
around amalgam restoration. The cavity varnish inhibited microleakage during the first
few weeks. After that the varnish will dissolved by oral fluids and replaced by the
corrosion products of the amalgam which form at the amalgam tooth interface.
2- Varnish is applied on dentin surfaces to minimize penetration of the acid from zinc
phosphate cements by occluding the orifices of the dentinal tubules.
3- Reduce post-operative sensitivity.
Properties:
1- Varnishes, neither possess mechanical strength, nor provides thermal insulation
because of thin film thickness.
2- When glass ionomer cement is used as a base material, varnish should not be used as
subbase, because glass ionomer cement contains fluoride, and varnish prevents fluoride
release and reaction with the tooth, also varnish prevents the chemical bonds between
tooth and glass ionomer cement.
3- Varnish should not be used when the restoration is composite resin. Because varnish
inhibits polymerization reaction - of composite resin material. So calcium hydroxide
can be used under composite resin.

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Manipulation: -
Varnish solutions are usually applied by a mean of a small round piece of cotton. A
thin layer is applied on the preparation then gently dried with steam of air. A minimum
of 2 thin layers should be applied, as the initial layer dries it leaves small voids, so the
second layer fills in the voids and produce a more continuous coating. Varnish
solutions should be tightly capped immediately after use to minimize loss of solvent.
Most varnishes are supplied with a separate bottle of a pure solvent this solvent used to
keep the varnish from becoming too thick, also used for removing varnish from
external tooth surface.
2- Bonding agent:
Generally bonding agents are unfilled resins which are used for mechanical adhesion of
the composite restoration to the conditioned enamel and dentin. The conditioning is
achieved by using of 37% phosphoric acid for 15-60 seconds then washing and dryness
of the tooth. These bonding agents act as liner for the composite restorations especially
for shallow cavities, because they occlude the orifices of dentinal tubules and reduce
post-operative sensitivities.
Also special bonding agents are introduced recently as amalgam bond which can act as
a liner for amalgam restorations by sealing the cavity against fluid flow and
microleakage.
3- Calcium hydroxide: Ca(OH)2
Usually referred as liner, intermediate base, or pulp capping agent; examples: calcipulp,
dycal, hydrex. Calcium hydroxide supplied as a two paste system one is a base and the
other is a catalyst.
Properties:
1- The set material has an alkaline PH (9.2-11.7), which reduces the acidity of zinc
phosphate when used as a sub base material in deep cavities.
2- The antimicrobial action of calcium hydroxide makes this material useful in indirect
pulp capping procedures.
3- Calcium hydroxide stimulate the odontoblast cells for the formation of secondary
dentin (stimulate the formation of dentinal bridge) when it is put directly over exposed
pulp tissue, so calcium hydroxide is used for direct pulp capping.
4- Water is important component for the setting reaction of calcium hydroxide based
liner.

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Manipulation:
Equal lengths of the different colored pastes are dispensed on a paper pad and then
mixed into a uniform color (homogenous) and then applied by using of dycal
applicator. The setting time is short (about 1-2 minutes); therefore, the mix should be
done quickly and then applied on a dry dentin so flow freely and easily. Proper setting
requires humidity; place a moist cotton pellet at the opening of the cavity, on top of the
newly placed cement for 30 seconds. Be sure that the cotton does not contact the
cement. After 30 seconds, check the cement gently with the explorer to ensure that it
cannot be penetrated.
A resin has been added to calcium hydroxide to improve its properties (improve
thermal and mechanical properties, reduce solubility) and the setting is performed by
light curing.
General Clinical Consideration: -
After cavity preparation, certain factors should be taken in consideration during lining
placement in the cavity:
1- The prepared cavity should be clean and dry before application of lining material.
The quadrant of the prepared tooth should be isolated completely form saliva, because
the entire lining and base material are sensitive to water during their application and
setting.
2- All liners and base materials undergo dissolution and disintegration in saliva with
time; therefore, they should not reach to the margins of the cavity (except varnishes and
bonding agent). So lining is placed on: pulpal floor in CI I, pulpal floor and axial wall
in CI II, axial wall in CI III, IV, and V.
3- In cavities prepared for amalgam restorations, the base material should not be
extended on the walls of the cavity because this material will block the undercuts
(convergence of the buccal and lingual walls) which are important for the amalgam
retention. Also all the retentive holes, grooves, and pins should be free from lining
before amalgam placement.
Cavities can be classified according to their proximity from the pulp into:
1- Shallow cavity preparation: - (as in fig bellow) there is no need for pulpal
protection, there is a sufficient thickness of dentin so that no protective base required.
For dental amalgam the cavity is coated with two thin coats of a varnish and restored.
For a composite the cavity is etched, coated with a single coat of a bonding agent and
restored. Both varnish and the bonding system provide chemical protection.

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2- Moderately deep cavity: - (as in fig bellow) a prepared cavity that extends into
dentin beyond the minimal depth necessary to attain retention and strength for the
restorative material. Varnish is used to coat the floor and walls, then a cement base
such as zinc phosphate cement, or modified ZOE cement may be contoured to
replace the missing dentine

3- Deep cavity: - (as in fig bellow) that includes some extension toward the pulp,
a liner such as Ca (OH) 2 should be applied on the pulpal and axial walls. On top a
cement base is placed such as zinc phosphate cement, or modified zinc oxide
euogenol cement or poly carboxylate cement then a varnish is used to coat the
walls. Recently, new protocol prefers the use of dycal with glass ionomer base,
because of the present of chemical bonding between the tooth and the glass
ionomer cement that will reduce microleakage and the sensitivity postoperatively.

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4-Deep cavity with exposure of the pulp: - exposure of a small area of the pulp
with no sign or symptoms of degenerating pulp, the choice of conservation pulp
capping is recommended. In an isolated clean field, calcium hydroxide is carefully
placed over the pulp and the border of dentin which surround the exposure site. A
base material is placed on top (such as zinc phosphate or reinforced zinc oxide
eugenol), and also glass ionomer cement base is preferred. The restoration of the
tooth should be completed as soon as possible. Secondary dentin barrier is likely
to be formed within a few weeks.

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