BIOCOMPATIBILITY OF RESTORATIVE MATERIALS

Dorlands Illustrated Medical Dictionary defines the term BIOCOMPATIBILITY as ein!

harmonious "ith life and not ha#in! to$ic or in%urious effects on iolo!ic function&'
In !eneral( iocom)atiility is measured on the asis of*
Locali+ed cytoto$icity
,ystemic res)onses'
Aller!enecity'
Carcino!enicity'
Based on these criteria( the re-uirements for dental material iocom)atiility include the
follo"in!*
./ It should not e harmful to the )ul) and soft tissues'
0/ It should not contain to$ic diffusile sustances that can e released and asored into
the circulatory system'
1/ It should e free of )otentially sensiti+in! a!ents that are li2ely to cause an aller!ic
res)onses'
3/ It should ha#e no carcino!enic )otential'
Currently( a ne" document is ein! de#elo)ed that "ill meet
international needs "hich is entitled P45CLI6ICAL 57A8LATIO6 O9 BIOCOMPATIBILITY
O9 M5DICAL D57IC5, 8,5D I6 D56TI,T4Y : T5,T M5T;OD,&'
In a road sense( a BIOMAT54IAL can e defined as any
sustance( other than a dru!( that can e used for any )eriod as a )art of a system that
creates<re)laces any tissue( or!an < function of the ody'
Thus( "hen dentists )urchase a material( they should 2no" if it is
safe( and if it is safe( ho" safe it is relati#e to other materials'
To e#aluate the iocom)atiility of materials #arious tests are carried
out'
A BRIEF NOTE ON PULPAL REACTIONS
Dentin )rotects the )ul) and o"es its #itality and its sensiti#ity to
stimulation of the dental )ul)'
This intimate relationshi) has far reachin! clinical im)lications'
The nature of )ul) reaction that follo"s )eri)heral in%ury of the dentin'
.' De)ends on the nature of causati#e a!ent'
0' Its )ro$imity to the )ul)'
1
i'e' Attrition= arasion i'e' Pro!ressi#e i'e Iatro!enic
and 5rosion Dental caries In%uries
PULP
45,PO6,5* Mild Irritation ,e#ere Irritation May result in
> 4e)arati#e dentine > Inflammation > Inflammation
of )ul) of )ul)
As )ul) inflammation can also e iatro!enic in ori!in Do 6ot ;arm& is a asic
)rinci)al that should e follo"ed y all memers of the health )rofession= as it is ironic that in
attem)tin! to correct the dama!e caused y dental caries'
- Iatro!enic )ul) in%ury can de#elo)*
.' durin! the )re)aration of a tooth for restoration'
0' durin! the insertion of the restorati#e material'
1' it can e due to inherent irritational )ro)erties of the
material= either
a' clinical com)onents of the material'
' in%urious )roducts !enerated durin!
settin! of the material'
P8LPAL 45ACTIO6 can also e caused y Bacteria
a' 5ither residual acteria left ehind in the ca#ity'
' Or y the acteria that !ain access to the ca#ity after restoration as a result of
microlea2a!e'
Before restoration= "hile ca#ity )re)aration( a sim)le rule should e follo"ed'
65754 C8T D4Y&
.' A#oid heat !eneration
y the use of ;0O coolant
0' Dentin dessication'
Comin! to the restorati#e materials= de)endin! on their chemical nature can e !rou)ed
as*
MATERIAL RESTORATIVE MATRIALS NON-METAL RESTORATIVE MATERIALS
.' Amal!am'
0' Direct 9illin! ?old'
D56TAL CA,TI6? ALLOY,
1' Techni-ue Alloy @?old/
3' Base Metal Alloys
.' Different 4estorati#e Materials'
0' Acrylic'
1' Com)osite'
3' Porcelain'
1) Amalgam
2
Con#entional Amal!am 4estorations are considered inert < mildly
irritatin! to the )ul)'
Mercury itself does not seem to contriute to any )ul) res)onse'
It "as su!!ested that )hysical forces durin! insertion of the amal!am
is a ma%or factors res)onsile for !reater res)onses rather than the to$ic( chemical(
or thermal )ro)erties of amal!am'
;o"e#er( if re)arati#e dentin is already )resent or if a cement is
)laced )rior to the insertion of the restoration there is only little reaction to the
con#entional forces'
,O45MA4A and A,,OCIAT5, @.BCD/ ,ho"ed that ;! reached the
)ul) in humans after C days if no ca#ity liner "as used'
The rate of diffusion of ;! into enamel and dentin "as in#ersely
related to the de!ree of minerali+ation @It "as found that areas in dentin near the
amal!am had a hi!h ;! content/'
Thus older )atients : there is less )enetration of ;! ions'
6on>#ital tooth : there is less e#en less )enetration of ;! ions @ecause the ;0O
com)onent in 5 and D not reduced/'
It "as found that( the discolouration of tooth "as caused y En < ,n
and not ;! "hen it !ets corroded @instead it "as found that ;! re)enetrates the
Amal!am and reacts freely "ith )re#iously unreacted alloy )articles'
;AL,5 @.BFG/ confirmed these findin!s= usin! human teeth'
Lichenoid reactions re)resentin! a lon!>term effect in the oral
mucous memrane ad%acent to Amal!am restoration is -uite often'
Buccal mucosa and lateral orders of the ton!ue'
9or many years a contro#ersy has ra!ed o#er the iocom)atiility of
amal!am restoration ecause of the )resence of elemental ;!'
The sym)toms of chronic ;! )oisonin! @element/ are*
Hea2ness Insomnia
9ati!ue Irritaility
Anore$ia ,hyness
Hei!ht loss Tremors in the e$tremities
The si!ns and sym)toms of methyl ;! )oisonin! @sea food/'
- Ata$ia @!ait disturances/'
- Paresthesia of e$tremities( li)s and ton!ue'
- Constriction of #isual fields @tunnel #iscous/'
9e" )atients react to e$tremely small amounts of ;! "ith the si!ns
and sym)toms of*
.' Mercury )oisonin!'
0' Multi)le sclerosis'
3
1' 5)ile)sy'
Dentists dia!nosed this condition as MIC4OM54C84IALI,M ;YP54,56,ITI7ITY&'
Acce)ted ;! le#els*
Patient "ith amal!am : the o#er ;! le#el
- 6ormal I'Fn!<ml
,ea food )er "ee2
- 0'1 to G'.n!<ml
0/ DI45CT 9ILLI6? ?OLD
The )ul) res)onses from the insertion of cohesi#e and com)acted
!old are also associated "ith condensation( "hether "ith land instruments < "ith
mechanical )neumatic instruments'
The res)onses de#elo) "hen the condensation occurs o#er freshly
cut dentinal tuules( ut not "hen dentinal tuules are lined "ith )re>o)erati#ely
formed re)arati#e dentin induced from )re#ious e)isodes of disease < restorati#e
)rocedures'
A))arently it "as found that= D? that is com)acted )ro)erly into
sound tooth structure )roduces only a minimal )ul) res)onse'
8nder e$tremely rare conditions @.*. million/= )atients "ho ha#e
een sensiti+ed to !old restorations "ith*
.' urnin! sensations'
0' lichenoid lesions of the oral mucosa'
1' !enerali+ed systemic reactions'
D'GJ of the female )atients had )resented*
a' lesions of oral lichen )lanus'
' Burnin! mouth syndrome'
Because of its @A!/ hi!h thermal conducti#ity )atients e$)erience
PO,T>OP54ATI75 ,56,ITI7TY' 9or a "oman( "ho re)orts that she is aller!ic to
certain metals( the follo"in! 1 o)tions can e )ursued if'
./ After a thorou!h medical history that includes -uestions on dermatolo!ic
reactions to coins( %e"ellery < dental metals( "e can conclusi#ely identify the
ALL54?56 as the com)onent of a ?OLD BA,5D < PALLADI8M BA,5D <
BA,5 M5TAL ALLOY @on trial asis/'
0/ If( the )atient states that she is aller!ic to !old alloy&= @this situation is hi!hly
unli2ely( ecause the incidence is less than .J com)ared "ith an aller!y
)otential of .IJfor "omen to 6i under e$traoral conditions'
1/ If( the )atient c<o aller!enicity to all metals and if out e$amination fails to identify
the most )roale aller!en( the )atient should e referred for medical dia!nosis
@dermatolo!ist < aller!ist/'
4
DENTAL CASTING ALLOYS
He ha#e to select alloys ased on indi#idual )atients s)ecific( functional( and economic
re-uirements There is no one alloy suitale for all a))lications for e'!'* certain ase metal alloys
contain Be( 6i( Co and Cr and the iocom)atiility of each metal #aries to different de!rees of
tissue tolerance'
./ B54ILLI8M * To date there ha#e een no documented cases of Be to$icity of dental
ori!in'
- ;o"e#er( under uncontrolled conditions( "hen inhalation of dust and fumes can
e antici)ated( the )resence of Be constitutes a reco!ni+ed health ha+ard'
- It may result in
Acute !"m C#"!$%c !"m
4es)onses #ary
from contact dermatitis to se#ere
chemical )neumatics
,ym)toms ran!e
from cou!hin!( chest )ain and !eneral
"ea2ness to )ulmonary dysfunction
A hi!h mortality rate of dental technicians "as found due to the
inhalation of Be #a)our : "hich resulted in lun! cancer and death'
Therefore "hen !rindin! of Be containin! alloys( there should e
ade-uate local e$haust #entilation'
0/ NIC&EL * 5)idermiolo!ic studies on "or2ers in non>dental industries ha#e identified 6i
and 6i com)ound as carcino!enic'
The ma%or ha+ardous route is as)iration'
There is no e$)erimental e#idence that 6i com)ounds are
carcino!enic "hen administered y oral < cutaneous routes'
It causes dermatitis @contact/ ecause it is a )otential sensiti+in!
a!ent and in sensiti+ed )atients intra>orally'
.' Burnin! and tin!lin! sensation durin! the first 03
hours and
0' later e$hiited a sli!ht erythematous reaction in the
mucosa'
;o"e#er( there is no correlation found et"een the incidence of 6i
hy)ersensiti#ity and the )resence intra>orally of 6i alloy restorations'
Co alloys : ha#e a )otential for ./ dermatolo!ic and 0/ systemic
effects that may result from )atient and )ersonnel e$)osure to coalt alloys'
Althou!h( aller!ic reactions may e of some concern( the to$icity
)otential of Co>Cr alloys a))ear to e insi!nificant'
Palladium has also some aller!ic )otential ut 2no"n )atients of this
metal aller!y ha#e not sho"n any reaction in the mucosa( "hen a study "as carried
out'
5
NON-METALLIC RESTORATIVE MATERIALS
A ma%or cause of iatro!enic )ul) in%ury is C;5MICAL I44ITATIO6&
caused y 4estorati#e Materials'
DC6A classified'
The restorati#e materials into 1 ma%or !rou)s accordin! to their
irritation -ualities'
GROUP I GROUP II GROUP III
./ LOH I44ITATIO6AL
POT56TIAL
- En O5
- Polycaro$yla
te
- ?IC
0/ MOD54AT5
I44ITATIO6AL
POT56TIAL
> En )hos)hate
1/ ;I?;
I44ITATIO6AL
POT56TIAL
- ,ilicate
cements
- 4esins
GROUP I
'INC O(IDE EUGENOL
;as lo" irritational )otential'
Its );( "hen freshly mi$ed is F'
EnO and 5 ha#e an>OBT86D56T 5995CT on )ul)'
5u!enol inhiits the synthesis of )rosta!landin @it should e recalled that/ are
amon! the'
./ Chemical mediators of inflammation'
0/ Contriute to )ain sensation in areas of in%ury'
;Y?4O,COPIC K8ALITI5, O9 EO5 may result in*
1) )%t#*"a+al ! lu%* "!m t#e ,ul, t#"!ug# *e$t%$al tu-ule./
LThus relie#in! )ressure on sensory ner#e endin! of the )ul)M'
It has A6TIBACT54IAL )ro)erty'
;o"e#er= )laced on an e$)osed )ul)'
EnO5 : does not stimulate re)arati#e dentino!enesis on the contrary= it elicits a lo">!rade
inflammatory res)onse'
The lo" irritational )otential of EnO5 ma2es it ideal as a ne!ati#e control in
studies that e#aluate )ul) reaction to restorati#e material'
'INC POLYCARBO(YLATE0
It is remar2aly I66OC8O8, des)ite a ); of .'F of the )olyacrylic acid li-uid of
the cement @this is due to the ra)id rise of the ); durin! settin! of the cement/'
The lar!e molecular si+e of the )olyacrylic acid and its
6
Tendency to form com)le$es "ith )roteins "ould limit its diffusion throu!h the
tissues'
In this re!ard )olycaro$ylate cements are e-ui#alent to EO5 cements'
PO,T>OP54ATI75 sensiti#ity effects are ne!li!ile for oth cements'
GLASS IONOMER CEMENT
The )ul) res)onse of ?IC is land'
This landness is attriuted to the asence of stron! acids and monomers'
Polyacrylic acid and related )olyacids are "ea2 and )ossess hi!her molecular
"ei!hts that may limit their diffusion throu!h the DT to the )ul)'
;o"e#er studies of Pameyir and ,tanley @.BD3/ sho"ed that "hen anhydrous
?IC "as )ermitted to set*
.' 8nder )ressure @continuous/ > simulatin! cro"n cementation
0' )ul) ascesses'
1' res)onse occurred "hen 4D thic2ness "as I'Gnm < less'
3' intense haemorrha!e
Hhen the 4DT "as nearly .mm : the set ?IC caused a mean inflammatory
cellular )ul) res)onse of .'CFN "hich e$ceeded the acce)tale res)onse le#el of .'GN
@Duralay study/'
@Thus this study sho"ed the im)ortance of 4DT in determinin! the )ul) res)onse to ?IC
lutin! a!ents/'
?IC( a))ear to e )ul) irritants only "hen used as lutin! a!ents'
Therefore it "as recommended that small da of C; e a))lied only to areas of
e$tensi#e cro"n )re)arations "hene#er 4DT "as .mm of the )ul) efore the
cementation )rocedure "as carried out'
@This )ro#ided the re-uired )ul) )rotection to the critical areas "ithout decreasin! the o#erall
adhesion enefits of the ?IC/'
Lately( dentin adhesi#es that seal DT and infiltrate etched dentin are ein! used in
addition to C;'
GROUP II0
'INC P1OSP1ATE CEMENT
It has an irritational )otential intermediate to EnO5 and silicate cement'
As a ase : it is not hi!hly to$ic'
As a lutin! a!ent : on )ressure( causes : a HID5,P45AD 1 : dimensional
lesion in#ol#in! all the coronal )ul) tissue > as the )hos)horic acid "ithin the mi$ of En
)hos)hate cement is forced in the DT and after O days'
An youn! tooth "ith "ide : o)en DT is more susce)tile to such an intense
inflammatory res)onse com)ared to an older tooth "hich has sclerotic < 4D @that loc2s
DT and )re#ents the acids from reachin! the )ul)/'
7
The ); of the cement 1 minute after mi$in! is 1'G= the ); ra)idly increases
thereafter( a))roaches neutrality in : 03 hours'
Thus( dama!e to the )ul) occurs durin! the first fe" hours after insertion of the
cement'
This dama!e can e )re#ented y*
.' A))lication of a))ro)riate #arnish( DBA' Line thin "as of C; "hich
eliminates BIJ of the se#erity of the ad#erse )ul) res)onse'
GROUP III0
SILICATE CEMENT
It has hi!h irritational )otential'
Bein! of its hi!h>)otential( it is used as an ideal material for the control in studies
that e#aluate )ul) reactions to restorati#e material'
The ); is elo" 1( at the time of insertion= and the ); remains elo" neutrality
e#en after . month'
A C; ase )ro#ides ade-uate )ul) )rotection from -uality of the cement'
RESINS 0 2TO(ICOLOGY)
There is no indication that commonly used acrylic resins )roduce systemic
effects in humans'
The amount of residual monomer in )rocessed )olymethyl @methacrylate/ is
e$tremely lo"'
The oral mucosa and underlyin! tissues function as arriers that si!nificantly
diminish the #olume of monomer reachin! the lood stream'
4esidual monomer that reaches the lood stream is ra)idly ;YD4OLYE5D to
methacrylic acid and e$creted @It is estimated that the half>life of methyl metacrylate in
circulatin! lood in 0I to 3I minutes/'
Clinical e$)erience indicates that true aller!ic reactions to acrylic resins seldom
occurs in oral ca#ity'
Theoretically( such reaction @to$ic and aller!ic/ could occur after contact "ith the )olymer(
residual monomer( en+oyl )ero$ide hydro-uinone( )i!ments etc'
The aller!ic reactions are dose de)endent'
The surface monomer is com)letely eliminated after .F hours of stora!e in ;0O'
Clinically( most )atients re)orted denture>induced ,O45 MO8T; "hich on
e#aluation indicates tissue irritation "hich is !enerally related to unhy!iene conditions <
trauma caused y ill fittin! )rosthesis'
4e)eated < )rolon!ed contact "ith monomer may result in CO6TACT
D54MATITI,'
This condition is commonly e$)erienced y dentists and dental )ersonnel
in#ol#ed in mani)ulation of acrylic resins'
Because of this )ossiility( dental )ersonnel should refrain from handlin! such
materials "ith un!lo#ed hands'
8
The hi!h concentration of monomer in freshly mi$ed resins may )roduce local
irritation and serious sensiti+ation of the fin!ers'
9inally( inhalation of monomer #a)our may e detrimental' Therefore the use of
monomer should e restricted to "ell #entilated areas'
COMPOSITE RESINS
This material "hether con#entional < microfilled= auto)olymeri+in! < )hoto
acti#ated @87<7L/ are found I44ITATI6? to the )ul)'
(a) CHEMICALLY CURED RESIN COMPOSITES:
The addition of fillers to the direct fillin!( CC4C in the .BCIs and FIs did not
reduce their )otential for creatin! se#ere )ul) res)onses'
The filled resin= if not )ro)erly LI65D( still cause C;4O6IC P8LPITI, for an
indefinite time e#en in ca#ities of ordinary de)th @De)th thic2ness of a))ro$imately .mm/'
This )otential for irritatin! the )ul) )ersisted ecause CI4Cs still re-uired the
use of matri$ )ressure to enhance ada)tation to the ca#ity "alls durin! )olymeri+ation'
The res)onse of )ul) to com)osite restorations may ta2e se#eral days to 1
"ee2s to de#elo) a massi#e )ul) lesion'
,ome moderate to se#ere de!rees of )ul) res)onse could e e$)ected no
matter "hich )ro)rietary CC4C is used'
Thus( a thin coatin! of a hard>settin!( Ca@O;/0 cement "as recommended for
dee) ca#ity )re)arations and o#er areas of all freshly cut dentin efore any com)osite
material "ere )laced'
Lichenoid reactions to 4esin Based com)osites : on lon!>term effect
(b) VISIBLE LIGHT CURED RESIN COMPOSITES
It is im)ortant to otain as com)lete a )olymeri+ation as )ossile throu!h the
entire com)osite restoration to minimi+e )ul) res)onse'
The le#el of the )ul) res)onse in dee) ca#ity )re)arations is more ecause
more chances of incom)lete curin! of the resin "hich )ermits an e#en hi!her
concentration of residual un)olymeri+ed monomers to reach the )ul)'
A -uestion can e raised no" "hich com)onent of com)osite elicits )ul)
in%uryP&
In a study of )ul) reactions to D com)onents of com)osite resins( none of the
com)onents tested elicited si!nificant )ul) in%ury'
It a))ears li2ely that reacti#e radicals !enerated durin! the )olymeri+ation of the
resin are res)onsile for )ul) in%ury'
Pul) in%ury y resin restorations can e totally aro!ated throu!h the a))lication
of a hard settin! Ca@O;/0 ase eneath the resin'
Hith )ro)er li!ht curin! techni-ue "ith incremental layerin! com)osite that "ere
)re#iously -uite to$ic to the )ul) ha#e ecome less so "ith the elimination of the need for
matrices and )ressure to !ain acce)tale ada)tation'
9
CONDITIONING 2ETC1ING) AGENTS
As the resin restoration lea2 adly( acid etch techni-ue "as de#elo)ed to*
@a/ Im)ro#e mar!inal seal et"een ca#ity and restoration'
Acid etchin! of enamel is safe'
.' Pro#ided a )rotecti#e ase of Ca @O;/0 is a))lied o#er e$)osed dentin )rior to
etchin!'
Acid etchin! of dentin*
.' Mar2edly increases its )ermeaility'
0' 4emo#es the amor)hous smear layer o#er cut dentin @"hich )lu!s
the orifices of the DT/'
1' It deminerali+es the )erituular dentin resultin! in increased tuular
diameter' ,uch )atent tuules )ro#ide easy access of irritants to the
)ul)'
- ,tudies su!!est that only the surface of the dentin .I>Qm de)ths/ needs to e
modified and not its dee)er layers'
Conditionin! techni-ues that are associated "ith "ea2er acids( shorter
)eriods of a))lication( and the elimination of ruin! and scruin! )rocedures
)roduce a minimal )ul) res)onse and satisfactory ondin!'
BONDING AGENTS
Bondin! a!ents do not a))ear to e to$ic'
Bet"een .BFG and .BB0( some studies demonstrated that ondin! a!ents
hel)ed'
.' 4educe the e$)ected )ul) res)onses induced y the suse-uent
)lacement of the more to$ic resin>ased com)osite materials'
Lee )harmaceutical coo)eration in .BFG
- had )roduced an AD;5,IO6 BOO,T54& @used either alone "ith enamelite( a
resin com)osite < in con%unction "ith GIJ )hos)horic acid/ that reduced the )ul)
res)onses( e#en thou!h the acid e#idently remo#ed the smear layer and o)ened
the tuules'
The resin )rimer is a))lied that infiltrate the deminerali+ed dentin surface @smear
layer and tuules/ and the e$)osed colla!en mesh to form a hyrid layer' On this layer a
ondin! resin is )laced and cured' This )lu!!in! of the DTs )re#ents the )enetration of
to$ic com)onents to the )ul) from suse-uently )laced resin>ased com)osite
restorations'
RESIN BASED COMPOSITE CEMENTS 2DUAL-CURE)0
In .BB0 Pameyor and ,tanley( found that*
Only "hen the dual>cure resin cement recei#ed no #isile li!ht ener!y did the
a#era!e )ul) res)onse le#el e$ceed the acce)ted le#el of iocom)atiility and resmled
)ul) res)onses similar to CC4Cs'
The increase e$)osure time to #isile li!ht is not harmful to )ul) tissue'
10
CAVITY VARNIS1 AND LINERS
Ca#ity #arnish )roduces a )ositi#e effect on the reduction of )ul)al irritation'
This effect is ecause of the reduced infiltration of irritatin! fluids throu!h
mar!inal areas'
The #arnish also )re#ents )enetration of corrosion )roducts of amal!ams into
the D'T'
It cannot e used under com)osite and ?IC restoration'
Ca#ity liners li2e Ca@O;/0( ?I and EO5 are used for acceleratin! the formation of
re)arati#e dentin in dee) ca#ities'
LUTING CEMENTS AND T1EIR APPLICATIONS
./ 9or retenti#e small sin!le tooth castin!s < 1>unit 9PDs'
Polycaro$ylate @has minimal )ul) irritation and lac2 of )osto)erati#e sensiti#ity/'
EnP( ?IC( I4M'
0/ Lon! s)an 9PDs : En )hos)hate < ?IC'
1/ ,ensiti#e teeth relie#in! cast restoration : En )olycaro$ylate < 4EO5 @landness/'
3/ Cast restoration in e$tremely caries acti#e )atients : ?IC @cause of 9 released throu!h
the )osto)erati#e sensiti#ity'
G/ Porcelain #eneers < inlays : 4esin cements and liners'
C/ Porcelain RC < Dicor : EnP < 4esin : 6on irritation to )ul) and sufficient stren!th and
added colour
F/ P and C cementation : ?IC @Increased stren!th anticario!enic and increased flo"/'
D/ Continually dislod!ed cast : ?IC < 4esin @"ith )rotect/'
B/ Castin!s cemented in a "et field : reinforced EO5 @lac2 of sensiti#ity to moisture/'
PROTECTIVE BASES
>Ideal ases should e "ell*
./ Tolerated y the )ul)'
0/ ,hould stimulate re)arati#e dentino!enesis' @in case an undetected microsco)ic
e$)osure of )ul) e$ists/'
1/ It should )ro#ide ade-uate )rotection of the )ul) from irritant com)onent of the restorati#e
material'
3/ Aundant effect'
G/ Antiacterial @to eliminate acteria in residual carious dentin "hen used "ith IPC/'
C/ Ade-uate com)ressi#e stren!th @to "ithstand forces incident to the condensation of the
material/'
F/ Lo" thermal and electric conducti#ity @to )rotect the )ul) from thermal shoc2 and
electro!al#anism/'
D/ ,hould e$hiit lo" acid : soluility and etch tend @in case if the acid comes in contact "ith
the material/'
11
9or i'e'
.' 9or metallic restoration li2e amal!am'
a' A hard settin! Ca@O;/0 and reinforced
EO5'
0' 9or D?9
a' En )hos)hate cement "ill )ro#ide a stron!er ase(
ho"e#er= Ca@O;/0 liner < ca#ity #arnish should e
a))lied )rior to the insertion of the cement : to
)rotect the )ul) from chemical irritation'
PULP CAPPING 2I$ Dee, Ca3%t%e.)
6umerous materials ha#e een in#esti!ated as )ul) ca))in! a!ents'
;o"e#er( Ca@O;/0 )re)arations ha#e est "ithstood the test of time'
There has een a "ides)read concern amon! dentists that Ca@O;/0 e#ents a
)ersistent stimulatin! effect on the )ul) that results in e#entual oliteration of )ul)'
,ome also elie#ed that it causes )ersistent inflammation of the )ul)'
The e$act mechanism y "hich C; !enerates a dentinal rid!e is not clear ut
its'
Caustic action associated "ith its hi!h ); @.. to .1/( "hen soluili+ed and its
reduction of su)erficial necrosis'
Here assumed to e the factors res)onsile for stimulation of secondary dentin
formation'
MICROLEA&AGE
Brannstrom and collea!ues @.BF.= F3/ ha#e )ro)osed that infection caused y
)enetration of microor!anism from mar!inal lea2a!e around the restoration'
And the residual microor!anisms left on the ca#ity floor cause a !reater threat to
the )ul) than is the to$icity of restorati#e material'
Hhen ca#ities are dee) : Bacteria S Irritation )otential of restorati#e materials are
res)onsile for )ul)al irritation'
Ber!enholt+ @.BD0/ )ointed out that althou!h microor!anisms may contriute to
)ul) res)onses eneath reactions= they a))ear to e unale to sustain a lon!>
standin! irritation to the )ul)'
8nless recurrent caries de#elo)s under a clinically : defecti#e restoration= the
dentin )ermeaility to acteria decreases o#er time( allo"in! the )ul) to heal'
This may )artially e$)lain "hy )ul) remain 7ITAL in most restored teeth'
Conse-uently )ul) de#itali+ation occurs due to*
.' Mechanical in%ury durin! cuttin!'
0' To$icity of restorati#e material'
1' Action of acteria'
5arlier hi!h irritatin! solution "ere used for sterili+ation of the ca#ity'
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But the need for ca#ity sterili+ation is -uestionale'
Because:
.' Dentin has sho"n to resist acteria in#asion'
0' and dee) ca#ities are usually !i#en a )rotecti#e ase of Ca@O;/0'
Both of "hich ha#e sho"n A6TIBACT54IAL P4OP54TI5,
A safe and effecti#e measures for ca#ity cleansin! is sim)ly rinsin! the ca#ity
"ith "arm ;0O'
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