BIOCOMPATIBILITY OF RESTORATIVE MATERIALS Dorlands Illustrated Medical Dictionary defines the term

BIOCOMPATIBILITY as ein! harmonious "ith life and not ha#in! to$ic or in%urious effects on iolo!ic function&' In !eneral( iocom)ati ility is measured on the asis of* Locali+ed cytoto$icity ,ystemic res)onses' Aller!enecity' Carcino!enicity' Based on these criteria( the re-uirements for dental material iocom)ati ility include the follo"in!* ./ It should not e harmful to the )ul) and soft tissues' 0/ It should not contain to$ic diffusi le su stances that can e released and a sor ed 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 su stance( 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)ati ility 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)' im)lications' The nature of )ul) reaction that follo"s )eri)heral in%ury of the dentin' .' a!ent' De)ends on the nature of causati#e This intimate relationshi) has far reachin! clinical

0'

Its )ro$imity to the )ul)'

i'e' Attrition= a rasion and 5rosion PULP 45,PO6,5* Mild Irritation > 4e)arati#e dentine

i'e' Pro!ressi#e Dental caries

i'e Iatro!enic In%uries

,e#ere Irritation > Inflammation of )ul)

May result in > Inflammation 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 mem ers 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)* .' restoration' 0' material' 1' it can e due to inherent irritational durin! the insertion of the restorati#e durin! the )re)aration of a tooth for

)ro)erties of the material= either a' material' ' in%urious durin! settin! of the material' P8LPAL 45ACTIO6 can also e caused y Bacteria )roducts !enerated clinical com)onents of the

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 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 .' Amal!am' 0' Direct 9illin! ?old' D56TAL CA,TI6? ALLOY, 1' Techni-ue Alloy @?old/ 3' Base Metal Alloys NON-METAL RESTORATIVE MATERIALS .' Different Materials' 0' Acrylic' 1' Com)osite' 3' Porcelain' 4estorati#e e

1)

Amalgam Con#entional Amal!am 4estorations are considered inert < mildly irritatin! to the )ul)'

Mercury itself does not seem to contri ute to any )ul) res)onse'

It "as su!!ested that )hysical forces durin! insertion of the amal!am is a ma%or factors res)onsi le 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'

,O45MA4B and A,,OCIAT5, @.CDE/ ,ho"ed that ;! reached the )ul) in humans after D 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 Fn < ,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 @.CGA/ confirmed these findin!s= usin! human teeth'

Lichenoid reactions re)resentin! a lon!>term effect in the oral mucous mem rane 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)ati ility of amal!am restoration ecause of the )resence of elemental ;!'

are*

The sym)toms of chronic ;! )oisonin! @element/

Hea2ness 9ati!ue Anore$ia Hei!ht loss @sea food/' > > Ata$ia @!ait distur ances/'

Insomnia Irrita ility ,hyness Tremors in the e$tremities

The si!ns and sym)toms of methyl ;! )oisonin!

Paresthesia of e$tremities( li)s and ton!ue' G

>

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' 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'Gn!<ml

,ea food )er "ee2 > 0/ 0'1 to A'.n!<ml 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 tu ules( ut not "hen dentinal tu ules are lined "ith )re>o)erati#ely formed re)arati#e dentin induced from )re#ious e)isodes of disease < restorati#e )rocedures' E

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* .' 0' 1' urnin! sensations' lichenoid lesions of the oral mucosa' !enerali+ed systemic reactions'

E'AJ 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 )ro a le aller!en( the )atient should e referred for medical dia!nosis

@dermatolo!ist < aller!ist/'

.I

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 suita le for all a))lications for e'!'* certain ase metal alloys contain Be( 6i( Co and Cr and the iocom)ati ility 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 4es)onses #ary from contact dermatitis to se#ere chemical C#"!$%c !"m ,ym)toms ran!e from cou!hin!( chest )ain and !eneral "ea2ness to )ulmonary dysfunction

)neumatics

..

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 cutaneous routes'

y oral <

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$hi ited 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'

.0

Co alloys : ha#e a )otential for ./ dermatolo!ic and 0/ systemic effects that may result from )atient and )ersonnel e$)osure to co alt alloys'

Althou!h( aller!ic reactions may

e of some e

concern( the to$icity )otential of Co>Cr alloys a))ear to 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' 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 ./ LOH I44ITATIO6AL POT56TIAL > > $ylate > ?IC > Fn O5 Polycar o GROUP II 0/ MOD54AT5 I44ITATIO6A L POT56TIAL > Fn )hos)hate GROUP III 1/ ;I?; I44ITATIO6 AL POT56TIAL > ,ilicate cements 4esins

.1

GROUP I 'INC O(IDE EUGENOL ;as lo" irritational )otential' Its );( "hen freshly mi$ed is G' FnO and 5 ha#e an>OBT86D56T 5995CT on )ul)' 5u!enol inhi its the synthesis of )rosta!landin @it should e recalled that/ are amon! the' ./ Chemical mediators of inflammation' 0/ Contri ute to )ain sensation in areas of in%ury' ;Y?4O,COPIC K8ALITI5, O9 FO5 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)' FnO5 : does not stimulate re)arati#e dentino!enesis on the contrary= it elicits a lo">!rade inflammatory res)onse' The lo" irritational )otential of FnO5 ma2es it ideal as a ne!ati#e control in studies that e#aluate )ul) reaction to restorati#e material'

.3

'INC POLYCARBO(YLATE0 It is remar2a ly I66OC8O8, des)ite a ); of .'G 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 Tendency to form com)le$es "ith )roteins "ould limit its diffusion throu!h the tissues' In this re!ard )olycar o$ylate cements are e-ui#alent to FO5 cements' PO,T>OP54ATI75 sensiti#ity effects are ne!li!i le for oth cements' GLASS IONOMER CEMENT The )ul) res)onse of ?IC is land' This landness is attri uted to the a sence 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 @.CE3/ sho"ed that "hen anhydrous ?IC "as )ermitted to set* .A

.' 0' 1'

8nder )ressure @continuous/ > simulatin! cro"n cementation )ul) a scesses' res)onse occurred "hen 4D thic2ness "as I'Anm < less' intense haemorrha!e Hhen the 4DT "as nearly .mm : the set ?IC caused a mean

3'

inflammatory cellular )ul) res)onse of .'DGN "hich e$ceeded the acce)ta le res)onse le#el of .'AN @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

.D

'INC P1OSP1ATE CEMENT It has an irritational )otential intermediate to FnO5 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 Fn )hos)hate cement is forced in the DT and after O days' An youn! tooth "ith "ide : o)en DT is more susce)ti le 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)/' The ); of the cement 1 minute after mi$in! is 1'A= 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 CIJ of the se#erity of the ad#erse )ul) res)onse'

.G

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$tremely lo"' The oral mucosa and underlyin! tissues function as arriers that si!nificantly diminish the #olume of monomer reachin! the lood stream' 4esidual monomer that reaches the lood stream is ra)idly ;YD4OLYF5D to methacrylic acid and e$creted @It is estimated .E

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( hydro-uinone( )i!ments etc' The aller!ic reactions are dose de)endent' The surface monomer is com)letely eliminated after .G 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$)erienced y dentists and en+oyl )ero$ide

dental )ersonnel in#ol#ed in mani)ulation of acrylic resins' Because of this )ossi ility( dental )ersonnel should refrain from handlin! such materials "ith un!lo#ed hands'

.C

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 )hoto con#entional < microfilled= are found

auto)olymeri+in!

acti#ated

@87<7L/

I44ITATI6? to the )ul)' (a) CHEMICALLY CURED RESIN COMPOSITES: The addition of fillers to the direct fillin!( CC4C in the .CDIs and GIs 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'

0I

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 o tain as com)lete a )olymeri+ation as )ossi le 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&

0.

In a study of )ul) reactions to E 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)onsi le for )ul) in%ury'

Pul) in%ury

y resin restorations can

e totally a ro!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)ta le ada)tation' CONDITIONING 2ETC1ING) AGENTS As the resin restoration lea2 adly( acid etch techni-ue "as de#elo)ed to* @a/ restoration' Acid etchin! of enamel is safe' .' Pro#ided a )rotecti#e ase of Ca @O;/0 is a))lied o#er Im)ro#e mar!inal seal et"een ca#ity and

e$)osed dentin )rior to etchin!'

00

Acid etchin! of dentin* .' Mar2edly increases its )ermea ility' 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 )eritu ular dentin resultin! in increased tu ular diameter' ,uch )atent tu ules )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 ru in! and scru in! )rocedures )roduce a minimal )ul)

res)onse and satisfactory ondin!' BONDING AGENTS Bondin! a!ents do not a))ear to e to$ic' Bet"een .CGA and .CC0( some studies demonstrated that ondin! a!ents hel)ed' .' 4educe the e$)ected )ul) res)onses induced y the su se-uent )lacement of the more to$ic resin> ased com)osite materials'

01

 >

Lee )harmaceutical coo)eration in .CGA had )roduced an AD;5,IO6 BOO,T54& @used either alone "ith enamelite( a resin com)osite < in con%unction "ith AIJ )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 tu ules'

The resin )rimer is a))lied that infiltrate the deminerali+ed dentin surface @smear layer and tu ules/ and the e$)osed colla!en mesh to form a hy rid layer' On this layer a ondin! resin is )laced and cured' This )lu!!in! of the DTs )re#ents the )enetration of to$ic com)onents to the )ul) from su se-uently )laced resin> ased com)osite restorations'

RESIN BASED COMPOSITE CEMENTS 2DUAL-CURE)0 In .CC0 Pameyor and ,tanley( found that* Only "hen the dual>cure resin cement recei#ed no #isi le li!ht ener!y did the a#era!e )ul) res)onse le#el e$ceed the acce)ted le#el of iocom)ati ility and resm led )ul) res)onses similar to CC4Cs' The increase e$)osure time to #isi le li!ht is not harmful to )ul) tissue'

03

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 FO5 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' Polycar o$ylate @has minimal )ul) irritation and lac2 of )osto)erati#e sensiti#ity/' FnP( ?IC( I4M' 0/ Lon! s)an 9PDs : Fn )hos)hate < ?IC' 1/ ,ensiti#e teeth relie#in! cast restoration : Fn )olycar o$ylate < 4FO5 @ landness/'

0A

3/ Cast restoration in e$tremely caries acti#e )atients : ?IC @cause of 9 released throu!h the )osto)erati#e sensiti#ity' A/ Porcelain #eneers < inlays : 4esin cements and liners' D/ Porcelain RC < Dicor : FnP < 4esin : 6on irritation to )ul) and sufficient stren!th and added colour G/ P and C cementation : ?IC @Increased stren!th anticario!enic and increased flo"/' E/ Continually dislod!ed cast : ?IC < 4esin @"ith )rotect/' C/ Castin!s cemented in a "et field : sensiti#ity to moisture/' PROTECTIVE BASES >Ideal ases should e "ell* ./ Tolerated y the )ul)' 0/ ,hould stimulate re)arati#e dentino!enesis' @in case an undetected microsco)ic e$)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/ A undant effect' reinforced FO5 @lac2 of

0D

A/ Anti acterial @to eliminate acteria in residual carious dentin "hen used "ith IPC/' D/ Ade-uate com)ressi#e stren!th @to "ithstand forces incident to the condensation of the material/' G/ Lo" thermal and electric conducti#ity @to )rotect the )ul) from thermal shoc2 and electro!al#anism/' E/ ,hould e$hi it lo" acid : solu ility and etch tend @in case if the acid comes in contact "ith the material/' 9or i'e' .' 9or metallic restoration li2e amal!am' a' A hard settin! Ca@O;/0 and reinforced FO5'

0' 9or D?9 a' Fn )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'

0G

;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 o literation of )ul)'

,ome also elie#ed that it causes )ersistent inflammation of the )ul)'

The e$act mechanism rid!e is not clear ut its'

y "hich C; !enerates a dentinal

Caustic action associated "ith its hi!h ); @.. to .1/( "hen solu ili+ed and its reduction of su)erficial necrosis' Here assumed to e the factors res)onsi le for stimulation of secondary dentin formation' MICROLEA&AGE Brannstrom and collea!ues @.CG.= G3/ 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'

0E

Hhen ca#ities are dee) : Bacteria S Irritation )otential of restorati#e materials are res)onsi le for )ul)al irritation' Ber!enholt+ @.CE0/ )ointed out that althou!h eneath

microor!anisms may contri ute to )ul) res)onses

reactions= they a))ear to e una le to sustain a lon!>standin! irritation to the )ul)' 8nless recurrent caries de#elo)s under a clinically : defecti#e restoration= the dentin )ermea ility to 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' But the need for ca#ity sterili+ation is -uestiona le' .' 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' 0C acteria

Because:

Both P4OP54TI5,

of

"hich

ha#e

sho"n

A6TIBACT54IAL

A safe and effecti#e measures for ca#ity cleansin! is sim)ly rinsin! the ca#ity "ith "arm ;0O'

1I