pediatric dentistry reqirements for restoration

1. Restorative Materials In Pediatric Dentistry

2. Contents
• Factors affect choosing material
• Requirements of ideal restorative material
• Silver amalgam
• Glass ionomer cement
• Modifications in GIC
• Calcium hydroxide cement
• Conclusion

3. Factors affect choosing material
• Patient′s age
• Caries risk
• Child′s ability to co-operate
• Characteristics of different materials
• Choice of material

4. Requirement of ideal restorative material
• Restoration of esthetics.
• Maintenance of the physical strength of the crown.
• Preserving the anatomy of the occlusal surface and
thus preserving the inter-relationship with the
opposing and the adjacent teeth.
• Prevention of further ingress of bacteria or their by-
products into the microspaces between the restoration
and the tooth.
• Long-term adhesion between the restoration and the
tooth to ensure complete isolation.

5. Silver Amalgam
• Dental amalgam is metallic restoration composed of a
mixture of silver and other metals with mercury.
• It′s the most reliable and inexpensive dental
restorative material of all.

6. Classification
1. Based on copper content:
• High copper content: copper content more than 12%
• Low copper content: copper content less than 6%
2. Based on zinc content:
• Zinc containing alloys: contain more than 0.01%
zinc
• Zinc free alloys: contains less than 0.01% zinc

7. 3. Based on particle shape and type:
• Lathe-cut: irregularly shaped fillings produced by
cutting an ingot of alloy on a lathe.
• Spherical: produced by atomizing an alloy, while still
liquid into a stream of inert gas.
• Admixed: it contains both lathe-cut and spherical
particles.

8. Properties of amalgam
• Increased mercury- leads to increased expansion,
creep and corrosion.
• Compressive strength- Admixed is 430 Mpa after 7
days.
• Tensile strength- admixed is 50 Mpa after 24 hrs.
• Surface hardness- 3-8 minutes.
• Setting time - 5-10 mins.

9. Amalgam restoration
• Selection of alloy
• Trituration
• Condensation
• Marginal breakdown and bulk fracture
• Bonded amalgam restoration
• Mercury toxicity

10. Selection ofAlloy
Rate of hardening, smoothness of the mix, and ease of
condensation and finishing vary with the alloy.
1)High copper alloy: When significantly more copper is available,
improved laboratory properties and clinical performance have been
demonstrated.
Advantage:
Have low creep. Creep is the tendency of a material to deform
continuously under a constant applied stress >> marginal breakdown
(ditching) commonly noted with amalgam restoration.
2)zinc-free, high-copper alloy should be used when the dentist
operates in a field where moisture control is difficult.

11. Trituration
The most serious error in amalgamation is undertrituration.
Undertriturated mix:
1. Appears dry and sandy and does not cohere into a single mass.
2. Amalgam will set too rapidly, which results in a high residual mercury
content.
3. Reduced strength.
4. Increased the likelihood of fracture or marginal breakdown

12. Condensation
Purpose of condensation
To adapt the amalgam to the walls of the cavity preparation as closely
as possible, to minimize the formation of internal voids

13. Marginal breakdown and bulk fracture
A commonly observed type of amalgam failure which the marginal
areas become severely chipped.
A thin ledge of amalgam may be left that extends slightly over the
enamel at the margins >> cannot support the forces of mastication
>> fracture, leaving an opening at the margins.
Bulk fracture of amalgam is much less common with high copper
amalgam alloys.

14. Causes:
Poor cavity design resulting in an insufficient bulk of material across
the isthmus.
Premature loading of the restoration >> amalgam gains strength
slowly over the first 24 hours.

15. Bonded Amalgam Restoration
Dental amalgam does not adhere to tooth structure, it must be
retained mechanically by the design of the cavity preparation
and/or mechanical devices such as pins.
“ Bonded amalgam restoration” chemically activated dentin-
bonding systems over which the amalgam is condensed before the
resin adhesive has hardened.

16. Mercury Toxicity
The amount of mercury released from the amalgam in
service is small compared with other sources of mercury
from air, water, and food.
Amalgam Alternative: GalliumAlloy
1. Mercury free metallic.
2. Early setting can polished in the same visit
3. Better marginal Seal.
4. More costly.
.

17. What about dental office personnel?
A potential hazard exists from long-term
inhalation of mercury vapor in the dental
clinic.
The dental clinic should be well ventilated.
All mercury waste and amalgam scrap
removed during placement or removal of
amalgam restorations should be collected
and stored in well-sealed containers.
• When amalgam is cut, water spray and high-speed
evacuation should be used.
• Biologically contaminated wastes containing mercury,
including extracted teeth, should be cold sterilized with
a chemical agent before disposal.

18. Indication
• Moderate to large restorations.
• Restorations that are not in highly esthetic areas of
the mouth.
• Restorations that have heavy occlusal contacts.
• Restorations that cannot be well isolated.
• Restorations that extend onto the root surface.
• Abutment teeth for removable partial denture.
• Temporary or caries control restorations.

19. Contraindication
• Esthetically prominent areas of posterior teeth.
• Small to moderate Class I and Class II restorations
that can be well isolated.
• Small Class VI restorations.

20. Advantages
• Ease of use.
• High tensile strength.
• Excellent wear resistance.
• Economical
• Adequate resistance to fracture.
• Favorable long term clinical research results.

21. Disadvantages
• Non- insulating.
• Not esthetic.
• Less conservative.
• Weakens tooth structure.
• More technique sensitive.
• More difficult tooth preparation.
• Initial marginal leakage.

22. Glass Ionomer Cement
• This material was developed by Wilson and Kent in
1972.
• These are adhesive tooth color anticariogenic
restorative material.
• It can be used as a luting cement, a lining under
another restorative material or as a restoration.
• It is also known as Poly Alkenoate cement and
Alumino Silicate Polyacrylic Acid (ASPA).

23. Powder :-
It is an acid soluble calcium fluroalumino silicate glass.
Silica - 41.9%
Alumina - 28.6%
Aluminum fluoride - 1.6%
Calcium fluoride - 15.7%
Sodium fluoride - 9.3%
Aluminum phosphate - 3.8%

24. Liquid :-
1.Polyacrylic acid in the form co-polymer with itaconic acid
&malic acid .
2.Tartaric acid: improves handling characteristic
&increase working time.
3.Water :Medium of reaction &hydrates the
reaction products

26. Classification
1. Type I- Luting
• Cementation of crowns, bridges and orthodontic devices.
• Powder : liquid ratio approximately 1.5:1
• Radiopaque
2. Type II – Restorative
 Type II. 1 Restorative esthetic
- All types of esthetic restorations
- Auto-cure or resin modified
- Powder : liquid ratio 3:1 or greater
- Radiopaque generally

27.  Type II. 2 Restorative
- Restorations under high occlusal load
- Auto-cure or resin modified
- Powder : liquid ratio 3:1 or greater
- Radiopaque
- Used as a dentin substitute or interim restoration
3. Type III – Lining or base
• Simple lining under a metallic restoration
• Powder : liquid ratio 1.5 :1
• Auto-cure
• Radiopaque
• High strength base for lamination technique
• Powder : liquid ratio 3:1 or greater

28. • Type I
• Type II
• Type III
• Type IV
• Type V
• Type VI
• Type VII
• Type VIII
• Type IX
– Luting
– Restorative
– Liner/base
– Pit & fissure sealant
– Luting for orthodontic purpose
– Core buildup material
– High fluoride releasing command set
– Atraumatic restorative treatment
− Pediatric Glass Ionomer cements
ACCORDING TO USES:

29. • Traditional glass ionomer
a. Type I --- Luting cement
b. Type II --- Restorative cements
c. Type III --- Liners&Bases
• Metal modified Glass Ionomer
a. Miracle mix
b. Cermet cement
• Light cure Glass Ionomer
• HEMA added to liquid
• Hybrid Glass Ionomer/resin modified Glass Ionomer
a.Composite resin in which fillers substituted with glass ionomer
particles
b. Precured glasses blended into composites
NEWER CLASSIFICATION

30. When the powder &
liquid are mixed,
Surface of glass
particles are
attacked by acid.
then Ca,Al,
sodium, & fluoride
ions are leached
into aqueous
medium.

31. • Polyacrylic acid chains are then cross linked by calcium ions,
however, over next 24 hours, calcium ions are replaced by
aluminium ions.
• Sodium ions may replace hydrogen ions of carboxylic groups, and
flourine ions are dispersed within the cross-linked (matrix) phase of
the set cement.
• The cross-linked phase becomes hydrated over time as it matures.
• A silica- rich gel that is formed on the surface of glass particles
sheaths the undissolved portion of glass particles.
• The set cement consists of undissolved glass particles with a silica
gel coating embedded in an amorphous matrix of hydrated calcium
and aluminium polysalts containing fluoride.

32. Water plays an important role in structure of
cement.
After hardening, fresh cement is extremely prone
to the cracking &crazing, due to drying of
loosely bound water .
Hence these cements must be protected by
application of varnish.

33. SETTING TIME
• Type I 4 - 5 minutes
• Type II 7 minutes

34. MANIPULATION
1.Preparation of tooth surface :-
The enamel &dentin are first cleaned with pumice slurry
followed by swabbing with polyacrylic acid for 5 sec.
After conditioning & rinsing ,tooth surface should isolate
& dry.
2.Proportioning & mixing :-
 Powder & liquid ratio is 3:1 bywt. Powder &liquid is
dispensed just prior to mixing.
 First increment is incorporated rapidly to produce a
homogenous milky consistency.
 Mixing done in folding method to preserves gel structure.
 Finished mix should have a glossy surface.

35. 3. Protection of cement during setting :-
• Glass ionomer cement is extremely sensitive to
air &water during setting.
• Immediately after placement into cavity,
preshaped matrix is applied to it.
4. Finishing :-
Excess material should be trimmed from margins.
Hand instruments are preferred to rotary tools to
avoid ditching.
Further finishing is done after 24hrs.

36. 5.Protection of cement after setting :-
• Before dismissing the patient ,restoration is
again coated with the protective agent to protect
trimmed area.
• Failure to protect for first 24hrs results in
weaken cement.

37. PROPERTIES

38. Solubility and disintegration
• Initial solubility is high due to leaching of
intermediate products.
• The complete setting reaction takes place in 24 hours,
cement should be protected from saliva during this
period.

39. Adhesion :-
• Glass ionomer cement bonds chemically to the tooth
structure.
• Bonding is due to reaction occur between carboxyl group of
poly acid &calcium of hydroxyl apatite.
• Bonding with enamel is higher than that of dentin ,due to
greater inorganic content.
Esthetics :-
GIC is tooth coloured material &available in different
shades.
Inferior to composites.
They lack translucency & rough surface texture .
Potential for discolouration & staining.

40. Biocompatibilty :
• Pulpal response to glass ionomer cement is favorable.
• Pulpal response is mild due to
- High buffering capacity of hydroxyapatite.
- Large molecular weight of the polyacrylic
acid ,which prevents entry into dentinal tubules.
Anticariogenic properties :-
•Fluoride is released from glass ionomer at the time of
mixing & lies with in matrix. Fluoride can be released out
without affecting the physical properties of cement.

41. • Initial release is high. But
declines after 3 months.
After this fluoride release
continuous for a long
period.
• Fluoride can also be taken
up into the cement during
topical fluoride treatment
and released again, thus GIC
act as fluoride reservoir.

42. Advantages
• It is a tooth colored material.
• It will adhere directly to enamel and dentin through
an ion exchange mechanism.
• It is biologically active, as it is capable of releasing
fluoride, calcium and phosphate ions.
• Coefficient of thermal expansion is similar to tooth
structure.
• Low thermal conductivity.

43. Disadvantages
• Its physical properties are not sufficient to enable it to
withstand heavy occlusal loads in large restorations.
• Opacity higher than resin.
• Less polishability than resin.

44. Indications
• Non stress bearing areas.
• Classes III and V restorations in adults.
• Classes I and II restorations in primary dentition.
• Temporary or “caries control” restorations.
• Crown margin repairs.
• Cement base under amalgam, resin, ceramics, direct, and
indirect gold.
• Core build-ups when at least three walls of tooth are remaining
(after crown preparation).

45. CONTRAINDICATIONS
 Class IV carious lesions or fractured incisors.
 Lesionsinvolvinglargeareasof labialenamelwhere esthetics is of
major importance
 Class II carious lesions where conventional
cavities are prepared.
 Replacement of existing amalgam restorations.
 Lost cusp areas.

46. 1.Resin modified glass ionomer cement (hybrid
ionomer) :-
Powder component consist of ion leachable fluroalumino
silicate glass particles &initator for light curing.
Liquid component consist of water & poly acrylic acid
with methacrylate &hydroxyl ethyl methacrylate
monomer.
MODIFICATIONS

47. Composition
• Powder:Ionleachableglassandinitiatorsforlight/
• chemical/ both typesof curing
• Liquid : water + Polyacrylic acid modified with MA and
HEMAmonomers.
• It isapowder:liquidsystemwith P:L=3:1

48. Thesequenceof the two settingreactionsin a dual-curedresin
modifiedglassionomer cement. Theboxescolouredin pink
indicate the glassionomer cementreaction,while thosein blue
indicate the resinpolymerizationreactioninitiated by light.
SETTING REACTION OF RMGIC

49. SETTING REACTION OF TRICURE RMGIC
Tri-cured: acid-base reaction +light activation +dark redox.

50. Comparison to Conventional Glass
Ionomer
• Generally improved physical properties
• Improved shades and translucency
• Water sensitivity reduced
• Can be finished almost immediately
• Slightly less fluoride release
• Fluoride can still be recharged
• Slight increase in thermal expansion
• Can be dual or tri-cure

51. Indications
• Lutingcementesp.in orthodontics
• Linerandbase
• Pitandfissuresealant
• Corebuildup material
• Foramalgamrepair
• ADVANTAGES
• LongWorkingtime
• Earlywatersensitivityisreduced
• Rapiddevelopmentof earlystrength

52. • Noetchingisneededeither to tooth for adhesionor for
the material if compositelamination isto bedone.
• Bondingto compositeis higher
• Finishingcanbedone immediately
• Flouride release
• Diametrical tensilestrengthishigher
DRAWBACKS
• Of coursesomedrawbacksstill need to be
tackled suchas
• increasedshrinkagewith concurrent microleakage
• Lowwear resistanceascomparedto composites Its
controversial biocompatibility

53. 3.Metal modified glass ionomer cement:-
• Glass ionomer have been modified by addition of filler
particles ,to improve strength ,fracture toughness &
resistance to wear.
Silver alloy admix / miracle mix:-
• This is made by mixing of spherical silver amalgam
alloy powder with glass ionomer powder.
Cerment:-
• Bonding of silver particles to glass ionomer particles by
fusion through high temperature sintering.

54. • MIRACLEMIX / SILVERALLOYADMIXGIC
• Sced and Wilson in 1980 incorporated spherical silver
amalgam alloy into TypeII GICpowder in aratio of 7:1
• Powder
• Glass–17.5%
• Silver–82.5%
• Particle sizeof silver is3–4µm
• Liquid
• Aqueous solution of copolymer of acrylic acid and or maleic
acid—37%
• Tartaric acid9%
METAL MODIFIED GIC

55. Disadvantages
• Poorresistanceto abrasion
• Resistantto burnishing
• Pooresthetics

56. Glass cerment
• Alsocalledascermetionomercements
• McLeanandGasserin1985first developed
• Fusingthe glasspowderto silverparticlesthroughsintering that canbe
madeto react with polyacid to formthecement
• Sintering is done at high pressure more than 300MPa and at a
temperatureof 8000Cwhichis groundto fine powder particle
sizeof 3.5 µm
• 5%titaniumdioxideisaddedto improve aesthetics
• It hasexcellenthandlingcharacteristics

57. • Indications
• Corebuild–up material
• Rootcapsof teeth underoverdentures
• Class I cavitiesinprimary teeth
• Preventiverestoration
• Temporaryposterior restoration
• Contraindications
• Anteriorrestorations.
• Areassubjectedto highocclusalloading

58. Properties
Strength-
• Both tensile and compressive strength is greater than
conventionalglassionomercement
Modulusof elasticity-
• tendsto berelatively lowerthan conventionalGIC
Abrasionresistance-
• greaterthan conventionalGICdueto silverparticle incorporartion

59. 4.Compomer :-
Compomer is a composite resin that uses an
ionomer glass which is the major component of
glass ionomer as the filler.
Small quantity of dehydrated polyalkenoic acid
incorporated with filler particles,
Setting reaction is light activated.
Adhesive system used with compomer is based on
acid etch found with all composite resin.

60. FLUORIDE
RELEASING
CAPABILITY
OFGIC
DURABILITY
OF
COMPOSITES
COMPOMER
4. Compomer

61. COMPOSITION
• Compomers are essentially a one – paste system containing ion leachable
glass & polymerizable acidic monomers with functional groups of
polyacrylic acid & methacrylates in 1 molecule.
• NaF and some other fillers are also present for additional F release and
Radio opacity.
• There is no water in the formulation.
• Glass particles are partially silanated to ensure bonding.

62. SETTING
REACTION
Setting reaction occurs in 2 stages
• Stage 1: In contrast to RMGIC, a typical composite resin network around
filler particles forms on light activation .
• Stage II : occurs over 2-3 months when the water from the saliva gets
absorbed and initiates a slow acid base reaction with formation of hydro
gels within the resin and low level fluoride release.

63. Propeties
• ADHESION: to tooth requires acid –etching as acid base reaction for ion
exchange which requires water does not occur for some time after
placement.
• FLUORIDE RELEASE: is limited. It is significantly less than Type II or
RMGIC. F release usually starts after about 2-3 months; it peaks initially
andthen fallsrapidly
• PHYSICAL PROPERTIES: fracture toughness, flexural strength and wear
resistancearebetter than GICbut lessthan composite.

64. Indication
• P&Fsealant
• Restoration of primary teeth, class III and V lesions along with
cervicalabrasionsanderosionsand intermediaterestorations
• Basesforcomposites,liners
• Smallcorebuild ups
• Fillingof pot holes& undercutsinoldcrown preparations
• Rootsurfacesealing

65. • CONTRAINDICATIONS
• ClassIVlesions
• ConventionalclassIIcavities
• Lostcuspareas
• Restorationsinvolvinglargelabial surface
• ADVANTAGES
• Superiorworkingcharacteristicsto RMGIC
• Easeofuse
• Easilyadaptsto the tooth
• Goodesthetics

66. 5.Giomer
• Recently introduced hybrid esthetic restorative material.
• Chemically, it is fluroalumino silicate glass reacted with
polyalkeonic acid in water prior to inclusion into silica
filled urethane resin.
• Mainly indicated for restoration of root caries, cervical
caries, class V cavities, and also in restoration of primary
teeth.
• Advantages-continuous fluoride release
- clinical stability
- high biocompatibility
- highly esthetic
- ease of bonding

67. ZIRCONOMER
• Zirconomer defines a new class of restorative glass ionomer that
promises the strength and durability of amalgam with the protective
benefits of glass ionomer while completely eliminating the hazard of
mercury.
• Its is also called as “WHITEAMALGAM”.
• The inclusion of zirconia fillers in the glass component of Zirconomer
reinforces the structural integrity of the restoration and impartssuperior
mechanical properties for the restoration of posterior load bearing areas
where the conventional restorative of choice is amalgam.

68. Ideal for Restoration of
• Class I & II cavities
• Structural base in sandwich restorations
• All classes of cavities where radiopacity is a prime requirement
• Core build-up under indirect restorations
• Root surfaces where overdentures rest
• Pediatric and Geriatric restorations
• Long-term temporary replacement for fracturedcusps
• Fractured amalgam restoration
• Suitable for ARTtechniques

69. Zirconomer Benefits
• Reinforced with special zirconia fillers to match the strength and durabilityof
amalgam.
• Sustained high fluoride release for anti-cariogenic benefits especially incases
with high caries risk.
• Packable and condensable like amalgam without the hazard of mercury, the
risk of corrosion, expansion and thermal conductivity.
• High flexural modulus and compressive strength ensures longevity instress
bearing areas.

70. • Chemically bonds to enamel/dentin and has tooth-like co-efficient of
thermal expansion resulting in low interfacial stresses and long-lasting
restorations.
• Ceramic fillers impart remarkable radiopacity for accurate follow upand
diagnosis
• Adequate working time with snap-set reaction
• Easy mixing and handling characteristics minimize chair time and enables
ease of bulk placement
• Excellent resistance to abrasion and erosion

71. Calcium hydroxide

72. Definition
• Calcium hydroxide is a strong alkali, which can be
formed by the reaction of calcium oxide. If the oxide
is treated with only sufficient water to make it crumble
to a fine, white, dry powder slaked lime is produced.
• Synonyms: calcium hydrate, caustic lime
hydrated lime, lime hydrate, slaked lime.

73. Composition
Acidic paste
• Alkyl salicylate (iso-butyl salicylate or 1-methyl triethylene
salicylate)
• Inert fillers – titanium oxide 12-14%
• Radiopacifer – barium sulphate 32-35%
• Calcium tungstate or calcium sulphate 14-15%

74. Basic paste
• Calcium hydroxide 50-60%
• Zinc oxide 10%
• Zinc stearate 0.5%
• Ethylene toluene sulphonamides and paraffin oil 39.5%

75. Classification
Based on the setting time
• Fast setting
• Controlled setting
• Slow setting
• No setting

76. • Based on mechanism of setting
• Self curing – dycal
• Light curing – prisma VLC dycal
• Based on vehicle used
• Aqueous vehicle
Eg. Water, saline dental anesthetic, ringers solution, aqueous suspension
of methylcellulose.
• Viscous vehicle – ex. glycerine, polyethylene glycol and propylene glycol.
• Oily vehicles – Olive oil, oleic acid, linoleic and isostericacid.

77. • Can be supplied in powder form –
powder can be mixed with distilled water,
saline solution to form a thick paste and
applied as such.
• Can be supplied as two paste system, one
base paste another catalyst paste.
• Can be supplied as single paste (visible
light).
Mode of supply

78. Vehicles used for Ca(OH)2
According to Fava:
• Allow gradual & slow ionic release
• Allow slow diffusion in the tissues with low solubility in tissue
fluids
• Have no adverse effect on the hard tissue induction

79. Aqueous
• Water
• Sterile water
• Distilled water
• Sterile distilled water
• Saline or sterile saline
• Anesthetic solution
• Ringer’s solution
• Methyl cellulose & carboxy methyl cellulose
• Anionic detergent solution

80. Viscous
• Glycerin
• Polyethylene glycol
• Propylene glycol

81. OILY
• Olive oil
• Silicone oil
• Camphor(the essential oil of camphorated parachlorophenol)
• Metacresylacetate
• Some fatty acids such as oleic linoleic isostearic acids

82. Properties
• Arrangement is amorphous matrix, crystalline fillers.
• Bonding – covalent, ionic
• Setting reaction – acid base reaction
• Insulator of thermal and electrical conductivity.
• Solubility : 0.3 - 0.5
• Elastic modulus is 588.
• Compressive strength more than 24 hours is 138.

83. Mechanism of action
• HEITHERSAY (1975):
• Ca reduces the permeability of new capillaries
• Increases concentration of Ca 2+
• Decreases inhibitory pyrophosphatase
• Increases the activity of calcium dependent pyrophosphatase
• Uncontrolled mineralization

84. HYDROXYL GROUP FROM Ca(OH)2
• Local buffer
• Neutralises lactic acid- osteoclasts
• Osteogenic effect – high ph
• Availability of ca & phosphorus ions
• Activation of alkaline phosphatase

85. • Alkaline phosphatase
acts
• Esters of phosphate
liberates
• Inorganic phosphatase
• Phosphoric esters phosphate ions
phosphate ions + calcium in bloodstream
Calcium phosphate (molecular unit of hydroxyapatite)
mineralization

86. Advantages
• Initially bactericidal then bacteriostatic.
• Promotes healing and repair.
• High pH stimulates fibroblasts.
• Neutralizes low pH of acids.
• Stops internal resorption.
• Inexpensive and easy to use.

87. Disadvantages
• Does not exclusively stimulate dentinogenesis.
• Does exclusively stimulate reparative dentin.
• Associated with primary tooth resorption.
• May dissolve after one year with cavosurface dissolution.
• May degrade during acid etching.
• Degrades upon tooth flexure.
• Marginal failure with amalgam condensation.
• Does not adhere to dentin or resin restoration

88. Clinical applications
• Vital pulp therapy.
• Direct pulp capping.
• Indirect pulp capping.
• Pulpotomy.
• Apexogenesis.
• Routine intracanal dressing between appointments.
• Routine dressing.
• Long-term temporary dressing.
• Large periapical lesions –
• Non surgical endodontic treatment
• Treatment of divergent apex in a pulpless tooth
(Apexification).
• Control of persistent apical exudates into the canal.

89. • Prevention of root resorption.
• Idiopathic.
• Following the replacement of an avulsed tooth, or transplantation of a
tooth.
• Repair of iatrogenic perforations.
• Treatment of root fractures.
• Constituents of root canal sealers.

90. • AS ALINER
• The calcium hydroxide pastes are now in general use as lining
materials. Their
• perceived advantages, in addition to their therapeutic effects are as
follows:
• They have a rapid initial set in the cavity under the
accelerating effect of moisture.
• They do not interfere with the setting reaction of the Bis-GMA
resins.
• It is generally considered that the initial set of the material in thin
sections is sufficiently hard to resist the applied condensation
pressures that are required even for the lathe cut amalgam alloys..
In operative dentistry

91. • Calcium hydroxide can be used both as a sub base and as a base.
It should be placed deep in deep portions of the cavity preparation
subsequently covered by a definitive supporting base.
• It helps in repair of pulpal tissue
• It provides chemical insulation
• It replaces the lost portion of the dentin.
• Calcium hydroxide bases are of relatively of low strength when
compared to the other bases. These bases are used only for their
therapeutic benefits, chemical insulation or for retaining the sub
bases.
AS A BASE

92. • plays a major role as an inter-visit dressing in the disinfection of the
root canal system.
• Calcium hydroxide is normally used as slurry of Calcium hydroxide
in a water base.
• At body temperature less than 0.2% of Calcium hydroxide is
dissolved into
• ca++ and OH- ions.
• Calcium hydroxide needs water to dissolve. Therefore it
is most advantageous to use water as a vehicle for the Calcium
hydroxide paste.
CALCIUM HYDROXIDE AS
AN INTRACANAL
MEDICAMENT

93. Direct contact experiments in vitro require a 24 hour contact period
for complete kill of enterococci.
Calcium hydroxide not only kills bacteria, but it also reduces the
effect of the remaining cell wall material lipo-polysaccharide.
It should be mixed to a thick mixture to carry as much Calcium
hydroxide
particles as possible. This slurry is best applied with a lentulo-spiral.

94. • Calcium hydroxide must be dissociated into Ca++ and OH-.
Therefore to be effective, an endodontic sealer based on calcium
hydroxide must dissolve and the solid consequently lose content.
• Thus one major concern is that the calcium hydroxide content
dissolve, leaving obturation voids. This would ruin the function
of the sealer, because it would disintegrate in the tissue.
• Recently introduced several calcium hydroxide sealers are
sealapex(kerr),apexkit(vivadent).
CALCIUM HYDROXIDE AS AN
ENDODONTICSEALER

95. •Comparative studies reveal their mild cytotoxicity, but their
antibacterial effects are variable.
•Further research is required to establish the tissue healing
properties of calcium hydroxide in root canal sealers.

96. • Calcium hydroxide is generally accepted as the material of
choice for pulp capping.
• Histologically there is a complete dentinal bridging with healthy
radicular pulp under calcium hydroxide dressings.
• When calcium hydroxide is applied directly to pulp tissue there is
necrosis of adjacent pulp tissue and an inflammation of
contiguous tissue.
• Dentinal bridge formation occurs at the junction of necrotic
tissue and vital inflamed tissue. Beneath the region of necrosis,
cells of underlying pulp tissue differentiate into odontoblasts and
elaborate dentin matrix.
CALCIUM HYDROXIDE AS A PULP CAPPING
AGENT

97. Pulpadent paste is considered to be most capable of stimulating
early bridge formation.
Hydrex has been considered that fast capable of forming a bridge.
Commercially available compounds of calcium hydroxide in a
modified form are known to be less alkanine and thus less caustic
on the pulp.
The action of calcium hydroxide to form a dentin bridge appears
to be a result of the low grade irritation in the underlying pulp
tissue after application.
•Three main calcium hydroxide products are Pulpadent, Dycal and
Hydrex(MPC).

98. • In apexification technique canal is cleaned and disinfected, when
tooth is free of signs and symptoms of infection, the canal is
dried and filled with stiff mix of calcium hydroxide and CMCP.
• Commercial paste of calcium hydroxide (eg. Calasept, Pulpdent,
Hypocal, Calyxl) may be used to fill the canals.
• Histologically the formation of osteodentin after placement of
calcium hydroxide paste immediately on conclusion of a vital
pulpectomy has been reported.
CALCIUM HYDROXIDE
INAPEXIFICATION

99. •There appears to be a differentiation of adjacent connective tissue
cells; there is also deposition of calcified tissue adjacent to the
filling material.
•The calcified material is continuous with lateral root surfaces, the
closure of apex may be partial or complete but consistently has
minute communications with the periapical tissue.

100. • It is the most recommended pulpotomy medicament for pulpally
involved vital young permanent tooth with incomplete apices.
• It is acceptable because it promoted reparative dentin bridge
formation and thus radicular pulp vitality is maintained to allow
uninterrupted physiological completion of root and root canals
CALCIUM HYDROXIDE IN
PULPOTOMY

101. Histologically pulp tissue adjacent to calcium hydroxide was first
necrotized by the high pH of calcium hydroxide.
This necrosis was accompanied by the acute inflammatory changes
in the underlying tissue.
After 04 weeks a new odontoblastic layer and eventually a bridge of
dentin developed.
Three histologic zones under calcium hydroxide in 4-9 days:
1.Coagulation necrosis.
2.Deep staining areas with varied osteodentin.
3.Relatively normal pulp tissue, slightly hyperemic and
underlying an odontoblastic layer.

102. • Internal resorption may result from overstimulation of the primary
pulp by the highly alkaline calcium hydroxide.
• This alkaline induced overstimulation could cause metaplasia
within the pulp tissue, leading to formation of odontoclasts.
• Also undetected microleakage could allow large numbers of
bacteria to overwhelm the pulp and nullify the beneficial effects of
calcium hydroxide

103. • Calcium hydroxide incorporated in a methylcellulose base such
as pulpdent, showed earlier and more consistent bridging.
• At present calcium hydroxide pulpotomy technique cannot
be generally recommended for primary teeth.
• recommended agent for carious and traumatic exposures in young
permanent teeth, particularly with incomplete closure.

104. • Sometimes a tooth undergoing root canal treatment shows
constant clear or reddish exudate associated with periapical
radiolucency.
• Tooth can be asymptomatic or tender on percussion. When
opened in next appointment, exudates stops but it again reappear
in next appointment, this is known as “weeping canal”.
• For such teeth dry the canals with sterile absorbent paper points
and place calcium hydroxide in canal.
• It happens because pH of periapical tissues is acidic in weeping
stage which gets converted into basic pH by calcium hydroxide.
CALCIUM HYDROXIDE IN
WEEPING CANALS

105. • Calcium hydroxide can act even in the presence of blood and other
tissue exudates.
• It has a definite characteristics of producing ca ions, resulting
in less leakage at the capillary junction.
• It causes contraction of the pericapillary sphincters, thus resulting
in less
plasma outflow. Hence, it is the material of choice for weeping
canals.

106. Conclusion
“ Primary teeth are a temporary dentition with
known life expectancies of each tooth. By matching
the ‘right’ restoration with the expected lifespan of
the tooth, we can succeed in providing a ‘permanent’
restoration that will never have to be replaced.”

107. THANK YOU