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New Filler Technology Leads to a Clinical Breakthrough
Restorative dentistry is evolving and clinicians are embracing more conservative and protective materials in their practices. There is no need to unnecessarily remove tooth structure in order to generate retention due to the advancements of bonding techniques and protocols. And even though, tooth preparations need to follow certain guidelines, much can be achieved with adhesive dentistry conservatively. Another approach is offering protective treatment utilizing materials that are more tissue friendly and provide some sort of interaction between the material and the remaining tooth structure. Mineral Trioxide Aggregate (MTA) is one such material.
Introduced in the 1990´s, MTA became a revolutionary material in endodontics. Many studies have shown its effectiveness in clinical applications such as perforation repairs, apexifications, pulpotomies and pulp capping. After its success as an endodontic material, companies started developing products that could be used in restorative dentistry with the compelling effects on tooth structure that MTA offers.
Products like BISCO’s TheraCal LC® resin-modified calcium silicate pulp protectant/liner has been successfully received by dental professionals like yourself. TheraCal LC contains similar ingredients of MTA, such as calcium silicate, which are responsible for providing the ability for hydroxyapatite crystal deposition upon contact with the dentin structure1. This type of reaction became possible due to the development of a new resin and filler technology. In order for this reaction to occur, resin must be hydrophilic to allow ion exchange between TheraCal LC and the dentin structure, however, it also needs to remain structurally sound over time (less soluble). The ease of use of TheraCal LC (light cured, controlled dispensing from a syringe) allows clinicians to be more accurate regarding the placement of the material, mixing and without setting prematurely.
This filler technology has opened a new door for product development. Now it has become possible to develop materials that can contain products like calcium and fluoride, which can be released via an ion exchange.
The roll of calcium in the generation of an alkaline pH and protective properties2,3,4,5,6 of the dentin/pulpal complex has been documented over the course of decades. It is well known by dentists, both clinicians and researchers, that calcium ions when released upon contact with the tooth structure will have a positive effect in the recovery of the pulp and tooth.
BISCO took this research and focused on the development of a new generation of self-adhesive cements that not only bonds to dentin, enamel, zirconia, metal and composite without the use of an additional primer, but also provides calcium and fluoride release to the tooth structure.
THERACEM was born! TheraCem® self-adhesive resin cement is not only convenient to use because it will bond to zirconia and most substrates with no priming or etching required, but most important, it will release calcium and fluoride ions, providing an alkaline pH after 30 minutes of polymerization7. TheraCem contains MDP, a functional or adhesion promoting monomer, as part of its formulation. MDP is responsible for achieving a strong bond without the use of additional primers to the restorative surface. TheraCem is dual-cured, easy to clean and it provides an alkaline pH.
These new materials, that are more compatible with the tooth, will certainly lead to the development of new technology, which should aim at protecting the remaining dental structure, and in some way, aid in the remineralization of the tooth. And whether these materials are intended to be used as pulp capping agents, liners, bases or cements, they will have an impact on the clinical approach of restorative dentistry and our patients. The age of “drill and fill” is over.
1. ADA definitions for direct and indirect pulp capping at:
www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter
2. Clinical and Radiographic comparison of indirect pulp treatment using light cure calcium silicate and Mineral Trioxide Aggregate on primary molars. A randomized clinical trial. Contemp. Clinical Dentistry 2016. Oct-Dec. 7(4) 475-480
3. Okabe T, Sakamoto M, Takeuchi H, Matsushima K (2006) Effects of pH on mineralization ability of human dental pulp cells. Journal of Endodontics 32, 198-2013
4. Sangwan P; Sangwan A; Duhan J; Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013; 46(1):3-195.
5. Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015 Winter;39(2):143-8.
6. Mechanical Properties of New Dental Pulp-Capping Materials Over Time. M. NIELSEN, R. VANDERWEELE, J. CASEY, and K. VANDEWALLE, USAF, JBSA-Lackland, TX, , J Dent Res 93(Spec Iss A): 495, 2014 (www.dentalresearch.org)
7. New Self-adhesive Resin Cement With Alkaline pH. Chen L, Gleave C, Suh B, J Dent Res96(A):#286, 2017.
Courtesy of Dr. Rolando Nunez
Fall 2017 BisDent Globe, Volume XXI1I, Issue II
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