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Reviewers Give High Marks to BISCO's New Base
Calcium-releasing bases and liners protect the integrity of the tooth and its restoration. They help to maintain pulp vitality and reduce postoperative sensitivity.1 They also provide insulation from the restorative materials placed on the surface of the tooth and the temperature and stress variations placed upon the tooth.
BISCO Dental’s TheraBase is a new dual-cured, calcium- and fluoride- releasing self-adhesive liner and base. It is hydrophilic and reacts with the tooth by releasing and recharging calcium and fluoride ions.* It also helps to promote a basic pH* (Figure 1). The self-etching, self-adhesive base simplifies the process by eliminating a separate etching and rinsing step, thus reducing the risk of postoperative sensitivity. Heat produced from the curing light is easily transmitted through clear bonding agents into deeper areas of the tooth, possibly raising pulpal temperatures and increasing the chance of negative pulpal effects.2 TheraBase’s self-adhesive property eliminates the need for a separate bonding agent in the deepest areas and covers deep dentin with an opaque protective material. Its physical advantages include good compressive strength and bond strength because it contains 10-Methacryloyloxydecyl dihydrogen phosphate (MDP), which is known to provide reliable and optimal bonding to dentin. The base is radiopaque and easily viewable on radiographs.
Twenty members of Catapult Education participated in the review. They were asked about their use, desired characteristics, and preferred materials for liners and bases. Almost all the evaluators utilize liners or bases. A vast majority of respondents use them any time a restoration depth extends well into dentin or when there is concerned risk of postoperative sensitivity. And 95% reported using a base when the final preparation is within 1 mm of the pulp, when affected dentin remains, or when questionable dentin is left in order to avoid pulpal exposure.
Compressive strength was selected by half of the evaluators as the No. 1 desirable characteristic. Other top choices included ease of use, fluoride release, the ability to dual cure the material, and calcium release.
There was a difference of opinion regarding the preferred materials for liners and bases. Flowable composite resins were used by two-thirds of those surveyed, whereas resin-modified glass ionomer and glass ionomers were used by 35% and 25% respectively, showing that some utilized multiple materials in their practices. Within that group is a smaller group of practitioners who use glass ionomer or resin-modified glass ionomer liners and bases for a majority of their restorations. Fluoride release, consistent (but lower) bond strengths, and reduced postoperative sensitivity are often cited as their motivations. However, because of their decreased strengths, many prefer a resin-based alternative. The properties of TheraBase allow most of these concerns to be met with a stronger material.
How did TheraBase rate according to the above preferences? The ease of use was rated excellent by a majority of evaluators. The working and setting time was rated as excellent or good by 90%. Ability to light cure, ease of dispensing, and placement were benefits highlighted by the group. Ultimately, 100% of the reviewers said that TheraBase would be incorporated into their practices. Positive comments included: “This is my new go-to material,” “Slick delivery tips,” “Stays where you put it,” and “I love it because it has every characteristic I need.”
TheraBase comes in an automix dual syringe with small disposable cannula tips that allow easy placement. The tooth should be excavated, and decay removed. The tooth structure should be irrigated with chlorhexidine and then excess moisture removed. If the preparation is within 1 mm of the pulp, TheraCal LC should be placed as a separate step (Figure 2). TheraCal LC provides significant calcium release,3** stimulates hydroxyapatite and secondary bridge formation,4,5 and promotes healing.1,4 TheraBase is expressed onto the dentin and allowed to self-cure or light cured for 20 seconds (Figure 3). Excess material can easily be removed prior to placement of phosphoric acid and bonding. The definitive composite restoration is placed over the base, shaped, and polished (Figure 4).
A patient presented to the office and interproximal decay was detected in the radiographs. An initial preparation through the enamel was performed to confirm the presence of decay on his lower first molar (Figure 5). The tooth was excavated and decay was removed (Figure 6). There was significant deep decay. The preparation was irrigated with chlorhexidine and excess moisture was removed. A thin layer of TheraCal LC was placed and light cured. TheraBase was placed and light cured (Figure 7). A sectional matrix (Garrison Dental Composi-tight) was placed (Figure 8). A bulk-fill composite (SonicFill 3, Kerr) was placed, cured, shaped, and polished (Figure 9).
TheraBase is a welcome addition to our choices of bases and liners. It is effective and easy to use. Catapult Education is pleased to offer a resounding vote of confidence to TheraBase, and it is highly recommended for use in your clinical practice.
CASES BY: Daniel H. Ward, DDS
1. Unique hydrophilic TheraBase Matrix
4. Completed Composite Restoration
5. Initial preparation through enamel to locate carious lesion
6. Final Class II preparation
7. TheraBase placed
8. Sectional Matrix placed
9. Completed Class II Composite Restoration
*Data on file.
**BISCO has the calcium release data for TheraCal LC on file.
REFERENCES
1. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod. 2006;32(3):198-201. doi:10.1016/j.joen.2005.10.041
2. Vinagre A, Ramos JC, Rebelo C, et al. Pulp tem- perature rise induced by light-emitting diode light- curing units using an ex vivo model. Materials (Basel). 2019;12(3):411. doi:10.3390/ma12030411
3. Gandolfi MG, Siboni F, Prati C. Chemical- physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012;45(6):571-579. doi:10.1111/j.1365-2591.2012.02013.x
4. The American Dental Association. Glossary of dental and clinical administrative terms. Accessed July 1, 2021. https:// www.ada.org/en/publications/cdt/ glossary-of-dental-clinical-and-administra-tive-terms
5. Gandolfi MG, Siboni F, Taddei P, Pradi C. Apatite- forming ability of TheraCal pulp-capping material. Paper presented at: IADR General Session 2011; March 18, 2011; San Diego, CA.
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