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23 Operative > 19 - Pulp Biology, Liners, and Bases > Flashcards

19 - Pulp Biology, Liners, and Bases Flashcards

1
Q

main functions of the pulp

A
  1. create dentin
  2. nutrition
  3. keep dentin layer HEALTHY by providing MOISTURE and essential NUTRIENTS
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2
Q

what nutrients do the pulp provide to dentin

A

albumin and fibrinogen

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3
Q

what are the 3 general types of pulpal cells

A
  1. formative
  2. defense
  3. reserve
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4
Q

what are the formative pulpal cells

A

odontoblast and fibroblasts

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5
Q

what cell:

Primary function is secretion of dentin during dentinogenesis.
Tooth development and the mature tooth

A

odontoblast

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6
Q

what cell:

the most abundant cell type in the dental pulp, aids in wound healing following pulp exposure.
Abundant in cell rich zone

A

fibroblasts

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7
Q

what cell:

Express all complement proteins, including the membrane attack
complex (MAC), allowing the lysis of cariogenic bacteria.

A

fibroblast

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8
Q

what are the defense cells

A

macrophages, histiocytes, and lymphocytes

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9
Q

what cells are undiferentiated mesenchymal cells that can develop into odontoblasts and/or fibroblasts

A

reserve

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10
Q

what are important regions during dentinogenesis

A

pre dentin and mature dentin

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11
Q

what is D, P, and arrows?

A

D = mature dentin
P = pre dentin

arrows = cell bodies of odontoblasts found at edge of pulp in columnar arragement

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12
Q

what are the layers of the pulp

A
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13
Q

how many levels of pulpal response

A

3!

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14
Q

what level of pulpal response:

Tubular sclerosis with formation of peritubular dentin
Tertiary dentine is focally secreted by odontoblasts positioned
beneath injured dentine tubules or a pulp exposure in
response to primary and secondary dentine injury.

A

Level 1

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15
Q

what level of pulpal response:

odontoblastic process and/or cell body death

A

level 2

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16
Q

what level of pulpal response:

inflammation and necrosis

A

level 3

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17
Q

what level has sclerotis dentin

A

level 1 pulpal response

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18
Q

what level of pulpal response:

  • dentinal tubules become sclerosed and filled w/ peritubular dentin
  • in response to slowly advancing irritant
  • narrows lumen of tubule to decrease dentin permeability
A

level 1

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19
Q

what is a slowly formed dentin that constrict dimensions of PULP CHAMBER? does this continue thru life?

A

Secondary dentin - YES!

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20
Q

what level:

Death of odontoblastic process
Eventually, death of cell body
Response to intermediate stimulus

A

level 2 pulpal response

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21
Q

level 2 pulpal response can lead to differentiation of new odontoblasts producing what

A

reparative dentin on pulpal wall = tertiary dentin

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22
Q

if only odontoblastic process dies, an empty dentinal tubule is left called what

A

dead tract

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23
Q

what are types of reactionary dentin

A
  1. tertiary
  2. reparative
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24
Q

Tertiary Dentin caused by externalstimulus, reactivates the dentinogenic activity of ___.

A

pre-existing odontoblasts

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25
Q

what functions as a biological seal stimulated by CaOH

A

reparative dentin

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26
Q

tertiary dentin is generated by what cells?

A

osteoblast like replacement cells (odontoblast is dead)

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27
Q

what pulpal response:

Pulpal inflammation and DEATH in
response to severe irritation

A

level 3

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28
Q

what pulpal response:

Due to acute caries, careless preparation or
improper material selection
The pulpal response can change from
reversible to irreversible as a result of
bacterial invasion or trauma

A

level 3 pulpal response

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29
Q

factors the influence level of response

A
  1. intensity of stimulus
  2. adequacy of pulpal blood supply
  3. cumulative effect of previous injuries
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30
Q

effects of aging on pulp

A
  1. Increased fibrosis and decreased cellularity
  2. Decreased circulation
  3. Lesser capability to repair
  4. Pulps of young teeth more susceptible to injury from cavity preparation because they are larger
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31
Q

pulps of [older or younger] people are more susceptible to injury from cavity preparation because they are larger. they are [more or less] likely to recover

A

young; more

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32
Q

hydrodynamic theory of pain contends that many pulpal response are result of what

A

dentinal tubular flow

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33
Q

what are certain treatments that occlude tubules that should prevent fluid flow and reduce pain? how does it do this

A

fluoride - reacts with Ca in dentinal fluid to form CaF

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34
Q

what triggers a pulpal response

A

stimulus

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35
Q

what are examples of pulpal injury caused by dentinst

A

Local Anesthesia
Frictional Heat
Light Curing Units
Dentin Desiccation (dehydration)
Exposure to Toxic Materials
Bacterial Contamination

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36
Q

how can you generate heat during cavity preparation

A
  1. rotational speed
  2. pressure exerted
  3. area of surface contact by instrument
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37
Q

how heat is generated w/ rotational speed

A

higher rpm = more heat

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38
Q

how heat is generated w/ pressure exursion

A

more force = more heat
w/ electric handpieces you get more torque (won’t stall out) so you can exert more force

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39
Q

how does the area of surface contact by instrument generate heat

A

larger burs = more heat, due to greater surface contact

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40
Q

elevating pulpal temperature by what temp can cause coagulation necrosis

A

10 C

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41
Q

steps to avoid head generation during cavity prep

A

Use Sharp Burs
Use Intermittent Pressure
Use a Coolant

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42
Q

what is the 3 coolant system (what is most effective and least effective)

A

Air/water - most effective
Water
Air- least effective

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43
Q

how can dentin by dehydrated

A

heat build up or over drying

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44
Q

T/F: tissue fluid from tubule creeps toward the dry surface because of capillary action

A

true

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45
Q

can pulpal tissue tolerate minor amounts of dehydration

A

YES

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46
Q

what happens during dehydration

A

a strong capillary actionaspirates the odontoblastic cell body into the tubule

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47
Q

once the cell body is aspirated into the tubule, what happens to the odontoblast

A

DIES

48
Q

Death followed by decomposition with infiltration of the pulp with cellular breakdown products produces ___

A

inflammation

49
Q

after dehydration, healthy pulp may recober by generating what odontoblasts

A

seocndary odontoblasts to produce reparative dentin

50
Q

what pulp may not recover after dehydration

A

non-healthy pulp or aging pulp

51
Q

what is the goal of proteting pulp

A

protect from unwanted side effects of restorative material and restorative process

52
Q

what do we need to protect the dental pulp from

A
  1. acidity of certain materials (zinc phosphate cement)
  2. thermal conductivity of certain materials (amalgam and gold)
53
Q

what are toxic chemical materials in dentistry

A

primarily acidic materials: ZnPhos, GIC, resins

54
Q

what are types of chemical damage

A
  1. direct damage
  2. indirect damage
55
Q

what is direct chemical damage

A

material itself causes damage

56
Q

what is indirect chemical damage

A
  1. Material does not cause damage, but alters conditions SO that some other factor can cause damage
  2. Bacterial leakage and contamination
57
Q

are dentinst capable of stimulating pulpal injury thru bacterial contaimination

A

yes

58
Q

what are sources of bacteria causing pulpal injury

A

Microleakage
Incomplete caries removal
Poor field isolation (Saliva)

59
Q

what is one of the only restorative materials capable of chemically bonding to tooth structure

A

glass ionomer

60
Q

what is microleakage

A

fluid, debris, micro-organisms can seep into the tooth-restoration interface
Seepage = microleakage

61
Q

is there adhesion beteween amalgam and tooth structure

A

no

62
Q

what are potential causes of gap formation in amalgam

A
  1. NO adhesion between amalgam and tooth structure
  2. Differences in coefficients of thermal expansion- amalgam vs tooth structure
  3. Dimensional changes during the setting reaction
  4. Inadequate condensation - NO MATTER HOW HARD YOU CONDENSE
  5. Trituration time Excessive contraction with excessive trituration
  6. Improper insertion and condensation
  7. Alloy particles
63
Q

what is the primary corrosion product in aged amalgam

A

silver sulfide

64
Q

what is the potential cause of leakage in composite

A
  1. Lack of adhesion between composite and tooth structure
  2. Dimensional changes during the setting reaction
  3. Curing shrinkage
  4. Bulk fill
  5. Improper insertion
  6. Saliva contamination
65
Q

what is the most corrosive phase in corrision

A

The copper-tin phase which replaces the gamma-2 phase is the most corrosive.

66
Q

A high-copper corrosion-resistant amalgam with a small initial gap can seal as rapidly as a _____

A

traditional low-copper corrosion-prone amalgam with a high initial gap.

67
Q

in a low-copper amalgam system, the most corrodible phase is what

A

tin-mercury (gamma-2) phase

68
Q

Burnishing the amalgam toward the
cavosurface has been shown to [enhanve or reduce] the EARLY microleakage associated with SA

A

REDUCE

69
Q

T/F: Studies show that double burnishing, pre- carve and post-carve is LESS effective than either one alone in reducing microleakage

A

FALSE! MORE EFFECTIVE!

70
Q

T/F: Evidence suggest that properly placed composites placed with proper application of adhesive, incrementally place to minimize stress at the cavo surface margin perform well with respect to leakage at the margins. Margins in dentine generated less reliable resistance to leakage.

A

true

71
Q

the combined ionomer-composite restorationop rovides what

A
  1. chemical bond to dentin
  2. micromechanical bonding of composite to ionomer surface
  3. acceptable esthetic result
72
Q

can heat and cold be transmitted toward the pulp thru metallic restorations

A

YES

73
Q

thermal diffusion thru material is a function of what parameters

A
  1. thermal conductivity of material
  2. thickness of material
74
Q

what are poor thermal condutors?

A

dentin and composites

75
Q

what thickness of dentin will minimize effects of microleakage

A

2.0 mm dentin

76
Q

as dentin thickness [increases or decreaess] the severity of microleakage decreases

A

INCREASES

77
Q

what is the single most important factors in protecting the pulp

A

remaining dentin thickness

78
Q

what are the indications for the use of intermediary materials

A
  1. Pulpal repair
  2. Prevention of toxic effects of materials- acid etching
  3. Thermal protection
  4. Electrical protection (Galvanic shock)
  5. Foundation to condense against
  6. Esthetics
  7. “Block out” of undercuts/indirect restorations
79
Q

what is a liquid primer like material that seals dentin surface prior to placing definitive restorative materials

A

cavity sealer

80
Q

what are current products used as cavity sealers? what are they used under

A

used under silver amalgam:
Gluma Desensitizer and G5 desensitizer

81
Q

what do sealers contain that are effective sealing agents for dentin

A

HEMA and glutaraldehyde

82
Q

examples of sealer products

A

Prime & Bond NT (used at CU)
Optibond
Scotchbond
Singlebond
Gluma
G5

83
Q

order of sealers, bases and liners from thinnest to thickest

A

sealer -> liner -> base

84
Q

what is usually a liner

A

CaOH or glass ionomer product

85
Q

what is applied in htin layer 0.5 mm and is a protective barrier between dentin and restorative material

A

liner

86
Q

what is:

Compatible with all restorative materials
Chemically bond to dentin (close adaptation)
Good thermal insulation
Light cured
Impregnated with CAOH

A

dimethacrylate liners

87
Q

what are dimethacrylate liners impregnated with

A

CaOH

88
Q

why does CaOH have a high pH (9-14) alkaline environment

A

Antibacterial
Promotes Odontoblastic Activity
Promote Sclerosis
o Reduce permeability

89
Q

CaOH must contact what or be within ___mm to be effective

A

contact pulp or within 1 mm

90
Q

if CaOH directly contacts to pulp what happens

A

leads to irritation and stimulates production of secondary dentin

91
Q

only direct pulp cap what tooth

A

asymptomatic tooth with no evidence of PA pathology

92
Q

how to apply CaOH to pulpal exposure? what is the best way

A

application instruments, perio probe, or directly out of syringe with clean tip (but flows too rapidly)

PERIO PROBE IS BEST WAY

93
Q

what is a substance under a resotration that:

blocks out undercuts in the preparation,
acts as a thermal or chemical barrier to the pulp,
controls the thickness of the overlying restoration

A

base

94
Q

what is the thickness of base

A

usually any thickness but usually 2 mm

95
Q

what are examples of bases

A
  1. ZOE /IRM-not used much anymore
  2. ZnPhosphate Cement
  3. Glass lonomers: Fuji IX sets in 3 min 35 sec, Fuji II LC (light cure), Vitrebond - light cured
  4. Ultrablend or Vitrebond (can be used as a liner or a base)
96
Q

what material is this:

A Bioactive liner and pulp capping material
Compatible with all restorative materials
Chemically bond to dentin ???
Good thermal insulation
VLC cure (light cured) Radiopaque
Impregnated with CAOH

A

dimethacrylate liner/base ultrablend

97
Q

what material is this:

INTRODUCED TO PROFESSION IN 1970s
Favorable properties
Biocompatibility
Chemical Adhesion
Fluoride release
Bonds to dentine- chemical
Hydroxyl ions chelate with Calcium

A

glass ionomer cements glass polyalkenoate

98
Q

what are the liquid and powder composition of glass ionomer

A

liquid = polyacrylic acid
powder = aluminosilicate class

99
Q

what part of glass ionomer provides chemical bond to clacium of denitn which results in chemical bond to tooth structure and bonds to first calcium ion it contacts

A

polyacrylic acid (liquid)

100
Q

what part of glass ionomer releases fluoride

A

alumino-silicate glass (powder)

101
Q

for glass ionomer to be “TRUE”, the constituents when mixed must result in what? not what?

A

must eraults in acid-base reaction (not light cure)

102
Q

when to use cavity conditioner

A

when glass ionomer used as permanent restoration

103
Q

how long do you scrub cavity conditioner with cotton pellet into prep

A

20 seconds

104
Q

what is a mild polyacrylic acid solution that removes smear layer and acquired pellicle

A

cavity conditioner

105
Q

what increases bond strength between glass ionomer and tooth structure

A

cavity conditioner

106
Q

what is this:

1-2microns thick
Surface accumulation of debris
Organic and inorganic components
Dentine chips
Odontoblastic remnants

A

smear layer

107
Q

what is this:

A glycoprotein film
High in Calcium ions
From saliva
Forms on the surface of enamel and dentin in seconds
It forms Does NOT rinse off

A

dental pellicle or acquired pellicle

108
Q

the surface of enamel and dentin attract what the creates the pellicle layer

A

salivary glycoproteins and bacterial products

109
Q

how to use dentin conditioner

A

Use on all dentin to be covered
Pre-treat with polyacrylic acid conditioner.
Significantly increases the ionic bond to dentin.
Removes the acquired pellicle and smear layer. Or will bond to PELLICLE.
Use a small cotton pellet to scrub the surface of the tooth.

110
Q

advantages of GI bases

A
  1. Fluoride Release
  2. Minimal Solubility
  3. Bond to Tooth Structure (lonic Bonding to Calcium and Phosphate, Chemical bond to dentin through attachment to calcium
    carboxyl group to Ca+)
  4. Good Strength (Can condense SA against it)
  5. Radio-opaque
111
Q

advantages of GI

A
  1. biocompatible (must have 1 mm of dentin between GI and pulp)
  2. reduces post-op sensitivity with resins (no gap beneath restoration and tooth, no gap = no flexion = no pumping of tubular fluid)
112
Q

disadvantages of GI

A

extreme moisture sensitivity!!!

  1. If water absorbed during initial set, becomes chalky and soft (autocure)
  2. If dehydrate, crack and craze (both autocure and VLC)
  3. Short working time (autocure)
  4. Does not stimulate pulpal repair
113
Q

what is a composite material consisting of cermaic and metallic materials

A

CERMET

114
Q

what is this:

  1. glass ionomer cement with 100% fine
    silver alloy powder
  2. has high temperature resistance and
    hardness
  3. metal has the ability to undergo plastic
    deformation.
  4. High Radiopacity and strong color contrast
  5. releases Fluoride
A

CERMET

115
Q

what material:

Releases Fluoride
Bonds with calcium
- Will bond to Acquired Pellicle
- Remove Acquired Pellicle prior to cementation
Low solubility

A

crown cementation - resin modified glass ionomer cement

23 Operative (15 decks)

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