Has Calcium Hydroxide Met Its Match from the New Bio-Adhesive Cavity Liners?

Dental practice has for decades utilized calcium hydroxide as a material for pulp capping and cavity lining. This use is based upon: the biological response of the pulp to isolate itself from calcium hydroxide, and that after initial cell necrosis, the pulp produces “reparative” dentin as a barrier between the pulp and the calcium hydroxide.

One of the statements about biological repair that I learned along the way was that “we” have a much better system of dealing with acidic challenges as opposed to basic challenges. Meaning our bodies can deal with acids much better than bases. Feel free to challenge me on this point, or add some factual detail. My primary assertion here is that the “healing” produced by calcium hydroxide may not be the best stimulus to result in an ideal, healthy situation. For example, continuous insult or injury from calcium hydroxide can result in de-vitalization of the tooth and end in complete calcification of the tooth. I hear you, some are already saying maybe that is not a bad thing.

No calcium hydroxide liner can really claim to be bio-compatible, it “works” by killing every cell in sight. Try putting any pH 14 material in a Petrie dish of cells and see what happens next. Thus the need for palliative basing materials such as zinc oxide -eugenol to as we say “quiet down” the pulp. Again, place a nano-scale amount of eugenol in a Petrie dish and see what happens, i.e. eugenol is one of the most toxic compounds known. As a tooth pain relieving treatment this dates back centuries. My premise: as much as I like eugenol, there must be a better way.

Another major disadvantage in use of the calcium hydroxide liners, or even calcium silicate (Portland Type III Cement), is that they have very little or no adhesion to dentin, and as a consequence often come loose when placing a composite material over them, let alone condense an amalgam on top of them, as we once did.

Within the last decade, dental material products now contain needed components to aide in tissue accommodation, such as in re-mineralization with amorphous calcium phosphate (ACP). These compounds have been used in some sealants and in some composites for quite a while. A few companies are now advertising them as “bio-active”.

There has been a new class of cavity liners that have been introduced that follow this approach, one of providing essential components for repair such as calcium, that are bio-compatible, and are also bio-adhesive. Bio-adhesive being defined as a material that is both bio-compatible and has biologically active adhesive components. These new cavity liners are also highly radio-opaque, with an aluminum equivalent of 3.5 mm, meeting the ISO 4049 standard to be classified as radio-opaque, using the more stringent endodontic requirement. This radio-opacity allows them to be easily observed in comparison to dentin and enamel.

Want more? In addition these new cavity liners are truly anti-bacterial, bacteria being a primary cause of sensitivity associated with secondary caries. These new cavity liners handle much better that the older calcium hydroxide liners or calcium silicates, and are esthetic compared to the grey calcium silicate liners.

So, I encourage you to take a look at this new group of cavity liners based upon the biological principles of bio-compatibility and bio-adhesion.

www.DenaliCorporation.com/SuperLiner.htm

 

"I'm Glad I Waited" - Cements Developed for Implants

Many years ago, the field of implantology took major steps towards the success that it is now enjoying. Around 10 years ago, after this success I considered developing a product for the cementation of implant crowns.

I am glad I waited! Today one of the biggest causes of implant failure is due to cement induced peri-implantitis.

There are many reasons why cements are now one of the biggest reasons for implant failure.

From a biological perspective, the tooth socket no longer has a periodontal ligament, a natural barrier that reduces excess cement accumulation.

From a placement perspective implants may not initially be as stable as a natural tooth with potential greater mobility and compression during crown seating, again allowing for excess cement to be extruded into the “sulcus”. Cement visualization may also be complicated by pink colored cements, making excess cement removal difficult.

From a practice perspective, reluctance exists by some to select a permanent cement, and choose to use a temporary cement while keeping the option open to remove the crown, if needed. Temporary cements by design are weak and often crumbly, making again excess cement removal more difficult in having to remove all of these little bits and pieces.

Finally, nearly ALL implant cements are NOT radio-opaque, making their diagnostic observation impossible. I know that some readers may believe their cement is radio-opaque because it says so on the package, I also did at one time. For this proof, I cite  “Radiographic Appearance of Commonly Used Cements in Implant Dentistry”, Pette, G.A., Ganeles, J., and Norkin, F.J., Intl J Periodontics Restorative Dentistry, 2013, Jan-Feb 33(1):61-8., a publication which evaluates this claim. The authors concluded that these cements “are not radiographically detectable at an appropriate sample thickness”.

How would you know if your cement is radio-opaque if you can’t see it? After observing tissue inflammation is not the time to learn that your cement is not radio-opaque. This paper and the development of a new generation of implant cements are based on a 350% level of radio-opacity, not at the < 100% aluminum equivalent that are cited in this paper.

And if this is not enough, in a healing and already compromised environment, almost all implant cements are not anti-bacterial, allowing weak, crumbly, porous excess cement to be a site for bacterial growth.

All of these conditions can lead to inflammation, tissue breakdown, and cement induced peri-implantitis.

So, in 10 years, we have learned a lot as to what an implant cement should provide.

Still wondering about the importance of cement induced peri-implantitis, just look at the websites of some of the leading implant companies to see their cases of peri-implantitis, a problem which I can assure you they want to go away. This is a topic of another blog, someday.

To solve these problems, a current generation of true implant cements has emerged. These products are long-term cements, not weak, soluble, crumbly temporary cements; they are strong, but retrievable; they are enamel or dentin colored; they should be at least 350% aluminum equivalent radio-opaque; and they are anti-bacterial.

I encourage both new practitioners and experienced implantologists to learn more about these cements and avoid the all too common problem of trying to retrieve excess cement that they can not see, until its too late.

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One such product that solves this problem is Harmony Implant Cement.

To learn about its qualities and benefits, please visit www.DenaliCorporation.com.