Back to BisDent Globe Articles

 

BISCO TheraBase Case Report

bisco therabase

Compressive strength is an especially important factor to consider in choosing a base. A published study on dental bases reported that the compressive strength of both Dycal and VLC Dycal decreased significantly between the 24-hour and 90-day periods. In addition, of the three photosensitive GI base/liners tested, only Fuji Lining LC had significantly higher compressive strengths in all three time periods.1

This reinforces the importance of mechanical properties and their potential clinical significance. A weak dental base will eventually undermine the restoration.2 Studies of the interface between dental bases and the restorative materials have further discovered the potential incompatibility issues.3,4 Weak bond strengths between dental bases and restorative materials lead to “gap” formation upon polymerization which encourages microleakage and recurrent caries.5, 6

In addition, acidic glass ionomer products may prevent tricalcium silicate hydration and retard setting.3,8

The ideal base material would therefore have sufficient compressive strength, a satisfactory bond
to dentin, be dual curable for deep placement, similar properties as dentin, have a distinguishable radiopacity and be biological compatible with beneficial ion release.9-12

The patient presented as a healthy young male without distress concerned about a dark molar and previously reported dental history of “sensitivity’ post-operatively. Radiographic examination revealed a deep carious occlusal lesion of the mandibular second molar and the patient scheduled for a restorative procedure. At that appointment, the molar was anesthetized with Single Tooth Anesthesia (Milestone Scientific) and a rubber dam placed for isolation. The occlusal preparation uncovered deep dentin carious involvement. Full caries excavation removing all infected dentin was achieved with a round bur and a sharp spoon excavator. Undermined enamel was also removed by “beveling” with the round bur. 

large dark carious lesions

1. Large dark carious lesions of second molar that undermined the enamel and with chipped mesial lingual cusp.

bisco therabase case report figure four

2. Obvious deep caries evident that will require a strong base material.

bisco therabase case report figure five

3. All the dental caries have been removed and a retentive preparation completed.

Cannon4

4. TheraBase was placed to reinforce the enamel walls and to provide calcium ion release

After preparation, all debris was removed with a copious water spray and the dentin left moist for placement of a resin modified dicalcium/tricalcium silicate base/liner. The base was light-cured for 20 seconds but due to proprietary technology, it will continue to cure as a dual-cured material releasing calcium ions and maintaining an alkaline pH. This material may be utilized as a bulk filling base material and as a dentin replacement. A high viscosity acid etchant was placed on only the enamel margins for 30 seconds and then on the dentin for 3 seconds to remove the smear layer, but leaving the dentinal plugs, reducing the likelihood of post-operative sensitivity. All-Bond Universal® adhesive was then placed. Two coats were applied, and light-cured for 20 seconds. Reveal® HD Bulk, a bulk fill resin based composite was then injected into the cavity preparation and properly packed with a condenser to remove any air voids and to achieve marginal integrity. Preliminary anatomy was created with the “acorn” lateral condenser and the composite light-cured with a high output LED curing light (Demetron Demi). Final occlusal anatomy was accomplished with a R.A.P.T.O.R. bur and the surface polished with Rally polishers (Garrison).

bisco therabase case report figure three

5. Image of the dual cured, photo- initiated TheraBase and All-Bond Universal adhesive placed.
Please note the “glossy” finish with no voids apparent.

bisco therabase case report figure two

6. The gross anatomy was achieved with Raptor burs. The rubber dam is then removed.

large dark carious lesions

7. The occlusion was marked and the bite adjusted. The final polishing is completed with Rallye (Garrison) points.

TheraBase® has all the necessary properties for a successful dental base material.13, 14 However, the ease of placement and the universal applicability of TheraBase makes it an ideal material for a dentist’s operative armamentarium. The dental profession has historically used several dental base materials, such as, resin modified glass ionomers and calcium hydroxide cements that have not proved in research studies statistically superior from each other.15

Therefore, dental professionals should adopt the use of new resin-modified calcium silicate materials that have both superior physical and handling properties. 

 

REFERENCES

1. Lewis B. A., Burgess J. O., Gray S. E., Mechanical Properties of Dental Base Materials. American Journal of Dentistry

2. von Fraunhofer JA, Marshall KR, Holman BG. The effect of base/liner use on restoration leakage. Gen Dent. 2006;54(2):106-9.

3. Camilleri J. Scanning electron microscopic evaluation of the material interface of adjacent layers of dental materials. Dent Mater. 2011;27(9):870-8.

4. John NK, Manoj KV, Joseph B, Kuruvilla A, Faizal N, Babu BS. A comparative evaluation of the internal adaptation of various lining materials to dentin under light cure composite restorations: A scanning electron microscope study. J Int Oral Health. 2017;9(1):6-11

5. Chen L, Cannon M, Suh BI. SEM and bond strength evaluation of adaptation between liners-composites. J Dent Res. 2015;31(1):e7-8.

6. Chen L, Cho A, Cannon M, Suh BI. Effects of RMGI liners overlaid on resin-modified calcium silicate materials. International Association of Dental Research. J Dent Res. Abstract. 2018.

7. Altinci, P., Mutluay, M., Tjäderhane, L., & Tezvergil-Mutluay, A. (2018). Effect of calcium fluoride on the activity of dentin matrix-bound enzymes. Archives of oral biology, 96, 162–168. https://doi.org/10.1016/j.archoralbio.2018.09.006

8. Yavari HR, Borna Z, Rahimi S., Shahi S, Valizadeh H, Ghojazadeh M. Placement in an acidic environment increase the solubility of white mineral trioxide aggregate. J Conserv Dent. 2013;16(3):257-60.

9. Gandolfi MG, Siboni F, Botero T, et al. Calcium silicate and calcium hydroxide materials for pulp capping: biointeractivity, porosity, solubility and bioactivity of current formulations. J Appl Biomater Funct Mater. 2015;13(1):43-60.

10. 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.

11. Profeta AC. Preparation and properties of calcium-silicate filled resins for dental restoration. Part II: micro-mechanical behaviour to primed mineral-depleted dentine. Acta Odontol Scand. 2014;72(8):607-617.

12. Prati C, Gandolfi MG. Calcium silicate bioactive cements: Biological perspectives and clinical applications. Dent Mater. 2015;31(4):351-370.

13. Cannon M. L. How to use cavity liners to provide better care. Dental Products Review. April 2018.

14. Cannon M. L. The Routine Use of Incompatible Dental Materials in Dentistry- Why? Dental Learning. May 2021.

15. Mickenautsch S., Yengopala V., Banerjee A., Pulp response to resin-modified glass ionomer and calcium hydroxide cements in deep cavities: A quantitative systematic review. Dental Materials Volume 26, Issue 8, August 2010, Pages 761-770

Courtesy of Dr Mark Cannon.

Summer 2021

 

Back to BisDent Globe Articles