Materials for Base Liners

Application of insulating bases in vital amputation

Vital amputation is a dental technique consisting of the partial removal of the neurovascular bundle. During this procedure, exclusively the coronal pulp and/or the portion located in the root canal orifices is subject to removal.

Once the main surgical phase is completed, the crucial final stage of treatment begins, requiring the use of special base materials. It is at this stage that an insulating base is applied. The dentist's actions are strictly regulated: first, a specialized therapeutic base is applied, directly on top of which the insulating base is placed to act as a separating barrier. This treatment process concludes with the placement of a filling. Depending on the clinical picture, this filling may be either temporary or permanent.

Topographic diagram of devitalized amputation

The devitalized amputation technique requires the use of a complex array of various dental preparations. These materials are used in a strict sequence dictated by the specific topographic layout of the layers within the tooth cavity. The entire algorithm includes the following stages:

1. Application of arsenic paste — this preparation is necessary for the initial devitalization of the tissues.
2. Placement of a cotton pellet soaked in a special anesthetic liquid.
3. Application of water-based dentin, which functions as a reliable temporary dressing.
4. Introduction of an impregnating solution or suspension directly into the canal orifice.
5. Preservation of the anatomical structure of the tooth itself — dentin.
6. Application of a plastic, subsequently hardening paste intended for root canal filling.
7. Placement of an insulating base, which separates intra-canal materials from external restorative ones.
8. Final tooth restoration using a permanent filling.

Alternative approaches: extirpation methods

General principles of pulpitis treatment are not limited to amputation methods. In global dental practice, the most widespread method is extirpation, a procedure involving the complete removal of the root pulp.

The essence of the vital extirpation method is that both the coronal and root pulp are removed without any prior application of devitalizing agents (e.g., arsenic pastes). This manipulation requires reliable anesthetic support. For this purpose, local anesthesia is used, which can be performed via infiltration or conduction techniques.

Modern local anesthetics are used as the primary active ingredients:

• 2% lidocaine solution;
• 3–4% articaine solutions;
• mepivacaine solutions.

To increase the procedure's efficacy, vasoconstrictors such as epinephrine (adrenaline), norepinephrine (noradrenaline), and other similar agents are added to lidocaine and articaine solutions. The primary goal of using such additives is a substantial increase in the duration of anesthesia and a simultaneous reduction in the total amount of administered anesthetic.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Composition and mechanism of action of arsenic pastes for devitalization.
• Properties of water-based dentin and rules for its application as a temporary dressing.
• Characteristics of plastic hardening pastes for root canal filling.
• Differences between infiltration and conduction local anesthesia techniques.
• Pharmacodynamics of epinephrine and norepinephrine in combination with articaine and lidocaine.

Other topics in "Chapter 7. Endodontics"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.