The role of temporary materials in pulpitis treatment
When treating pulpitis over multiple appointments (e.g., via devital amputation), it becomes necessary to reliably seal the tooth cavity between patient visits. During the first visit, the dentist establishes access to the pulp, applies special devitalizing agents, and hermetically seals the cavity with artificial dentin, which serves as a temporary filling.
During the second visit, this temporary filling and the cotton pellet are removed using an excavator. An important criterion for correct execution at this stage is the complete absence of pain and bleeding upon probing the point of cavity exposure. After removing the temporary material, the dentist widens the canal orifices (using round burs, endo-burs, Gates Glidden, Largo), directing the bur movements away from the pulp chamber to achieve vertical walls that align with the walls of the carious cavity. This is followed by thorough antiseptic treatment (e.g., with a 3% hydrogen peroxide solution or a 2% chloramine solution).
In a number of clinical situations, water-mixed dentin is used as an insulating base. It is applied to the bottom of the cavity and covered with a special base cement, while the therapeutic calcium hydroxide base is placed strictly over the root canal orifices.
Transition to permanent restorations: nanocomposites
Following the successful use of temporary filling materials, the anatomical shape of the tooth is restored using permanent materials. Nanocomposites are among the most demanded groups. They are characterized by ultra-high strength, a pronounced "chameleon effect", and rapid polishability to a dry gloss.
A prominent representative is Filtek Supreme. Its structural elements consist of nanomers (5 to 75 nm) and nanoclusters (0.6–1.4 µm) comprising silicon dioxide and zirconium dioxide. Filler loading reaches 78.5% by weight, and polymerization shrinkage is only 2.2%, allowing the material to be placed in horizontal layers. The color palette includes 34 shades.
Another universal nanocomposite is Grandio (by VOCO). It is 87% filled (ceramic glass and silicon dioxide nanoparticles) and exhibits a minimal shrinkage of 1.57%. Available in 14 shades according to the classical Vita shade guide.
The universal material Premise by Kerr deserves special attention. Its composition combines three types of fillers: quartz nanoparticles, barium glass, and a pre-polymerized PPF filler. The shrinkage of this composite is reduced to 1.6%.
Flowable (low-modulus) composite materials
In situations requiring the filling of microscopic defects or the creation of a super-adaptive layer, flowable composites are used (introduced into practice in 1977). Their base is a modified matrix of high-flow resins. The main features of these formulations are a low modulus of elasticity and thixotropy. The material is capable of spreading into a thin film, penetrating hard-to-reach areas while not sagging from undercut surfaces.
Indications for the use of flowable materials:
- Restoration of Class III–V cavities.
- Tunnel restorations and invasive/non-invasive fissure sealing.
- Repair of marginal adaptation and restoration of small enamel or porcelain chips.
- Cementation of veneers, porcelain inlays, and fiber-reinforced splinting systems (Ribbond, FiberSplint).
Despite being radiopaque and elastic, they have a drawback: high polymerization shrinkage (about 5%). Therefore, they must be applied in layers no thicker than 1.5 mm. Popular representatives: Filtek Flow, Arabesk Flow, Revolution, Tetric Flow.
Packable (condensable) composites
For restoring extensive cavities in posterior teeth, packable composites were developed as an aesthetic alternative to dental amalgam. These formulations (e.g., Solitaire 2 and Filtek P60) are based on a modified "thick" polymer matrix with hybrid fillers up to 3.5 µm in size.
Key advantages of packable composites:
- Very high strength, comparable to that of amalgam.
- Excellent resistance to masticatory wear.
- Optimal handling characteristics: the material has a dense consistency, does not flow, does not stick to dental instruments, and is easily condensed.
Briefly: answers to topical questions
What are the chemical composition and filler particle sizes of the packable composites Solitaire 2 and Filtek P60?
The packable composites Solitaire 2 and Filtek P60 are based on a modified "thick" matrix and contain hybrid fillers. The filler particle size in these materials is up to 3.5 µm.
Additional material properties:
- Strength — very high, with values close to that of amalgam.
- Resistance — highly resistant to wear.
- Handling characteristics — have a dense consistency, can be condensed (packed), do not flow, and do not stick to dental instruments.
To memorize the filler composition in the Premise nanocomposite, use the acronym "QBP": Q — Quartz nanoparticles, B — Barium glass, P — Pre-polymerized filler (PPF).
Class and exam questions
What instruments are used to remove a temporary artificial dentin filling?
An excavator is used to remove the temporary filling material and cotton pellet from the prepared tooth cavity.
Where exactly are the therapeutic and insulating bases placed?
The therapeutic calcium hydroxide base is placed strictly over the canal orifices. The insulating base (water-mixed dentin) is applied to the bottom of the cavity and then covered with base cement.
What is the main problem with flowable composites, and how is it solved?
Their main disadvantage is significant polymerization shrinkage, which reaches 5%. To prevent the material from pulling away from the walls, it is applied in a thin layer not exceeding 1.5 mm in thickness.
What else to study on this topic
- Impregnation methods and root canal depophoresis
- Features of accessing the tooth cavity
- Layered restoration technique and creation of a super-adaptive layer
- Application of fiber-reinforced splinting systems (Ribbond, FiberSplint)
Master the entire topic in the «Propaedeutics of Dentistry» course
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