Everyday Clinical Use of TheraCal® LC
A single material can be used for both direct and indirect pulp capping during caries removal and restoration.
For years, dentists have struggled with pulpal protection during caries removal and restoration. Until now, materials have not been strong enough, often chipping or dissolving away, while others are quite expensive. To meet the goal of protecting pulp and prevent endodontic therapy in an efficient, cost-effective manner, a newer product has been introduced, called TheraCal® LC (BISCO, www.bisco.com). TheraCal LC is a light-cured, resin-modified calcium-silicate liner that can replace calcium hydroxide, glass ionomers, and other restorative materials. With calcium-silicate particles that release calcium to the tooth structure where it benefits the dentin and associated pulp chamber complex, TheraCal LC contributes to a regenerative effect, stimulating hydroxyapatite formation. The material comes in a syringe for precise placement and can be easily light-cured, providing immediate thermal insulation while allowing the restorative process to proceed.
TheraCal LC can be used for both direct and indirect pulp-capping, as well as a liner up to 1 mm. It is recommended that a suspect tooth be pulp-tested prior to anesthesia to determine if endodontic therapy may be required.
As a direct pulp-capping material, the greatest success would be covering a mechanical or traumatic pulp exposure and preventing a subsequent root canal therapy. Small carious exposures are also indicators for TheraCal LC, but hemostasis must be complete and the patient informed of the possibility of endodontic therapy.
Using TheraCal LC
After the tooth is prepared and isolated, remove the outer decayed dentin or superficial dentin. As you proceed deeper into the tooth, a caries indicator liquid may be used closer to the pulp on the inner carious dentin or deep dentin. Slowly excavate to remove all caries from the margins and work toward the pulp. When you see the pink pulp tissue showing through, be very judicious. Work around the pulp horns with care. Remove the caries where the indicator has stained very slowly, checking the dentin with a fluorescence-emitting caries diagnostic device. Some decay may be left to avoid a large pulpal exposure.
When the reading is a lower value, the dentin may be repaired and would be enhanced greatly with the use of TheraCal LC. Careful air abrasion of the excavated preparation can improve bond strength. Cover all moist effected surfaces with TheraCal LC, light-cure, and proceed with the bonding procedure (Figure 1). The tooth is then etched with either a total-etch or selective phosphoric-acid technique. A bonding agent is then used before seating the restoration (Figure 2).
TheraCal LC also can be used as a general base, covering the dentin to help reduce sensitivity and providing a thermal barrier. The pulpal floor can be covered before proceeding with the restorative process. Following any restorative preparation, air abrasion may improve bond strength. This would not be done with a direct pulp exposure until after the TheraCal LC is placed to cover the pulp.
This author has been has been using TheraCal LC since early 2012 and has been very successful in preventing many teeth from undergoing endodontic therapy. This has become his material of choice in moderate to deep preparations, whether for direct or indirect restorations.
This article was written by Fred Peck, DDS, AAACD, a private practitioner in Cincinnati, Ohio.
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