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Inside Dentistry
August 2022
Volume 18, Issue 8

A 21st-Century Material for All Deep Restorations

Bisco’s TheraBase® is a dual-cure, self-adhesive base/liner that releases calcium and fluoride

Mark L. Cannon, DDS, MS

For Mark L. Cannon, DDS, MS, dentistry is about finding the best solutions for every patient—even the most challenging ones. Cannon has operated a multispecialty practice focused on pediatric dentistry and orthodontics for more than 40 years, and he treats a patient base that includes a large number of children with severe mental and physical disabilities. In addition to being in private practice, Cannon is also a professor at Northwestern University's Feinberg School of Medicine in the Department of Otolaryngology - Division of Dentistry, and he is the research coordinator for the Pediatric Dental Program at the Ann & Robert H. Lurie Children's Hospital of Chicago. "The whole reason that we are here is the patient," Cannon says. "The most important thing is to provide the best care that we can, both efficiently and in a manner that is compatible with dealing with the special needs population. That goal has driven me to examine ways that we can improve prevention efforts, materials, and techniques, and in doing so, I have been fortunate to work with some brilliant people and two excellent laboratories."

Not every dentist treats patients with special needs, and Cannon acknowledges that it is not easy. "Treating these patients involves a lot of extra requirements, from better materials to simpler procedures," he says. "All of these patients have compromised oral hygiene, and many have abnormal habits, such as severe bruxism or severe clenching. They may actually torment their dental restorations more than the average patient does." With that in mind, Cannon has dedicated much of his time to developing uses for tricalcium and dicalcium silicates in dentistry. "We need biologically active materials that provide a source of ions and the appropriate environment for remineralization of the tooth structure and protection of the pulp. That is where it's at in dentistry. We need to be able to reverse early carious lesions and prevent recurrent decay because more than 50% of restorations are being replaced due to recurrent caries. We need better bonds and stronger restorations."

That pursuit led to Cannon's involvement in the development of BISCO's TheraBase®, a dual-cure, calcium- and fluoride-releasing, self-adhesive base/liner. "It is a very easily applied, very user-friendly material that is self-adhesive, will adhere to the dentin, reduces steps, has a high calcium release, and becomes alkaline. It is the only product of its kind," he says.

Cannon calls the ease of use provided by TheraBase "pure genius." "Whenever you have a deep restoration, you simply prepare the tooth, remove the caries, and apply TheraBase," he says. "The self-mixing tip allows it to be applied precisely wherever it is needed, and it is a dual-cure material, so you can light cure it, but it will continue to cure with a very high degree of polymerization, which improves the mechanical properties of restorations." Those properties include high compressive and flexural strength, and because TheraBase also contains the 10-MDP monomer, it achieves a strong bond to dentin. "It provides a much stronger bond and a much stronger base than a glass ionomer does," Cannon says.

Other factors that make TheraBase unique include its alkaline pH and its ability to release calcium and fluoride. "The material is slightly acidic when first placed, exhibiting a pH of 4, but it transitions to an alkaline pH in 30 minutes*," Cannon says. "Alkalinity is very important for the pulp because—along with improving the availability of hydroxyl ions—it stimulates the odontoblastic cells to lay down more dentin to help protect the pulp and reduce sensitivity in the future. It also forms an extra protective layer."1

The calcium release, however, is something that glass ionomers did not offer. "High calcium release also stimulates greater odontoblastic activity," Cannon says.1 "High levels of calcium and a high pH are bacteriostatic factors, which inhibit the growth of oral pathogens, even in the event of inadvertently missed caries or contamination."

Cannon emphasizes that he has long been a proponent of always placing a glass-ionomer base for composites via the "sandwich technique" and explains that TheraBase only increases the benefits. "The previous materials released fluoride, but unset glass ionomer usually has a pH of approximately 3.6, which does not encourage healing," he says. "Resin-modified glass ionomers were a 20th-century technology. We are in the 21st century, and we need to use 21st-century technologies."

TheraBase's radiopacity provides yet another advantage. Cannon notes the frequency with which mysterious dark spots appear on new patients' radiographs. "You ask yourself, ‘Is it leakage, or is it some base or liner that isn't showing well?'" he says. "Many restorations with radiolucent bulk fills also pose issues. This solves that problem."

Whether used as a base material, for a buildup before seating a crown, or placed on top of TheraCal LC® in situations involving pulp exposure, TheraBase is Cannon's material of choice for all deep restorations. "I also recommend it to endodontists for applications involving endodontically treated teeth," he says. Because the patient always comes first, Cannon hopes to get as many other dentists using TheraBase as possible. "The ease of application makes it reliable and able to deliver reproducible results for everybody," he says. "It checks every box that a dentist can have. It is an ideal material that every dental student should learn about and that all practitioners should incorporate into their practices tomorrow."

Key Points

TheraBase chemically bonds to tooth structure and releases and recharges calcium and fluoride ions.*

The calcium release generates an alkaline pH* that promotes pulp vitality.2

A dual-cure material that will polymerize even in deep restorations where light cannot reach.

Stronger and more durable than other base materials, glass ionomers, and resin-modified glass ionomers.*

*Data on file.

References

1. Koh ET, Torabinejad M, Pitt Ford TR, Brady K, McDonald F. Mineral trioxide aggregate stimulates a biological response in human osteoblasts. J Biomed Mater Res.1997;37(3):432-439.

2. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod.2006;32(3):198-201.

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