Advantages of Glass Ionomer Cement as A Base Rather than A Varnish in Pulp Capping

Abstract

Indirect pulp treatment (IPT) or indirect pulp capping (IPC) is a conservative alternative therapy for primary and permanent teeth that have deep carious lesions nearing the pulp in the absence of any symptomatology related to pulp degeneration. This is achieved by removing only weakened, humid dentinal tissue that does not resist manual excavation, and intentionally leaving behind the deep most layer adjacent to the pulp. The healing mechanism in pulp capping involves the repair in the dento-pulpal complex through the formation of a dentin-like matrix known as tertiary dentin by dental pulp. Several dental materials have been used as IPC agents for the maintenance of vitality of deeply carious teeth. Glass ionomer cement (GIC) offers a combination of strength, rigidity and fluoride dispensing properties of silicate particles along with the biocompatibility and adhesive properties of a polyacrylic acid. The cement’s adhesion, based on an ion exchange mechanism with the dental tissue, is a unique phenomenon. Although, the adhesive strength has only been understood scarcely so far, it is known that the occurrence of bond failure in case of GIC is mostly from cohesive breakdown in the cement as opposed to adhesive failure at the dento-cement interface. Due to low amounts of polymerization related material contraction, GIC has proven to retain better than composite resins and provides a superior quality of bacterial seal. This seal prevents the progression of pulpal inflammation by preventing further microleakage of bacteria, endotoxins, and lipopolysaccharides at the dentin and glass ionomer interface. New generations of light cure GIC offer even greater retention to dentinal surfaces than traditional chemically cured GIC. However, the cement is appropriate only as an IPC.