Resin-Modified Calcium Silicate Pulp Protectant/Liner

TheraCal LC is a light-cured, resin-modified calcium silicate filled liner designed for use in direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. It can be used as an alternative to calcium hydroxide, glass ionomer, RMGI, IRM/ZOE and other restorative materials. TheraCal LC performs as a barrier and protectant of the dental pulpal complex.

TheraCal LC’s precise placement allows its use in all deep cavity preparations. The light-cured set permits immediate placement and condensation of the restorative material. Its proprietary formulation allows for a command set with a light curing unit while maintaining ease of placement due to thixotropic properties. The proprietary hydrophilic resin formulation creates a stable and durable liner.

Unique Benefits:

• Calcium release stimulates^1* hydroxyapatite and secondary dentin bridge formation^2,3
• Alkaline pH promotes healing and apatite formation^2,4
• Significant calcium release¹ leads to protective seal^5,7,8
• Protects and insulates the pulp^5,6
• Moisture tolerant¹ and radiopaque – can be placed under restorative materials and cements

Clinical Significance:

• The proprietary formulation of TheraCal LC consists of tri-calcium silicate particles in a hydrophilic monomer that provides significant calcium release* making it a uniquely stable and durable material as a liner or base

FAQ

What are the differences and similarities between TheraCal LC and Mineral Trioxide Aggregate (MTA) material?
TheraCal LC is a resin-modified calcium tri-silicate that has enhanced physical properties when compared to MTA material. Essentially, the primary chemical used in both materials are similar (Portland cement) but TheraCal LC contains a patent pending hydrophilic resin, which allows for immediate light curing and facilitates calcium release. Similar to MTA material, TheraCal LC promotes healing due to the alkaline pH, and the calcium release assists in the formation of dentin bridge.

What is the difference between TheraCal LC and Calcium Hydroxide
Calcium hydroxide is the primary chemical contained in many dentin liners and pulp capping agents. One of the known limitations of calcium hydroxide-based materials is their relatively high solubility, which leads to dissolution of the material over time.

Do I need to bond before placing TheraCal LC?
Bonding is not required or recommended before placement of TheraCal LC on dentin. TheraCal LC allows the maximum amount of calcium release. However, in a non-retentive preparation (such as a Class V non-carious cervical lesion), a bonding agent may be used prior to placement of TheraCal LC for an enhanced bond.

I am using RMGI for liners and pulp-capping; why should I switch?
TheraCal LC promotes hydroxyl-apatite formation through ion/water exchange with the tooth structure. Resin-modified glass ionomers are unable to promote hydroxyl-apatite formation and have been shown to be cytotoxic to the pulpal complex.  Due to the inclusion of polyacrylic acid, RMGI’s may actually inhibit apatite formation.

What can I use TheraCal LC for?
TheraCal LC can be used as a liner under all restorative materials. It can also be used as a direct or indirect pulp-capping agent.

Will TheraCal LC wash out over time?
No, TheraCal LC is virtually insoluble when compared to other traditional calcium hydroxide-based liners and pulp-capping agents.

Brochures

* Bisco has, on file, the calcium release data for Theracal LC.
1. Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping . International Endodontic Journal. 2012 Jun;45(6):571-9.
2. ADA definitions for direct and indirect pulp capping at: www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter
3. Apatite-forming Ability of TheraCal Pulp-Capping Material, M.G. GANDOLFI, F. SIBONI, P. TADDEI, E. MODENA, and C. PRATI J Dent Res 90 (Spec Iss A):abstract number 2520, 2011 (www.dentalresearch.org)
4. Okabe T, Sakamoto M, Takeuchi H, Matsushima K (2006) Effects of pH on mineralization ability of human dental pulp cells. Journal of Endodontics 32, 198-201.
5. Sangwan P; Sangwan A; Duhan J; Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013; 46(1):3-19
6. Selcuk SAVAS, Murat S. BOTSALI, Ebru KUCUKYILMAZ, Tugrul SARI. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances. Dent Mater J. 2014;33(6):764-9.
7. Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015 Winter;39(2):143-8.
8. Mechanical Properties of New Dental Pulp-Capping Materials Over Time. M. NIELSEN, R. VANDERWEELE, J. CASEY, and K. VANDEWALLE, USAF, JBSA-Lackland, TX, , J Dent Res 93(Spec Iss A): 495, 2014 (www.dentalresearch.org)

Self-Adhesive Resin Cement

TheraCem is a dual-cured, calcium and fluoride-releasing, self-adhesive resin cement indicated for luting crowns, bridges, inlays, onlays and posts (prefabricated metal/non-metal/fiber posts).

Delivering a strong bond to Zirconia and most substrates, along with easy clean-up and high radiopacity, TheraCem offers the clinician a reliable and durable cementation of indirect restorations.

Unique Benefits:

• Continuous calcium and fluoride release¹
• Transitions from acidic to alkaline pH in minutes²
• Specially formulated to allow for quick and easy clean-up
• A high degree of conversion ensures a higher physical strength
• Easy to identify on radiographs for quick and effective diagnosis
• Easy auto-mix, dual-syringe provides a consistent mix for immediate delivery

Clinical Significance:

• Delivers a strong bond to zirconia and most substrates with no priming or etching required

Brochures

1. Gleave CM, Chen L, Suh BI. Calcium & fluoride recharge of resin cements. Dent Mater. 2016 (32S):e26.
2. New Self-adhesive Resin Cement With Alkaline pH. Chen L, Gleave C, Suh B, J Dent Res96(A):#286, 2017.

Dual-Cured Resin-Modified Calcium Silicate Pulpotomy Treatment

TheraCal PT is a biocompatible, dual-cured, resin-modified calcium silicate designed for pulpotomy treatment. TheraCal PT maintains tooth vitality by performing as a barrier and protectant of the dental pulpal complex.

Working Time: Minimum 45 seconds at 35°C
Setting Time: Maximum 5 minutes at 35°C

• Calcium Release*
  Unique hydrophilic matrix facilitates calcium release
• Alkaline pH*
  pH of 11.5 at 7 days
• Radiopaque*
  Easy identification and differentiation from recurrent decay and other restorative materials
• Easy Syringe Application
  No mixing by hand
• Dual-Cured
  One-layer confidence
• Moisture Tolerant*
  Low water solubility

Clinical Significance:
The chemical formulation of TheraCal PT consists of synthetic Portland Cement calcium silicate particles in a hydrophilic matrix which facilitates calcium release.*

FAQ

TheraCal PT and TheraCal LC – is there a reason to have both?
TheraCal PT is not intended to replace TheraCal LC.
TheraCal PT and TheraCal LC share some of the same indications for use, however we recommend you use TheraCal PT for pulpotomies and continue to use TheraCal LC as a liner and for direct and indirect pulp capping. This approach is more cost effective based on the number of applications from 1 box of TheraCal LC (4 – 1g syringes = 40-50 uses depending on application/s) verses TheraCal PT’s 1 – 4g syringe (approximately 12 – 15 pulpotomy applications).

What are the indications for TheraCal PT?
Primary indication: Pulpotomies
TheraCal PT can also be used for pulp capping, and as a liner or base.

What is the shelf life of TheraCal PT?
18 Months. TheraCal PT syringe is pouched and should remain so until ready to use. Once pouch is opened, use TheraCal PT within 90 days.

What is the storage for TheraCal PT?
TheraCal PT should be stored at room temperature (68°-77° F; 20°-25° C)

What is the working time?
Minimum of 45 seconds

What is the setting time?
Maximum of 5 minutes

How many applications can you get out of the 4g syringe of TheraCal PT?
Approximately 12 – 15 pulpotomy applications

What is the color of TheraCal PT?
A1/Natural

Do you need to place a bonding agent first?
No. Achieve hemostasis, place TheraCal PT, light-cure for 10 seconds and place desired adhesive, base, and/or restoration following manufacturer’s directions for restoring tooth.

What is the difference between TheraCal PT and Calcium Hydroxide?
One of the known limitations of calcium hydroxide-based materials is their relatively high solubility, which leads to dissolution of the material over time. TheraCal PT is moisture tolerant and will not wash out.

What are the differences and similarities between TheraCal PT and Mineral Trioxide Aggregate (MTA) material?
TheraCal PT is a resin-modified calcium tri-silicate that has enhanced physical properties when compared to MTA material. Essentially, the primary chemical used in both materials are similar but TheraCal PT contains a unique hydrophilic resin, which facilitates calcium release. Similar to MTA material, TheraCal PT has an alkaline pH.

Can disinfectants, desensitizers or wetting agents (i.e. Chlorohexidine, Gluma, Sodium Hypochlorite) be used prior to placing TheraCal PT?
Yes, after hemostatsis, disinfectants, desensitizers or wetting agents can be used.
Please note per the instructions for use: when chlorohexidine and sodium hypochlorite are used together staining may occur. If used together there should be a saline rinse in between.

Does Theracal PT have the same viscosity as TheraCal LC?
No. TheraCal PT is more viscous.

How are TheraCal PT and TheraCal LC different and/or alike?
Unlike TheraCal LC, TheraCal PT is a dual-cured material indicated for pulpotomies. TheraCal PT and LC both use THERA technology which is a unique hydrophilic resin matrix that facilitates calcium release. PT and LC are both radiopaque, moisture tolerant and offer an alkaline pH.

Brochures

Resin-Modified Calcium Silicate Pulp Protectant/Liner

TheraCal LC is a light-cured, resin-modified calcium silicate filled liner designed for use in direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. It can be used as an alternative to calcium hydroxide, glass ionomer, RMGI, IRM/ZOE and other restorative materials. TheraCal LC performs as a barrier and protectant of the dental pulpal complex.

TheraCal LC’s precise placement allows its use in all deep cavity preparations. The light-cured set permits immediate placement and condensation of the restorative material. Its proprietary formulation allows for a command set with a light curing unit while maintaining ease of placement due to thixotropic properties. The proprietary hydrophilic resin formulation creates a stable and durable liner.

Unique Benefits:

• Calcium release stimulates^1* hydroxyapatite and secondary dentin bridge formation^2,3
• Alkaline pH promotes healing and apatite formation^2,4
• Significant calcium release¹ leads to protective seal^5,7,8
• Protects and insulates the pulp^5,6
• Moisture tolerant¹ and radiopaque – can be placed under restorative materials and cements

Clinical Significance:

• The proprietary formulation of TheraCal LC consists of tri-calcium silicate particles in a hydrophilic monomer that provides significant calcium release* making it a uniquely stable and durable material as a liner or base

FAQ

What are the differences and similarities between TheraCal LC and Mineral Trioxide Aggregate (MTA) material?
TheraCal LC is a resin-modified calcium tri-silicate that has enhanced physical properties when compared to MTA material. Essentially, the primary chemical used in both materials are similar (Portland cement) but TheraCal LC contains a patent pending hydrophilic resin, which allows for immediate light curing and facilitates calcium release. Similar to MTA material, TheraCal LC promotes healing due to the alkaline pH, and the calcium release assists in the formation of dentin bridge.

What is the difference between TheraCal LC and Calcium Hydroxide
Calcium hydroxide is the primary chemical contained in many dentin liners and pulp capping agents. One of the known limitations of calcium hydroxide-based materials is their relatively high solubility, which leads to dissolution of the material over time.

Do I need to bond before placing TheraCal LC?
Bonding is not required or recommended before placement of TheraCal LC on dentin. TheraCal LC allows the maximum amount of calcium release. However, in a non-retentive preparation (such as a Class V non-carious cervical lesion), a bonding agent may be used prior to placement of TheraCal LC for an enhanced bond.

I am using RMGI for liners and pulp-capping; why should I switch?
TheraCal LC promotes hydroxyl-apatite formation through ion/water exchange with the tooth structure. Resin-modified glass ionomers are unable to promote hydroxyl-apatite formation and have been shown to be cytotoxic to the pulpal complex.  Due to the inclusion of polyacrylic acid, RMGI’s may actually inhibit apatite formation.

What can I use TheraCal LC for?
TheraCal LC can be used as a liner under all restorative materials. It can also be used as a direct or indirect pulp-capping agent.

Will TheraCal LC wash out over time?
No, TheraCal LC is virtually insoluble when compared to other traditional calcium hydroxide-based liners and pulp-capping agents.

Brochures

* Bisco has, on file, the calcium release data for Theracal LC.
1. Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping . International Endodontic Journal. 2012 Jun;45(6):571-9.
2. ADA definitions for direct and indirect pulp capping at: www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter
3. Apatite-forming Ability of TheraCal Pulp-Capping Material, M.G. GANDOLFI, F. SIBONI, P. TADDEI, E. MODENA, and C. PRATI J Dent Res 90 (Spec Iss A):abstract number 2520, 2011 (www.dentalresearch.org)
4. Okabe T, Sakamoto M, Takeuchi H, Matsushima K (2006) Effects of pH on mineralization ability of human dental pulp cells. Journal of Endodontics 32, 198-201.
5. Sangwan P; Sangwan A; Duhan J; Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013; 46(1):3-19
6. Selcuk SAVAS, Murat S. BOTSALI, Ebru KUCUKYILMAZ, Tugrul SARI. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances. Dent Mater J. 2014;33(6):764-9.
7. Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015 Winter;39(2):143-8.
8. Mechanical Properties of New Dental Pulp-Capping Materials Over Time. M. NIELSEN, R. VANDERWEELE, J. CASEY, and K. VANDEWALLE, USAF, JBSA-Lackland, TX, , J Dent Res 93(Spec Iss A): 495, 2014 (www.dentalresearch.org)