The first member of BISCO’s award-winning TheraFamily, TheraCal LC is once again a standout star among DPS readers for its versatility and unique healing properties.
When innovators see a problem, they waste no time getting down to work and finding a solution. That said, the perfect solution can take days, months, and even years to come to fruition. That was the case when the talented R&D team at BISCO set out to answer a nagging question: Why do most traditional calcium hydroxide products inhibit ion release during pulp capping? The quest for an answer ushered in a decade of research that ultimately led to the introduction of TheraCal LC, a proprietary hydrophilic resin formulation that allows for a high release of both calcium and hydroxide ions. With this one product, BISCO solved a conundrum that had long vexed the entire dental industry.
In the years since TheraCal LC’s debut in 2011, it has become one of those products many dentists simply can’t do without. One such dentist is Dr. Craig Aebli, who practices in Sanford, FL. “I do a fair amount of restorative dentistry, and with a lot of composites, so it’s not unusual for me to have patients that have deep areas of decay,” said Dr. Aebli. “I probably reach for TheraCal LC several times a week,” he added.
TheraCal LC is part of BISCO’s award-winning TheraFamily of restoratives, which includes TheraCal PT, TheraCem, and TheraBase. The resin-modified calcium silicate-filled liner material is ideal for direct and indirect pulp capping, and is light-cured for immediate placement; it also serves as a protective liner under composites, amalgams, cements, and other base materials.
Significant Calcium Release
With its unique proprietary formulation, TheraCal LC promotes significant calcium release,* which also leads to a protective seal.1,3,4 The calcium release stimulates hydroxyapatite and secondary bridge formation.6, 7, 8
“I started using TheraCal LC almost as soon as the product was released,” Dr. Aebli explained. “Once I heard about it and read the results it was producing, I wanted to try it right away. You want a material that will help the pulpal tissue, so that it can start forming dentin bridges. The unique formulation of TheraCal LC allows that ion exchange to occur so that everything can proceed properly,” he continued.
“In my many years of using this method, I have never had any patients come back saying, ‘My tooth still hurts,' or 'My tooth’s starting to bother me again.'”
—Craig P. Aebli, DDS, MS, FAGD
Promotes Pulp Vitality
TheraCal LC insulates the pulp by forming a protective barrier against thermal changes.1,2 Additionally, the alkaline pH promotes pulp vitality.5 Dr. Aebli has been using TheraCal LC for many years now and continues to see excellent patient outcomes.
“I typically use it on patients that have deep caries, and especially if I get a pulpal exposure and I still feel it’s a vital pulp,” he explained. “If I don’t have a lot of bleeding and I can get the bleeding under control by placing a cotton towelette that’s soaked in sodium hypochlorite, I then proceed with placing TheraCal LC on the area, just enough to cover that exposed tissue and a little bit overlying the dentin.”
“Next, I light-cure it and then proceed with BISCO’s TheraBase as an additional base for an added protective layer,” he continued. “In my many years of using this method, I have never had any patients come back saying, ‘My tooth still hurts,' or 'My tooth’s starting to bother me again,’” he added. “That’s really as much as I can ask for in a successful product.”
Post-op sensitivity is one of those conditions that all dentists go to great lengths to avoid, and Dr. Aebli is no exception. The good news? He has rarely had patients develop sensitivity issues, a situation he believes is a direct result of using TheraCal LC.
“I’ve had instances where patients come to see me about a filling that had originally been placed at another dental office,” Dr. Aebli recalled. “It may have been a deep filling, and they were presenting with a great deal of sensitivity. We discuss their options and if I feel it’s warranted, I will advise them to elect to have the filling redone, and I always use TheraCal LC as part of my treatment. In all these years, it’s very rare that I ever have a patient return with that same sensitivity—it always seems that they’re doing much better and have less problems with the tooth, and I believe it’s due largely to TheraCal LC.”
Simplicity of Syringe Delivery
TheraCal LC is flowable and can be dispensed into deep preps onto moist dentin in 1-mm increments. Once light cured, it can be used with all bonding techniques, including self-, selective-, and total-etch. Highly thixotropic, it will stay where it’s placed, and the ready-to-use syringe allows for precise delivery. This convenience is another reason TheraCal LC is at the top of Dr. Aebli’s go-to product list.
“TheraCal LC is dispensed in a syringe, with just a small tip applicator that you attach to the syringe. You can dispense out just as much as you need directly onto the tooth and it flows well,” he explained. “If I need to move it around a little with an explorer, I can do that, and once I have it in place, I just light-cure it and it’s set. It can’t get much easier than that, and it’s definitely an improvement over some of the other products where you have to mix a powder and liquid together.”
In addition to ease of use, TheraCal LC also adds versatility to its list of attributes. According to BISCO, it can also be used as an alternative to calcium hydroxide, glass ionomer, RMGI, IRM/ZOE, and other restorative materials.
TheraCal LC is compatible with any bonding technique and can be placed under cements and restorative materials, including composites and amalgams.
An Operatory Staple
Awarded the DPS Recommended Product badge in 2015, and a favorite among Dental Product Shopper readers in the years since, TheraCal LC remains an operatory staple for Dr. Aebli for 3 key reasons: "Its ease of application, the fact that it’s a light-cured material, and the good results I’ve continuously received with pulpal healing. These features are a huge advantage when you’re trying to restore a tooth with deep caries and pulp exposures.”
On the next page, read "Case in Point: Solving A Restorative Challenge." Dr. Andrés E. López shares a recent case snapshot where he used several BISCO products in tandem, including TheraCal LC, to resolve a fistula and place an overlay on a patient's lower left molars.
*BISCO has on file the calcium release data for TheraCal LC. **Data on file, BISCO Inc.
1 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.
2 Savas S, Botsali MS, Kucukyilmaz E, Sari T, Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO light curing unit at different curing distances. Dent Mater J. 2014;33(6):764–69.
3 Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015;39(2):143–48.
4 Nielsen M, Vanderweele R, Casey J, Vandewalle K, USAF, JBSA-Lackland, TX. Mechanical properties of new dental pulp-capping materials over time. J Dent Res. 2014;93(Spec Iss A):495. (www. dentalresearch.org)
5 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.
6 Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012;45(6):571–79.
7 ADA definitions for direct and indirect pulp capping at: www.ada.org/en/publications/cdt/ glossary-of-dental-clinical-and-administrative-ter.
8 Gandolfi MG, Siboni F, Taddei P, Modena E, Prati C. Apatite-forming ability of TheraCal pulp-capping material. J Dent Res. 2011;90(Spec Iss A): abstract 2520.
9 Gleave CM, Chen L, Suh BI. Calcium & fluoride recharge of resin cements. Dent Mater. 2016;(325):e26.
Republished DENTAL PRODUCT SHOPPER | June 10, 2022 Issue
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