Over the last 50 years, many studies have demonstrated the advantages of selective caries removal, beginning with Mertz- Fairhurst in 1962. The selective caries removal model has shown great success in maintaining pulpal health. This multistep process completely removes the peripheral decay to solid dentin (to create a sealed restoration) while the pulpal wall

is excavated until a somewhat firm or soft dentin is reached. There are multiple approaches and techniques to selective caries removal but often some caries or cariogenic bacteria remain.

The question then arises of how best to seal this area and provide

the best pulp protection. This is where liners truly have their utility. Traditionally, liners have been used for multiple reasons: their antibacterial properties along with their ability to seal the dentinal tubules against the ingress of microorganisms, remineralization of the dentin, and protection of the pulp from potential negative effects of restorative materials. An array of liners exhibit these properties, such as the Ceramir® Protect LC Syringe, which is a light-cured, resin-modified bio- ceramic pulp protectant for direct and indirect pulp capping.

Back in the day, Dycal was the

calcium hydroxide liner that set the stage for the usage of liners. The indication for Dycal was to place it in small increments to protect the pulp and especially when caries removal approached within 0.5 mm of the pulpal tissue. In regard to the calcium hydroxide’s antibacterial properties, these become evident as the calcium hydroxide disassociates.
Calcium and hydroxyl ions are then created, and these hydroxyl ions create an alkaline pH that is antimicrobial. Ultimately, this affects the remaining bacteria directly by alter-ing their metabolism and overall growth.

However, issues with calcium hydroxide included solubility,

low compressive strengths, low elastic modulus, and decreasing antibacterial activity over time.

To compensate, resin-modified glass-ionomer (RMGI) liners were recommended to be placed over the calcium hydroxide and allow for the sequence of etching and bonding for composites. Gaps were then found between the liners and thus emerged the latest era of bioceramic liners.

Ceramir Protect LC was launched into the marketplace as the latest entry in this bioceramic liner cat- egory. The single-component system delivers a liner that is insoluble and radiopaque and has the properties of both an alkaline pH and calcium release. Results have demonstrated twice the calcium release, which equates to more availability to stimulate the deposition of tertiary dentin and remineralization.

Catapult Education’s review of Ceramir Protect LC showed the following:

} 90% of reviewers currently use liners

} 95% of reviewers found the handling and narrow syringe tips ideal

} 92% of reviewers would use this product as a liner in their practice

Catapult Education gave this liner stellar reviews and presented Doxa Dental with the Catapult Vote of Confidence for its Ceramir Protect LC Syringe.