How Does Thera Work? Let’s Count

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How Does Thera Work? Let’s Count the Ways

By: Dental Product Shopper

7/30/2024

TheraCal LC, along with the other 3 members of BISCO’s Thera family, once again gets rave reviews from DPS readers for its unique healing abilities and versatility

If you’ve ever had a dental product that works so well you find yourself using it just about every day, then you’ll know exactly how Jason Ingber, DDS, feels about BISCO’s TheraCal LC.

“I will treat a patient using TheraCal LC almost every day,” said Dr. Ingber, who practices in Waterford Township, MI. “The price is right, and it’s simple to use. I use it on deep preparations as an indirect pulp cap and mostly on small pinpoint pulpal exposures as a direct pulp cap. It's easy to use in the syringe form and easy to place in both situations. It handles well and seems to set up nicely so that I can place my restoration immediately over it.”

TheraCal LC: The King of Calcium Release

TheraCal LC owns the rare and highly respected distinction of being named a DPS Readers’ Choice award winner 5 years in a row. Launched in 2011 and the inaugural member of BISCO’s Thera family of calcium-releasing products, TheraCal LC is typically used for direct and indirect pulp caps to preserve tooth structure and revitalize the pulp,1,2 avoiding unnecessary root canals and extractions.

BISCO: Leading the Way

Calcium-releasing products are riding a wave of popularity in the dental industry thanks to the two-fold benefits of preserving tooth structure and protecting exposed pulp. But BISCO researchers were studying the positive effects of calcium release long before TheraCal LC was introduced over a decade ago.

“One of the biggest benefits of calcium release is the alkaline pH it creates, which is shown to be a detriment to bacterial growth,”^3,4said Dr. Erick Yu, BISCO’s Manager of R&D Technology. And it’s that same calcium-releasing feature that promotes a more conservative approach to dentistry, allowing many dentists to avoid root canals, which can be both painful and costly for patients. It’s a fact perfectly illustrated in one of Dr. Ingber’s recent patient cases, in which TheraCal LC played a starring role.

“I had a female patient who I felt needed root canal therapy on tooth No. 20 due to a pulpal exposure,” Dr. Ingber shared. “This patient could not afford the root canal, so I suggested that we possibly could buy time if I tried a direct pulp cap with TheraCal LC and then placed a direct composite. She agreed, and since then has had no postop sensitivity. Now, 2 years later, this patient has dental insurance and can afford a crown on this tooth. But no root canal was ever needed, and she can’t stop thanking me enough for performing heroics on her tooth and taking a conservative and honest approach!”

Extremely Easy to Apply

TheraCal LC is a pulp protectant/liner that can be light-cured for immediate placement. The resin-modified calcium silicate material also can be used as a protective liner under composites, amalgams, cements, and other base materials. Moisture tolerant and compatible with any bonding technique, TheraCal LC is highly radiopaque and its calcium release* stimulates hydroxyapatite and secondary dentin bridge formation.^1,2

“If I have a small pulpal exposure, I try to isolate the tooth and place TheraCal LC directly on the exposure and light cure,” Dr. Ingber explained. “The same situation applies in very deep restorations where I will use it as a base, lining the deepest portion closest to the pulp, and then directly place etch, bond, and my final restoration,” he continued.

A Go-To Pulp Cap

It’s a frequent scenario that’s also very familiar to Ziba Zadeh, DDS, who has been using TheraCal LC for over a decade in her San Jose, CA, practice.

“TheraCal LC is a great product to use as a pulp cap,” she shared. “For areas that are very close to the pulp or have pinpoint exposure, I place the product and then light cure. I have had great success with it to avoid unnecessary root canals. The delivery is also very easy!”

Less Postop Sensitivity

Over the years, Dr. Ingber has found patients experience more postop sensitivity when other liners are used, especially when the material does not adhere to dentin when pulp is exposed to moisture. But that has not been the case with TheraCal LC.

A common denominator throughout his TheraCal LC patient success stories? “It’s usually the patient who has gross decay and can’t afford extensive dental treatment,” Dr. Ingber explained. “When I remove caries, whether deep or a small pulpal exposure, I will routinely reach for TheraCal LC and apply it as a base before placing my final restoration. I will always tell my patients that they may need a root canal in the future because of such deep decay, but more often than not, these patients have less postop sensitivity and no need for endodontic therapy.”

TheraCal PT: Pulpotomies Made Easy

In addition to TheraCal LC, Dr. Zadeh also points to another member of BISCO’s Thera family: TheraCal PT. A biocompatible, dual-cured, resin-modified calcium silicate material, TheraCal PT is primarily designed for pulpotomy treatments. With a minimum working time of 45 seconds and a maximum setting time of 5 minutes at 35° C, TheraCal PT is particularly well suited for younger patients who can’t tolerate lengthy chair times. TheraCal PT acts as a barrier and protects the dental pulpal complex, while also maintaining tooth vitality.

It can be placed on pulp exposures after hemostasis is obtained and is suitable as a protective liner or base under a variety of substrates.

“I use TheraCal PT for pediatric cases and I have had great success with it,” Dr. Zadeh shared. “In my experience, I have found it to be super easy to place and light cure, and I especially like the easy syringe application because there’s no more hand mixing the product. I've also found that the applicators are well designed, which makes applying it to hard-to-access areas very easy.”

TheraCem: Cement with Confidence

Launched in 2017, TheraCem is a dual-cured, self-adhesive resin cement indicated for luting crowns, bridges, inlays, onlays, and prefabricated metal, nonmetal, or fiber posts. TheraCem offers continuous calcium and fluoride release and transitions from acidic to alkaline pH in just minutes.*

Dr. Yu describes it as an "adhesive glue" between dentin, enamel, and the restoration. "One of its unique properties is it starts acidic and transitions to alkaline," he added. "It contains MDP, but after being exposed to moisture, the calcium silicate kicks in and it switches to alkaline mode.”⁵

Along with an easy cleanup and high radiopacity, TheraCem also contains the MDP monomer for a strong bond to zirconia, metal, and alumina substrates without the need for separate priming or etching.

TheraBase: Build a Strong Foundation

TheraBase, the most recent addition to the Thera family, is a dual-cured, calcium-and fluoride-releasing, self-adhesive base/ liner that chemically bonds to tooth structure. It offers a high compressive strength, absorbs occlusal forces without fracturing, and contains MDP for a reliable and optimal bond to dentin. Highly radiopaque, TheraBase is easy to use and packaged in an automix dual-syringe for a consistent mix and immediate delivery with minimal waste.

“TheraBase is my liner of choice, and I use it daily,” shared John Horn, DMD, in Hegins, PA. “It is easy to manipulate, and I like to use it under deep cavity preps or teeth that I suspect will be prone to sensitivity issues or have previously been sensitive. I like it better than similar products because I know the research behind it is sound.”

He continued, "Both TheraCal LC and TheraBase are great because they’re quality products that are easy to use. I like BISCO materials because they're backed by sound research and the company's Direct-to-You Promise. I tell other dentists that BISCO products will help them succeed and achieve consistent, predictable results.”

References:

_{*Data on file.}

_{1. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endo. 2006;32(3):198-201.}

_{2. 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 number 2520. www.dentalresearch.org.}

_{3. ElReash AA, Hamama H, Eldars W, et al. Antimicrobial activity and pH measurement of calcium silicate cements versus new bioactive resin composite restorative material. BMC Oral Health. 2019;19:235. https://doi.org/10.1186/ s12903–019- 0933-z.}

_{4. Kim RJY, Kim MO, Lee KS, et al. An in vitro evaluation of the antibacterial properties of three Mineral Trioxide Aggregate (MTA) against five oral bacteria. Arch Oral Biol. 2015;60(10):1497-1502.}

_{5. Chen L, Gleave C, Suh B. New self-adhesive resin cement with alkaline pH. J Dent Res. 2017;96(A):286.}