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Deep Cavity Liner Selection — ORE Part 1 MCQ

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ModerateRestorative DentistryDeep Cavity Liner SelectionORE Part 1

A vital upper first molar requires a large composite restoration. After caries removal, the deepest dentine is very close to the pulp, with no pulp exposure. Which liner approach is most appropriate before placing the composite restoration?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Place calcium hydroxide selectively, then cover it with RMGIC

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

A is correct. In the conventional management of an extremely deep cavity without pulp exposure, calcium hydroxide is confined to the small area closest to the pulp. It is then covered with resin-modified glass-ionomer cement (RMGIC), which protects the weak, soluble liner before adhesive composite placement. Zinc oxide-eugenol is unsuitable beneath resin composite because eugenol may inhibit resin polymerisation. Calcium hydroxide should not be spread across the entire cavity floor because it provides poor bulk support and is relatively soluble. The key distinction from options C and E is the very limited remaining dentine thickness described: this is the circumstance in which selective liner use is indicated. Direct composite placement is not an appropriate management strategy for a pulp exposure.

Reference: Arandi NZ. Calcium hydroxide liners: a literature review. Clinical, Cosmetic and Investigational Dentistry. 2017. https://pubmed.ncbi.nlm.nih.gov/28761378/