Restorative pulpal and repair responses.
BACKGROUND
Each year, about 90 million new restorations are placed in the United States and 200 million are replaced. Controversy surrounds the pulpal reactions and frequency of bacterial microleakage associated with common restorative materials. The authors investigated and compared pulpal reactions to different types of restorative materials.


METHODS
Two hundred seventy-two teeth with standardized rectangular Class V unexposed cavities were restored with resin-based composite bonded to dentin; resin-based composite bonded to enamel; resin-modified glass ionomers, or RMGI; amalgam lined with zinc polycarboxylate, or ZnPC; amalgam lined with calcium hydroxide, or Ca(OH)2; or zinc oxide-eugenol, or ZnOE. Teeth were extracted for orthodontic reasons between 20 and 381 days later. The authors categorized pulpal responses according to standards set by the Federation Dentaire Internationale and the International Organization for Standardization. Bacteria were detected using Brown-Brenn-stained sections. Pulpal responses were evaluated using histomorphometric analysis and analysis of variance statistics.


RESULTS
The results showed that RMGI was the best material for preventing bacterial microleakage, and resin-based composite bonded to enamel was the worst. In regard to minimizing pulpal inflammatory activity, ZnOE was the best material and resin-based composite bonded to enamel was the worst. In terms of maximizing odontoblast survival beneath deep cavity preparations, Ca(OH)2, was the best material and RMGI was the worst.


CONCLUSIONS
The results show that bacterial microleakage, pulpal injury and repair responses varied widely with different restorative materials.


CONCLUSIONS
The authors recommend that RMGI be used to restore teeth with cavities that are shallow to moderate in depth, with the floor of deep cavities being lined with Ca(OH)2 before the teeth are restored with RMGI.
Murray
P E
PE
School of Dentistry, University of Birmingham, St. Chad's Queensway, Birmingham, England, B4 6NN. p.e.murray@bham.ac.uk
About
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I
Franquin
J C
JC
Remusat
M
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Smith
A J
AJ
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002126:Calcium Hydroxide / Q000494:pharmacology; D002470:Cell Survival; D002648:Child; D004396:Coloring Agents; D003188:Composite Resins / Q000494:pharmacology; D003723:Dental Amalgam / Q000494:pharmacology; D003736:Dental Cavity Lining; D003737:Dental Cavity Preparation / Q000145:classification; D003743:Dental Enamel / Q000648:ultrastructure; D003763:Dental Leakage / Q000382:microbiology; D003764:Dental Materials / Q000494:pharmacology*; D003782:Dental Pulp / Q000187:drug effects* / Q000382:microbiology; D003793:Dental Restoration, Permanent / Q000145:classification; D003804:Dentin / Q000648:ultrastructure; D017220:Dentin-Bonding Agents / Q000494:pharmacology; D005260:Female; D005899:Glass Ionomer Cements / Q000494:pharmacology; D006801:Humans; D008297:Male; D009804:Odontoblasts / Q000187:drug effects; D011076:Polycarboxylate Cement / Q000494:pharmacology; D011671:Pulpitis / Q000209:etiology / Q000473:pathology; D019279:Resin Cements / Q000494:pharmacology; D015035:Zinc Oxide-Eugenol Cement / Q000494:pharmacology
D004396:Coloring Agents; D003188:Composite Resins; D003764:Dental Materials; D017220:Dentin-Bonding Agents; D005899:Glass Ionomer Cements; D011076:Polycarboxylate Cement; D019279:Resin Cements; D015035:Zinc Oxide-Eugenol Cement; D003723:Dental Amalgam; D002126:Calcium Hydroxide