Short term human primary pulpal response after direct pulp capping with fourth-generation dentin adhesives

The purpose of this study was to evaluate the effects of the total-etch and direct pulp capping techniques on the short-term response of mechanically exposed human primary tooth pulps using three commercially available adhesive resin systems. Class V cavities were prepared on the buccal surface of intact mandibular primary molars and exposed with a carbide bur on the cavity floor. The entire cavity except the exposure site received 36% phosphoric acid gel conditioning. Exposed pulps were capped with one of the three adhesive resins, followed by restoration of the cavities with the respective restorative materials. The teeth were extracted after 60 days and prepared according to normal histological techniques. Serial sections were stained with H/B for histological evaluations. The histopathological evaluation showed that a few of the samples in the Scotchbond Multi Purpose (SMP) and Prime & Bond 2.1 (PB) groups exhibited “attempted bridge formation”, while no bridge formation was evident in the other samples. Syntac Single Component (Syntac) exhibited the most severe histological response, while the mildest reactions were observed in the SMIP group. Based on the conditions of the present study, direct pulp capping with dentin bonding agents following the total-etch technique in primary teeth can not be recommended.

1. Suarez CL, Stanley FIR, Gilmore HW. Histopathologic response of the human dental pulp to restorative resins. J Am Dent Assoc 80: 792-800, 1970.

2. Dickey DM, El-Kafrawy AK, Mitchell DF. Clinical and microscopic pulp response to a composite restorative material. J Am Dent Assoc 88: 108-113, 1974.

3. Bergenholtz G, Cox CF, Loesche WJ, Syed SA. Bacterial leakage around dental restorations: Its effect on the dental pulp. J Oral Pathol 11: 439-50, 1982.

4. Cox CF, Bergenholtz G, Fitzgerald MI, Keys DR, Keys RI, Avery JK, et al. Capping of the dental pulp mechanically exposed to the oral microflora-A 5-week observation of wound healing in the monkey. J Oral Pathol 11: 327-39, 1982.

5. Keys DR, Heys RJ, Cox CF, Avery JK. The response of four calcium hydroxides on monkey pulps. J Oral Pathol 9: 372-9, 1980.

6. Keys DR, Cox CF, Heys RJ,Avery JK. Histological consideration of direct pulp capping agents. J Dent Res 60: 1371-1379, 1981.

7. Heitmann T, Unterbrink G. Direct pulp capping with a dentinal adhesive resin system: A pilot study. Quintessence int 26: 765-70, 1995.

8. Cox CF, Keall CL, Keall HJ, Ostro B, Bergenholtz G. Biocompatibility of restorative materials against exposed dental pulps. J Prosthet Dent 57: 1-8, 1987.

9. Nakabayashi N, Ashizawa MI, Nakamura MI. Identification of a resin-dentine hybrid layer in vital human dentine created in vivo: durable bonding to vital dentine. Quintessence Int 23: 135-141, 1992.

10. Goracci G, Mon G, Ba.zucchi MI. Marginal seal and biocompatibiity of a fourth generation bonding agent. Dent Mater 11: 343- 347, 1995.

11. Inokoshi S, Hosoda H, Harnirattisai C, Shimada Y. Interfacial structure between dentine and seven dentine bonding systems revealed using argon ion beam etching. Oper Dent 18: 8-16, 1993.

12. Inokoshi S, Iwaku MI, Fusayama T. Pulpal response to a new adhesive restorative resin. J Dent Res 61: 1014-19, 1982.

13. Harnirattisai C, Hosoda H. Pulpal responses to various dentin bonding systems in dentin cavities. Dent Mater J 10: 149-164, 1991.

14. Tsuneda Y, Hayakawa T, Yamamoto H, Ikemi T, Nemoto K. A histopathological study of direct pulp capping with adhesive resins. Oper Dent 20: 223-29, 1995.

15. Kitasako Y, Inokoshi 5, Tagami J. Effects of direct resin pulp capping techniques on short term response of mechanically exposed pulps. J Dent 27: 257-63, 1999.

16. Greely, CB. Pulp therapy for the primary and young permanent dentition. In: Forrester DJ, Wagner ML, Fleming J. Pediatric Dental Medicine. Philadelphia, Lea and Febiger 456-60, 1981.

17. Kennedy DB, Kappala JT. The dental pulp: biologic considerations of protection and treatment. In: Braham RL, Morris ME. Textbook of pediatric dentistry 2nd ed. Baltimore, Williams and Wilkins, pp. 492-522, 1985.

18. Turner C, Courts FJ, Stanley HR. A histological comparison of direct pulp capping agents in primary canines. J Dent Child 54: 423-8, 1987.

19. Cox CF, Subay RK, Ostro E, Suzuki S, Suzuki SH. Tunnel defects in dentin bridges: their formation following direct pulp capping. Oper Dent 21: 4-11, 1996.

20. Cox, CF, Bergenholtz G, Keys DR, Syed SA, Fitzgerald MI, Hayes RI. Pulp capping of dental pulp mechanically exposed to oral microflora: a 1-2 year observation of wound healing in the monkey. J Oral Pathol 14: 156-68, 1985.

21. Mathewson RI, Premosch R, Robertson D. Fundamentals of pediatric dentistry. 2nd ed. Chicago, Quintessence Publishing Co. 270, 1987.

22. Camp IN. Pedodontic-endodontic treatment. In: Cohen 5, Burns RC. Pathways of the pulp. 5th ed. St. Louis, The C.V.Mosby Co. 686-90, 1991.

23. Belanger GK. Pulp therapy for the primary dentition. In:Pinkham JR. Pediatric dentistry-infancy through adolescence. Philadelphia, W.B. Saunders p. 261, 1988.

24. Katoh Y. Chico-pathological study on the pulp irritation of adhesive resinous material (report 1): histopathological change of the pulp tissue in direct capping. Adhesive Dentistry 11: 199-211, 1993.

25. Suzuki S, Cox CF, White KC. Pulpal response after complete crown preparation, dentin sealing, and provisional restoration. Quintessence Int 25: 477-85, 1994.

26. White KC, Cox CF, Kanca J, Dixon DL, Farmer JB, Snuggs HM. Pulpal response to adhesive resin systems applied to acid etched vital dentin : Damp versus dry primer application. Quintessence Int 25: 259-268, 1994.

27. Fujitani MI, Inokoshi S, Hosoda H. Effect of acid etching on the dental pulp in adhesive composite restorations. Int Dent J 42: 3- 11, 1992.

28. Pameijer CH, Stanley HR. The disastrous effects of the “total etch” technique in vital pulp capping in primates. Am J Dent 11: 45-54, 1998.

29. Mjor IA. Pulp reaction to calcium hydroxide-containing materials. Oral Surg Oral Med Oral Pathol 33: 961-5, 1972.

30. Tronstad L, MIjor IA Capping of the inflamed pulp. Oral Surg Oral Med Oral Pathol 34: 477-85, 1972.

31. Stanley HR, Going RE, Chauncey HH. Human pulp response to acid pretreatment of dentin and to composite restoration. JADA 20: 817-25, 1975.

32. Eriksen HM, Leidal TI. Monkey pulp response to composite resin restorations in cavities treated with various cleansing agents. Scand J Dent Res 87: 309-17, 1979.

33. Kanca III J. Replacement of a fractured incisor fragment over pulpal exposure: A case report. Quintessence Int 24: 81-4, 1993.

34. Onoe N. Study on adhesive bonding systems as a direct pulp capping agent. Japan J Oper Dent 37: 429-66, 1994.

35. Tarim B, Hafez AA, Suzuki SH, Suzuki 5, Cox CF. Biocompatibility of compomer restorative systems on nonexposed dental pulps of primate teeth. Oper Dent 22: 149-58, 1997.

36. Bouillaguet 5, Wataha JC, Hanks CT, Ciucchi B, Holz J. In vitro cytotoxicity and dentin permeability of HEMA. J Endod 22: 244-8, 1996.

37. Stanley HR. Criteria for standardizing and increasing credibility of direct pulp capping studies. Am J Dent 11: 17-34, 1998.

38. Hebling J, Giro EMA, Costa CAS. Human pulp response after an adhesive system application in deep cavities. J Dent 27: 557-64, 1999.

39. Wijnbergrn MI, Van Mullem PJ. Effect of histological decalcifying agents on number and stainability of gram-positive bacteria. J Dent Res 66: 1029-31, 1987.

40. Gerzina TM, Hume WR. Diffusion of monomers from bonding resin-resin composite combinations through dentine in vitro. J Dent 24: 125-8, 1996.

41. Hanks CT, Strawn SE, Wataha IC, Craig RG. Cytotoxic effects of resin components on cultured mammalian fibroblasts. J Dent Res 70: 1450-5, 1991.

42. Gwinnet AJ, Tay FR. Early and intermediate time response of the dental pulp to an acid etched technique in vivo. Am J Dent 10: 35-44, 1998.

43. Jontell MI, Hanks CT, Bratel I, Bergenholtz G. Effects of unpolymerized resin components of the function of accesory cells derived from the rat incisor pulp. J Dent Res 74: 1162-7, 1995.

44. Pashiey DH. Dynamics of the pulpo-dentin complex. Critical review. Oral Biology and Medicine 7: 104-133, 1996.

45. Hussey DL, Biagioni PA, Loney PJ. Thermographic measurement of temperature change during resin composite polymerization in vivo. J Dent 23: 267-7 1, 1995.

46. Araujo FB, Barata JS, Garcia-Godoy, F. Clinical and radiographic evaluation of the use of an adhesive system over primary dental pulps. J Dent Res 75(SI): Abstract 2101 p280, 1996.