Abeer A. Hafez

Analysis of Pulpal Reactions to Restorative Procedures, Materials, Pulp Capping, and Future Therapies

Every year, despite the effectiveness of preventive dentistry and dental health care, 290 million fillings are placed each year in the United States; two-thirds of these involve the replacement of failed restorations. Improvements in the success of restorative treatments may be possible if caries management strategies, selection of restorative materials, and their proper use to avoid post-operative complications were investigated from a biological perspective. Consequently, this review will examine pulp injury and healing reactions to different restorative variables. The application of tissue engineering approaches to restorative dentistry will require the transplantation, replacement, or regeneration of cells, and/or stimulation of mineralized tissue formation. This might solve major dental problems, by remineralizing caries lesions, vaccinating against caries and oral diseases, and restoring injured or replacing lost teeth. However, until these therapies can be introduced clinically, the avoidance of post-operative complications with conventional therapies requires attention to numerous aspects of treatment highlighted in this review.

Bacterial microleakage and pulp inflammation associated with various restorative materials

OBJECTIVES Many restorative materials are claimed to be successful in preventing bacterial microleakage and minimizing pulp inflammation. However, information regarding the in vivo performance of materials in comparison with each other is limited. The aim of this study was to evaluate and compare the pulp response of nine restorative materials when placed in non-exposed monkey cavities. METHODS 279 standardized non-exposed Class V cavities, were prepared into buccal dentin. Cavities were restored with a number of materials in the following categories: Zinc oxide eugenol (ZnOE), Calcium hydroxide [Ca(OH)(2)], zinc phosphate (ZP), Resin-modified glass ionomer (RMGI), Composite resin (CR), Bonded amalgam (BA), Gutta-percha (GP), Compomer and Silicate. Pulp tissues were collected and evaluated at short, intermediate and long-term intervals according to ISO guidelines; employing histomorphometric analysis, Spearmans rho and ANOVA statistics. Pulp responses were categorized according to FDI, ISO and ADA standards. Bacteria were detected using McKay stains. RESULTS Pulp inflammation was found to be correlated to bacterial microleakage around the restoration (p < or =0.0001). The frequency of bacterial microleakage was found to vary between restorative materials (p < or =0.0001). In rank order of preventing bacterial microleakage from best to the worst; RMGI (100%), BA (88%), ZnOE (86%), CR (80%), GP (64%), Ca(OH)(2) (58%), compomer (42%), silicate (36%) and ZP (0%). SIGNIFICANCE The most effective restorative materials to prevent bacterial microleakage and pulp injury from inflammatory activity were RMGI, BA, ZnOE and CR restorations.