Hilcia Mezzalira Teixeira

Short-term evaluation of the pulpo-dentin complex response to a resin-modified glass-ionomer cement and a bonding agent applied in deep cavities

OBJECTIVES To evaluate the response of the pulpo-dentin complex following application of a resin-modified glass-ionomer cement or an adhesive system in deep cavities performed in human teeth. METHODS Deep class V cavities were prepared on the buccal surface of 26 premolars. In Group 1 the cavity walls (dentin) and enamel were conditioned with 32% phosphoric acid and the dentin adhesive system One Step (Bisco, Inc., Itasca, IL, USA) was applied. In Groups 2 and 3, before total etching and application of bonding agent, the cavity floor was lined with the resin-modified glass-ionomer cement-Vitrebond (3M ESPE Dental Products Division, St. Paul, MN, USA) or the calcium hydroxide cement-Dycal (control group, Dentsply, Mildford, DE, USA), respectively. The cavities were restored using light-cured Z-100 composite resin (3M ESPE). The teeth were extracted between 5 and 30 days and prepared for microscopic assessment. Serial sections were stained with H/E, Massons trichrome and Brown and Brenn techniques. RESULTS In Group 1, the inflammatory response was more evident than in Groups 2 and 3. Diffusion of dental material components across dentinal tubules was observed only in Group 1, in which the intensity of the pulp response increased as the remaining dentin thickness decreased. Bacteria were evidenced in the lateral walls of two samples (Group 2) which exhibited no inflammatory response or tissue disorganization. CONCLUSIONS Based on the experimental conditions, it was concluded total acid etching followed by application of One Step bonding agent cannot be recommended as adequate procedures. In this clinical condition the cavity walls should be lined with a biocompatible dental material, such as Vitrebond or Dycal.

Response of human pulps following acid conditioning and application of a bonding agent in deep cavities

OBJECTIVES The aim of this in vivo study was to evaluate the human dental pulp response when a one-bottle adhesive system was applied on etched or unetched deep dentine. METHODS Eighteen class V deep cavity preparations were divided in three groups: group 1-total etching + two coats of single bond (SB) + composite resin (Z-100); group 2-enamel etching + two coats of SB + Z-100; group 3-cavity floor lined with a calcium hydroxide liner (Dycal) + acid-etching of enamel and lateral walls + two coats of SB + Z-100. Two teeth were used as intact control group. After 30 days the teeth were extracted and processed through H and E, Massons trichrome and Brown and Brenn staining techniques. RESULTS Moderate inflammatory response, disorganization of pulp tissue, as well as, deposition of thin layer of reactionary dentin were observed in group 1 teeth in which the remaining dentin thickness (RDT) was less than 300 microm. These histological findings appear to be related to long resin tags formation and bonding agent diffusion through dentinal tubules. In group 2, slight inflammatory response was observed only in one tooth in which the RDT was 162 microm. In group 3, all the teeth showed normal histological characteristics which were similar to the intact control group. Presence of bacteria was not correlated with the intensity of pulpal response. The patients reported no symptoms during the experiment. Radiographic evaluation showed no periapical pathology for any of the teeth. SIGNIFICANCE AND CONCLUSIONS Acid-etched deep dentin (RDT less than 300 microm) lined with SB causes more intense pulpal response than unetched deep dentin. Based on the results observed in the present study and the conditions in which it was carried out, we recommend the application of a biocompatible liner before etching deep dentin and applying SB.

Biocompatibility of Two Current Adhesive Resins

The purpose of the study was to evaluate the biocompatibility of two current adhesive resins and a calcium hydroxide cement. Fifty-four polyethylene tubes were filled with these dental materials, which were hand-mixed or light-cured according to the manufacturers directions: group 1--Clearfill Liner Bond 2 (Kuraray); group 2--Single Bond (3 M); and group 3--calcium hydroxide cement (Dycal-Dentsply). The materials were implanted into dorsal connective tissue of rats, which were killed 7, 30, and 60 days after the implantation procedure. The implant sites were excised, immersed in buffered Karnovskys fixative, and processed using routine histological techniques. Sections of 6 microns thickness were stained with hematoxylin and eosin and assessed under light microscopy. Both adhesive resins at 7 days elicited a moderate/intense inflammatory reaction that decreased over time. Fibrous capsules surrounding the tubes were observed at 30 days. Half of the samples in groups 1 and 2 showed thin fibrous capsule formation containing macrophages, capillaries, lymphocytes, fibroblasts, and collagen fibers. Connective tissue healing was observed even though many specimens exhibited a persistent inflammatory reaction mediated by macrophages and giant cells at the 60-day evaluation. Dycal allowed complete healing at 30 days with only a thin fibrous capsule. In conclusion, all experimental materials were successfully walled off by the connective tissue of the rat. However the adhesive resins may release particulates that may, in turn, induce a persistent local inflammatory reaction. Consequently, in this specific condition, these materials cannot be regarded as biocompatible. Dycal was less irritating than the adhesive resins and was better tolerated by the connective tissue.