Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system.
Level 2 - randomized trial
Randomized controlled trial evaluating human histological pulp response across five direct pulp capping interventions.
PubMed 15978268 · doi:10.1016/j.dental.2004.08.008
What was done
Direct pulp capping was evaluated in 25 caries-free human premolars scheduled for orthodontic extraction. Teeth were randomly assigned to five groups: Group 1 (acid etch + primer + adhesive), Group 2 (primer only), Group 3 (bonding resin only, light-cured 10 s), Group 4 (composite resin only, light-cured 40 s), and Group 5 (calcium hydroxide control). All teeth were subsequently restored with ScotchBond Multi Purpose Plus and Z-100 composite. After 60 days, teeth were extracted and evaluated by light microscopy (H/E) using a histological scoring system analyzed with non-parametric tests (alpha < 0.05).
What was found
Histological outcomes for groups 1–4 were inferior to calcium hydroxide (group 5). Pulp responses in groups 1–4 ranged from acute inflammatory cell infiltrates to varying degrees of necrosis. Groups 3 and 4 showed a trend toward better responses, with normal connective tissue present in more than half of their specimens. In group 5 (calcium hydroxide), 100% of teeth exhibited normal connective tissue beneath an amorphous dentin bridge. Specific numerical scores and exact p-values were not reported in the abstract.
Why it matters
This trial demonstrates that adhesive components and composite resins cause adverse pulpal inflammation or necrosis upon direct contact, reinforcing calcium hydroxide as the standard material for direct pulp capping.
Limits
The total sample size was small (25 teeth, 5 per group), and the number of individual human participants was not reported. The trial examined sound, caries-free premolars in orthodontic patients, which may not represent the biology of deep carious exposures in clinically compromised pulps. Quantitative histological scores and statistical test statistics are absent from the abstract.
Cited by
- supports Acidic and toxic bonding materials placed deep at the base of dental fillings can cause the dental nerve to die.