Critical Reviews in Oral Biology & Medicine, Vol 11, 467-480, Copyright © 2000 by International & American Associations for Dental Research
Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations
G. Bergenholtz
Department of Endodontology and Oral Diagnosis, Faculty of Odontology, Goteborg University, Sweden. Gunnar.Bergenholtz@odontologi.gu.se
The widespread use of resin and resin-monomers for bonding of dental
restorations to dentin has occurred because of a fundamental shift in the
view that injury to the pulp is induced by restorative procedures. While,
for many years, the toxic effects of restorative materials were thought to
be of crucial importance in the development of adverse pulpal responses,
the key role of bacterial leakage at the restoration-tooth interface is now
well-recognized. Consequently, if optimal conditions for the preservation
of pulpal health are to be ensured, dental restorations should provide an
impervious seal against the surrounding tooth structure. However,
polymerization shrinkage and contraction stresses induced during setting,
as well as a variety of technical difficulties encountered during the
clinical operation, often produce less than perfect results. Therefore,
modern restorative procedures involving resin and resin-bonded restoratives
must still rely on the ability of the pulp to cope with the injurious
elements to which it may be exposed during and after the procedure. This
review examines factors that may govern the pulp's response to restorative
procedures that involve adhesive technologies. An assessment is made of the
risks involved as far as the continued vital function of the pulp is
concerned. It is concluded that an intact, although thin, wall of primary
dentin often enables the pulp to overcome both toxic material effects and
the influences of bacterial leakage. In contrast, the pulp may not do
equally well following capping of open exposures with resin composites. A
dearth of controlled clinical studies in this area of dentistry calls for
confirmation that pulpal health prevails over the long term following the
use of total-etch and resin-bonding techniques.
