Pulpitis tendency in teeth with vital pulp restored with composite resins: a cross-sectional retrospective study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20243432Keywords:
Pulpitis, Composite resin, Cavity depth, Pulp healthAbstract
Background: This study evaluates pulpitis tendency in vital teeth restored with composite resin after at least one year, focusing on the effect of cavity depth and the use of a base material on pulp status.
Methods: A retrospective analysis was conducted on 212 patients with one tooth restored by dental senior students. At the follow-up, periapical and bitewing radiographs, cold tests, percussion, and palpation were performed. Cavity depth was measured from bitewing radiographs, and the periapical index (PAI) was recorded. The restored teeth were compared with contralateral sound teeth to assess the impact of the resin on pulp tissue.
Results: Composite resin restorations significantly affected pulp status compared to intact teeth (p=0.002). Five out of 212 teeth became necrotic, and four developed symptomatic irreversible pulpitis (SIP). Four necrotic cases occurred in cavities deeper than 3.60 mm, and all SIP cases were associated with cavities deeper than 3.10 mm. Cavity depth was a significant predictor of adverse pulpal outcomes. However, using calcium hydroxide as a base did not significantly affect pulp health.
Conclusions: The study concludes that composite resin restorations, mainly in deep cavities, can negatively impact pulp vitality. Cavity depth is a key factor in the risk of pulp necrosis and SIP, while calcium hydroxide base did not reduce pulpitis incidence. Larger studies with longer follow-up periods are recommended to confirm these findings and explore potential protective factors.
Metrics
References
Demarco FF, Conde MC, Cavalcanti BN, Casagrande L, Sakai VT, Nor JE. Dental pulp tissue engineering. Braz Dent J. 2011;22(1):3-13.
Goldberg M. The dental pulp: biology, pathology, and regenerative therapies. Springer. 2014.
Root RK. Clinical infectious diseases: a practical approach. Oxford University Press, USA. 1999.
Yu C, Abbott PV. An overview of the dental pulp: its functions and responses to injury. Aust Dent J. 2007;52:S4-6.
Dawson V, Amjad S, Fransson H. Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review. Int Endod J. 2015;48(7):627-38.
Lee S-M, Kim S-Y, Kim J-H, Soo-Kyung J, Hae-Won K, Jung-Hwan L, et al. Depth-Dependent Cellular Response from Dental Bulk-Fill Resins in Human Dental Pulp Stem Cells. Stem Cells Int. 2019;2019(1):1251536.
Grieve AR, Alani A, Saunders WP. The effects on the dental pulp of a composite resin and two dentine bonding agents and associated bacterial microleakage. Int Endod J. 1991;24(3):108-18.
Tadin A, Marovic D, Galic N, Kovacic I, Zeljezic D. Composite-induced toxicity in human gingival and pulp fibroblast cells. Acta Odontol Scand. 2014;72(4):304-11.
Trushkowsky RD, Gwinnett AJ. Microleakage of Class V composite, resin sandwich, and resin-modified glass ionomers. Am J Dentistr. 1996;9(3):96-9.
Bergenholtz G. Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations. Crit Rev Oral Biol Med. 2000;11(4):467-80.
Dawson VS, Amjad S, Fransson H. Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review. Int Endod J. 2015;48(7):627-38.
Alovisi M, Baldi A, Comba A, Roberta G, Gaetano P, Mauro M, et al. Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study. J Clin Med. 2024;13(13):3962.
Fan J, Xu Y, Si L, Li X, Fu B, Hannig M. Long-term clinical performance of composite resin or ceramic inlays, onlays, and overlays: a systematic review and meta-analysis. Oper Dent. 2021;46(1):25-44.
Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endodont Dental Traumatol. 1986;2(1):20-34.
Ijaimi ZA, Abubakr NH, Ibrahim YE. Assessment of the Quality of Composite Resin Restorations. Open J Stomatol. 2015;05(02):19-25.
Pedano MS, Li X, Yoshihara K, Landuyt KV, Meerbeek BV. Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents Towards Human Tooth-Pulp Cells: A Systematic Review of in vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials. Materials. 2020;13(12):2670.
Schneider T, Hakami-Tafreshi R, Tomasino-Perez A, Tayebi L, Lobner D. Effects of dental composite resin monomers on dental pulp cells. Dent Mater J. 2019;38(4):579-83.
Bergenholtz G. Inflammatory response of the dental pulp to bacterial irritation. J Endod. 1981;7(3):100-4.
Bergenholtz G. Effect of bacterial products on inflammatory reactions in the dental pulp. Scand J Dent Res. 1977;85(2):122-9.
Khabbaz MG, Anastasiadis PL, Sykaras SN. Determination of endotoxins in the vital pulp of human carious teeth: association with pulpal pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(5):587-93.
Whitworth JM, Myers PM, Smith J, Walls AW, McCabe JF. Endodontic complications after plastic restorations in general practice. Int Endod J. 2005;38(6):409-16.
Baratieri LN, Ritter AV. Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique. J Esthet Restor Dent. 2001;13(1):50-7.
Ertuğrul İhF, Yazkan B, Ertuğrul CÇ. Protective Effects of Base Cements Against Intrapulpal Temperature Rise During Curing of Composite Resins: An in vitro Study by Pulpal Blood Microcirculation Model. Int J Exp Dent. 2018;7(2):85-90.
Bezzon OL, Rivera DS-h, Silva RAB, Daniela SBO, Daniel SH, Paulo NF, et al. Resin Luting Materials: Tissue Response in Dog's Teeth. Microsc Res Tech. 2015;78(12):1098-103.
Yasuda Y, Inuyama H, Maeda H, Akamine A, Saito T. Cytotoxicity of One‐step Dentin‐bonding Agents Toward Dental Pulp and Odontoblast‐like Cells. J Oral Rehabil. 2008;35(12):940-6.
Junior LJdSA, Penha KJdS, Souza AF, Estevam COL, Fernando CM, Darlon ML, et al. Is There Correlation Between Polymerization Shrinkage, Gap Formation, and Void in Bulk Fill Composites? A ΜCT Study. Braz Oral Res. 2017;31:e100.
Dahl JE, Ørstavik D. Responses of the Pulp-dentin Organ to Dental Restorative Biomaterials. Endod Top. 2007;17(1):65-73.
Üşümez A, Öztürk AM, Aykent F. The Effect of Dentin Desensitizers on Thermal Changes in the Pulp Chamber During Fabrication of Provisional Restorations. J Oral Rehabil. 2004;31(6):579-84.
Assunção GSM, Ocarino NdM, Sofal LC, Serákides R. Microscopic Alterations of the Dental Pulp in Surgically Extracted Teeth of Dogs. J Vet Dent. 2023;40(3):227-35.
Ilie N, Bucuta S, Draenert M. Bulk-fill Resin-based Composites: An in vitro Assessment of Their Mechanical Performance. Oper Dent. 2013;38(6):618-25.
Şişman R, Aksoy A, Yalçın M, Karaöz E. Cytotoxic effects of bulk fill composite resins on human dental pulp stem cells. J Oral Sci. 2016;58(3):299-305.
Lee S-M, Kim S-Y, Kim J-H, Soo-Kyung J, Hae-Won K, Jung-Hwan L, et al. Depth-Dependent Cellular Response from Dental Bulk-Fill Resins in Human Dental Pulp Stem Cells. Stem Cells Int. 2019;2019:1251536.
Toh WS, Yap A, Lim SY. In vitro Biocompatibility of Contemporary Bulk-fill Composites. Oper Dent 2015;40(6):644-52.
Mathur VP, Dhillon JK, Logani A, Kalra G. Evaluation of indirect pulp capping using three different materials: A randomized control trial using cone-beam computed tomography. Indian J Dent Res. 2016;27(6):623-9.
Hashem D, Mannocci F, Patel S, Manoharan A, Brown JE, Watson TF, et al. Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial. J Dent Res. 2015;94(4):562-8.
Sahin N, Saygili S, Akcay M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clin Oral Investig. 2021;25(6):3945-55.