Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system

Objectives. The objective was to evaluate the response of human pulps capped with different components from a total-etch three-step adhesive system. Methods. Direct pulp capping was performed in 25 caries-free human premolars scheduled for extraction due to orthodontic treatment. The teeth were randomly divided in five groups, and capped with the following materials: Group 1-acid+ primer+adhesive were used as recommended; Group 2-only primer was applied; Group 3-only bonding resin (tight-cured for 10s); Group 4-only composite resin (light-cured for 40 s); Group 5-calcium hydroxide. After capping, all teeth were restored with ScotchBond Multi Purpose Plus and Z-100 was placed incrementally. After 60 days, the teeth were extracted and processed for light microscopic examination (H/E) according to a histological score system. These were subjected to non-parametric tests (alpha<0.05). Results. Overall, the histological features showed that groups 1-4 were quite similar and inferior to group 5. In groups 1-4 the pulp response varied from acute inflammatory cell infiltrate with varying degrees to necrosis. The groups 3 and 4 showed a trend towards better pulp response, since a normal connective tissue could be observed in more than half of the sample. All teeth from group 5 showed normal connective tissue below an amorphous dentin bridge. Significance. Adhesive components (primer or adhesive) as well as a composite should be avoided for pulp capping. Ca(OH)(2) should be the first choice for pulp capping. (C) 2004 Academy Dental Materials. Published by Elsevier Ltd. All rights reserved.