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Direct adhesive pulp capping: pulpal healing and ultra-morphology of the resin-pulp interface.

PURPOSE
To test the hypothesis that healing of adhesively capped pulps may depend on the type of adhesive system used and its specific application approach.


MATERIALS AND METHODS
Buccal Class V cavities were prepared in 24 intact monkey teeth. After exposing the pulps, infiltration anesthesia (Xylocaine containing 1:80,000 epinephrine) was administered around the root apex. Two adhesives that make use of a different hybridization approach, Clearfil Liner Bond II (CLB-II) and Super-Bond D Liner II (SB-II) were directly applied to the exposed cavities. The pulpal response was histopathologically investigated using light microscopy at 3 and 90 days. In addition, the resin-pulp interface was characterized by transmission electron microscopy in an attempt to elucidate the underlying mechanisms of healing.


RESULTS
In the CLB-II capped pulps, little inflammation was detected at 3 days with the bonding resin intimately attached to the exposed pulpal tissue. At 90 days, a complete dentin bridge was formed in close adaptation to the resin cap. The ultra-structure of a thin intermediary layer at the bridge front resembled a so-called "reversal line". This layer typically appears during remodeling of bone to couple the newly formed to the old osseous tissue. In the SB-II capped pulps, an acute inflammation was in progress immediately beneath the bonding resin at 3 days. This tissue was resorbing the resin that had infiltrated relatively deeply into the pulp. Whereas healing of CLB-II capped pulps appeared to have been initiated promptly, healing of SB-II capped pulps was probably retarded. The formed soft-tissue hybrid layer had first to be resorbed before the formation of a dentin bridge could have been initiated. Hence, the dentin bridge was not completely finished at 90 days and no evidence of a "reversal line"-like layer could be detected. These results suggested that although both the adhesives tested appeared effective as pulp capping materials, the process and duration of healing substantially differed.