Direct Pulp Capping with A Self-Etch Adhesive in Carious Teeth

Methods: 12 noninflammated wisdom teeth with deep carious lesions scheduled for extraction were used in the study after receiving signed consent of patients. Following caries removal, the pulps of teeth were exposed with sterile round steel burs ( # 014, NTI,Germany). 6 teeth of experimental group were restored with adhesive system and composite resin (Clearfil APX, Kuraray,Japan). The control group was capped with Dycal ( Dentsply/Caulk, USA) and composite resin. 3 teeth from experimental group were extracted after one week due to pulpal inflammation and severe pain. 9 teeth were extracted at 90 days after testing for their pulp vitality. The teeth were fixed,sectioned and stained for histopathological evaluation using a light microscope.The following parameters were evaluated:pulp tissue disorganization, inflammotory cell infiltration, reparative dentin formation and dentin bridging over the exposure sites.

Results: All dycal capped teeth exhibited no pulp inflammation.But odontoblast density was reduced beneath the cavities.Partial or complete dentin bridge formation was found on exposure sites.In SE Bond capped teeth,the pulp tissue showed significant disorganization zone with loss of the odontoblast layer and predentin.Dense inflammatory infiltration under exposure sites were observed with the presence of hemorrhagic foci.The areas away from exposure site also showed slight inflammatory cell infiltration. No signs of dentin bridging was found at the wound surfaces.

Conclusion: The self-etch adhesive system SE Bond should not be considered for direct pulp capping in deep carious lesions until further studies have been performed.