Читать книгу Endodontic Materials in Clinical Practice - Группа авторов - Страница 38

Resin‐based systems were first suggested for pulp capping in the mid‐1990s [122] and remained fashionable for the next 10–15 years. The initial interest came from non‐primate studies, which showed that mechanical exposures treated with adhesive systems led to pulp healing [123, 124]. Primate studies using uncontaminated mechanically‐induced exposures also showed positive results, demonstrating that resin‐based systems led to healing responses similar to those obtained with calcium hydroxide, the gold standard at the time [125, 126]. Further studies were conducted which reproduced more realistic conditions, such as capping of bacterial contaminated pulps. These represented the most common clinical situations, as most exposures result from a deep carious lesion or are treated when an operative field is not controlled with a rubber dam [127]. Between 2005 and 2008, seven human studies compared the histological response between resin‐based systems and calcium hydroxide, with between 16 and 40 teeth in each. All showed a more favourable response in the calcium hydroxide group compared to the resin‐based one irrespective of whether an etch‐and‐rinse or a self‐etch system was used [128].

Resin‐based adhesive systems are not suitable candidates for VPT due to their cytotoxic effects [129]; the challenge of obtaining a bacterial tight seal when there is likely to be moisture (open wound of the pulp), which will reduce polymerization [130]; the amount of unpolymerized material with a high prevalence of toxic components at the wound site; and certain components in the resin that reduce the pulp’s immune response, leading to reduced microbial clearance [131]. It is thus well established that resin‐based adhesives should not be used for VPT [1].