Endodontic complications after plastic restorations in general practice

Area of Science:

• Restorative Dentistry
• Dental Materials Science
• Pulp Biology

Background:

• Dentine and pulp protection are critical in restorative dental procedures.
• Conventional calcium hydroxide lining has been a standard for decades.
• Newer techniques like conditioning-and-sealing require efficacy comparison.

Purpose of the Study:

• To evaluate if conditioning-and-sealing is non-inferior to calcium hydroxide lining for dentine and pulp protection.
• To identify factors influencing pulpal breakdown post-restoration.

Main Methods:

• A randomized controlled trial involving 602 healthy adults requiring posterior tooth restorations.
• Cavities were treated with either calcium hydroxide lining or conditioning-and-sealing.
• Restorations were monitored for pulpal breakdown up to 36 months.
• Logistic regression analyzed treatment variables and pulp outcomes.

Main Results:

• No significant difference in pulp protection between conditioning-and-sealing and calcium hydroxide lining up to 36 months.
• Pulp breakdown was strongly associated with deep or pulpally exposed cavities (OR 7.8) and composite restorations (OR 2.13).
• Pulpal exposure was the primary determinant of adverse pulp outcomes (OR 28.4).

Conclusions:

• Conditioning-and-sealing offers comparable pulp protection to calcium hydroxide lining in routine dental care.
• Residual dentine thickness is a crucial factor in pulp response to restorative treatment.
• Composite resin restorations in deep or exposed cavities showed higher rates of pulpal breakdown compared to amalgam.