[Biocompatibility of crown and bridge materials. 1. Substances in contact with dentin]

It is mandatory that the materials and drugs used in restorative dentistry be free from side effects resulting in potential tooth loss or irreversible damage to vital dental tissues. Up to now there have been no reliable in vitro methods available for the evaluation of pulp reactions. Since numerous different materials and drugs are successively applied to prepared dentine, pulp reactions are caused by cumulative action, and the causative factors, except for extremely toxic substances, cannot be revealed by clinical and/or posttreatment studies alone. At present, the evaluation of pulp reactions must still rely on histologic studies using human or animal teeth. Reports on pulp reactions to materials and drugs are reviewed. Few dependable figures have been reported on pulp reactions to dentinal medication, "sterilization", disinfectants and on the biologic response to and effectiveness of varnishes, liners, desensitizing agents, smear-layer removers, etc. Resins and composite materials seem to provoke acute reactions, mainly by the heat generated during setting, and chronic reactions due to the stimulation of bacterial growth. Except for glass ionomer cements, most of the publications show a high degree of agreement on the tissue reactions to luting agents. Regarding dentine bonding agents, however, it has not been possible to draw any conclusions, so far.