The disastrous effects of the "total etch" technique in vital pulp capping in primates

To determine by means of a histopathological study in sub-human primates whether etching of an exposed pulp (the "Total Etch" technique) followed by capping with dentin bonding agents is a viable clinical treatment modality.

In six sub-human primates, 147 Class V preparations were made for five experimental and two control groups. After exposing the pulps, the preparations were intentionally contaminated, rinsed, dried and then disinfected with a 2% chlorhexidine solution for 60 s. In the five experimental groups, the entire preparation including the exposed pulp was etched with a 35% phosphoric acid gel, which was rinsed after 20 s. This was followed by a second application of chlorhexidine. In Groups 1-3, All Bond 2, ProBond and Permagen A&B dentin bonding agents were applied as pulp capping materials. In Group 4, a light-cured calcium hydroxide was tested while Group 5 was treated with a chemically-cured calcium hydroxide. Groups 6 and 7, the controls, were also contaminated, rinsed, dried and disinfected. After the exposed pulps had been protected with a chemically-cured calcium hydroxide (Group 6) or a light-cured calcium hydroxide (Group 7) the preparations were etched and restored with a bonded resin composite. The effect of the above described treatments were evaluated at 5, 25 and 75 days. After sacrifice and routine histological preparation, histological sections were graded among other parameters for inflammatory response, bridge formation, maintenance of vitality, presence of dentin chips and evidence of microleakage microorganisms.

The 2% chlorhexidine applied immediately after exposure was an effective hemostatic agent. After subsequent etching, the hemostatic effectiveness was greatly reduced. Exposure size for all seven groups ranged from 0.13-1.55 mm. The average at 5, 25 and 75 days measured 0.74, 0.66 and 0.77 mm, respectively. In the five experimental groups, the 25- and 75-day groups had a total of 68 teeth of which 24 (35%) became non-vital and 23 (33%) teeth demonstrated bridge formation. In the three experimental groups using a bonding agent, the 25- and 75-day groups had a total of 40 teeth of which 18 (45%) became non-vital and 10 (25%) exhibited bridge formation. In the "No Etch" control groups, the 25- and 75-day groups had 28 teeth of which two (7%) became non-vital and 23 (82%) exhibited bridge formation. Microorganisms were found in a large percentage of all groups, although their numbers were few. However, they were present in vital and non-vital teeth, in the presence and absence of bridge formation and had no direct bearing on the success or failure of the pulp capping procedure.