Local and systemic responses to dental composites and glass ionomers

Effects of resin materials dedicated for additive manufacturing of temporary dental restorations on human gingival keratinocytes

OBJECTIVE

This study investigated the effect of eluates of conventional and 3D-printed resin materials for manufacturing temporary dental restorations on gingival keratinocytes.

METHODS

Three-dimensional (3D)-printed resin materials: 3Delta temp (Deltamed), NextDent MFH (Nextdent), Freeprint temp (Detax), GC temp (GC), were compared to Grandio disc (Voco) and Luxatemp (DMG). Human gingival keratinocytes (IHGKs) were exposed to eluates of the materials and XTT assays were performed at 24 h, 48 h, 72 h, or 144 h. For quantification of the proinflammatory response, the protein amount of IL-6 and 8 was determined in the supernatants using ELISA. One-way ANOVA with post hoc analysis was used to compare differences in cell viability and IL-6 and IL-8 levels between groups.

RESULTS

At 24 h, and more remarkably at 48 h, a significant decrease in cell viability occurred for the 3D-printed materials compared to the untreated IHGKs, but also compared to Grandio disc and Luxatemp. Except for the expression of IL-8 in presence of the eluate of Grandio disc at 24 and 48 h, all tested materials caused attenuation of IL-6 and 8 from IHGKs for any observation period.

CONCLUSIONS

The materials for additive manufacturing affect cell proliferation differently than the subtractive manufactured material Grandio disc and the conventional material Luxatemp.

CLINICAL SIGNIFICANCE

In comparison to conventional and subtractive manufactured restorations, 3D printed temporary restorations might induce more negative effects on the gingival and probably also on pulpal health since viability and the proinflammatory response of oral keratinocytes are more intensively affected by these materials.

Is 'Digital Dentistry' Dangerous for Teeth? Problems Associated with Zirconia and CAD/CAM Restorations

The increasing prescription of metal-free dental restorations has come about as a result of various patient demands and somewhat narcissistic expectations. However, some dental professionals have contributed to the rise in popularity of these materials and techniques. This article highlights the potential pitfalls of undertaking inherently destructive procedures, particularly when performed for questionable "cosmetic" reasons.

Double-blind Study on Materials Testing with Applied Kinesiology

Applied Kinesiology (AK) is a scientifically unproven method used in complementary medicine to recognize the (in)tolerance of dental materials. Test-retest reliability of AK was examined. The working hypothesis was the assumption that the reliability of AK would not exceed random chance. Two dentists qualified in AK examined 112 volunteers to determine individual (in)tolerance toward two dental composite materials. After the first examination, 31 subjects were excluded from further testing. At the end of the open test phase, 34 of 81 participants had been classified as “tolerant”, and seven as “intolerant” to both materials. The remaining 40 individuals showed a combination of either tolerant (to material I)/intolerant (to material II), or the reverse (n = 20 each). Retrieval rate was tested under blind conditions. In 14 cases, the results of the open and blinded tests matched, whereas in 26 cases they did not (95% confidence interval, 21%-52%; p = 0.98). This outcome confirmed our working hypothesis.

Interaction between LPS and a dental resin monomer on cell viability in mouse macrophages

OBJECTIVE

Lipopolysaccharide (LPS) from cariogenic microorganisms and resin monomers like HEMA (2-hydroxyethyl methacrylate) included in dentin adhesive are present in a clinical situation in deep dentinal cavity preparations. Here, cell survival, expression of proteins related to redox homeostasis, and viability of mouse macrophages exposed to LPS and HEMA were analyzed with respect to the influence of oxidative stress.

METHODS

Cell survival of RAW264.7 mouse macrophages was determined using a crystal violet assay, protein expression was detected by Western blotting, and HEMA- or LPS-induced apoptosis (cell viability) was analyzed by flow cytometry. Cells were exposed to HEMA (0-8mM), LPS (0.1μg/ml) or combinations of both substances for 24h. The influence of mitogen-activated protein kinases (MAPK) was analyzed using the specific inhibitors PD98059 (ERK1/2), SB203580 (p38) or SP600125 (JNK), and oxidative stress was identified by the antioxidant N-acetylcysteine (NAC).

RESULTS

Cell survival was reduced by HEMA. LPS, however, increased cell survival from 29% in cultures exposed to 8mM HEMA, to 46% in cultures co-exposed to 8mM HEMA/LPS. Notably, LPS-induced apoptosis was neutralized by 4-6mM HEMA but apoptosis caused by 8mM HEMA was counteracted by LPS. Expression of NOS (nitric oxide synthase), p47^phox and p67^phox subunits of NADPH oxidase, catalase or heme oxygenase (HO-1) was associated with HEMA- or LPS-induced apoptosis. While no influence of MAPK was detected, NAC inhibited cytotoxic effects of HEMA.

SIGNIFICANCE

HEMA- and LPS-triggered pathways may induce apoptosis and interfere with physiological tissue responses as a result of the differential formation of oxidative stress.

Biocompatibility Evaluation of Dental Luting Cements Using Cytokine Released from Human Oral Fibroblasts and Keratinocytes

Dental luting cements are commonly used in dentistry for cementation of prosthetic restoration. Many previous studies focused on the measurement of the cell viability as the method of cytotoxicity evaluation during biocompatibility study for the material. In this study, the biocompatibility of various dental luting cements were evaluated using the new method of cytokine release measurement in order to better simulate inflammatory reactions in animal or clinical model using two different oral cells; immortalized human gingival fibroblast and immortalized human oral keratinocytes. Cells were exposed to extractions of various commercially available dental luting cements for different durations. Cytokines of IL-1α and IL-8 were measured from the supernatants of the cells and the results were then compared to the conventional MTT viability test. The result from the conventional cell viability study showed a relatively simple and straight forward indication that only one of the dental luting cements tested in this study was cytotoxic with increasing duration of exposure for both cells. Meanwhile, the result from the cytokine measurement study was much more complex at the time point they were measured, type of cells used for the study and the type of cytokines measured, all of which influenced the interpretation of the results. Hence, the better understanding of the cytokine release would be required for the application in biocompatibility evaluation.

Biocompatibility of various dental materials in contemporary dentistry: a narrative insight

In the past few decades, there has been an increase in demand for safety evaluation and control of dental materials used daily in dentistry; however, this task is difficult and cumbersome. Dental materials that are passive and do not react with the oral environment will be more stable and have superior durability. It is expected that dental materials will be universally accepted and will not cause harm or injury to the surrounding structures in the oral cavity. This is an entirely negative approach to the material tolerance and biocompatibility, and hides the possibility that some positive gains can be achieved. Side-effects of dental materials are believed to be rare, and generally, those that have been reported are mild. There are wide varieties of materials used in dentistry, which include liners, irrigants, intracanal filling materials, intracanal medicaments, prosthetic materials, restorative materials, subgingival implants, and mouth rinses. Therefore, in this study, the biocompatibility of various commonly-used clinical materials used in contemporary dentistry was discussed.

Effect of fluoride-containing desensitizing agents on the bond strength of resin-based cements to dentin

Objective:

The objective of this study was to evaluate the effect of desensitizing agents containing different amounts of fluoride on the shear bond strength of a dual polymerized resin cement and a resin-modified glass ionomer cement (RMGIC) to dentin.

Material and Methods:

One hundred human molars were mounted in acrylic resin blocks and prepared until the dentin surface was exposed. The specimens were treated with one of four desensitizing agents: Bifluorid 12, Fluoridin, Thermoline and PrepEze. The remaining 20 specimens served as untreated controls. All groups were further divided into 2 subgroups in which a dual polymerized resin cement (Bifix QM) or a resin-modified glass ionomer cement (AVANTO) was used. The shear bond strength (MPa) was measured using a universal testing machine at a 0.5 mm/min crosshead speed. The data were analyzed statistically with a 2-way ANOVA, Tukey HSD test and regression analysis (α=0.05). The effect of the desensitizing agents on the dentin surface was examined by scanning electron microscopy.

Results:

The fluoride-containing desensitizing agents affected the bond strength of the resin-based cements to dentin (p<0.001). PrepEze showed the highest bond strength values in all groups (p<0.001).

Conclusion:

Regression analysis showed a reverse relation between bond strength values of resin cements to dentin and the amount of fluoride in the desensitizing agent (p<0.05).

In vitro genotoxicity of root canal sealers

AIM

To evaluate the effect of leakage on differences in genotoxicity of root canal sealers ex vivo according to their main components using two different cytogenetic assays.

METHODOLOGY

Six materials of different composition (GuttaFlow, Epiphany, Diaket, IRM, SuperEBA and Hermetic) were tested on human peripheral blood lymphocytes using the comet assay and chromosomal aberration analysis. Prepared materials were eluted in physiological solution for 1 h, 1 day, 5 and 30 days. Thereafter cultures were treated with 8 microg, 4 microg and 2 microg of each sealer. Frequencies of chromatide and chromosome breaks and accentric fragments were determined. Comet assay was used to evaluate primary DNA damage by measuring tail length and tail intensity. Chi-square, Fisher's PLSD (Protected Least Significant Difference) and Kruskall-Wallis non parametric tests were used for statistical analysis.

RESULTS

After 1-h elution only the highest dose of Diaket, Hermetic and SuperEBA significantly (P = 0.035, P = 0.048, P = 0.037 respectively) affected the measured cytogenetic parameters. The migration ability of DNA was more strongly affected than induction of chromosomal aberrations. After elutions longer than 24 h none of the tested sealers exhibited a genotoxic effect.

CONCLUSION

Under the conditions used in the study all sealers had acceptable biocompatibility in terms of genotoxicity.

Cytotoxic effects of dental resin liquids on primary gingival fibroblasts and periodontal ligament cellsin vitro

Cytotoxic effects of resin liquids of three in situ relining dental polymers, Alike, Kooliner, and Tokuso Rebase, and their major components, methyl methacrylate (MMA), isobutyl methacrylate (IBMA), and 1,6-hexanediol dimethacrylate (1,6-HDMA) were investigated. The concentrations of major monomers in these resin liquids were determined by high-performance liquid chromatography. Cellular viability of human gingival fibroblasts (GF) and periodontal ligament (PDL) cells were evaluated by the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide assay. Moreover, patterns of cell death were analysed using annexin V/propidium iodide staining with flow cytometry. The results indicated that Alike liquid contained 91.3% MMA, Kooliner liquid contained 94.5% IBMA, and Tokuso Rebase liquid contained 65.8% 1,6-HDMA. All materials examined had cytotoxic effects on GF and PDL cells in dose-dependent manners. Tokuso Rebase liquid appeared to be the most cytotoxic among the various resin liquids examined. The effects of Kooliner and Tokuso Rebase liquids may have resulted from IBMA and 1,6-HDMA, respectively. Furthermore, the majority of treated cells died from necrosis; whereas a small portion of cells died from apoptosis. In conclusion, the results demonstrated that these liquid forms of dental polymers and their major monomers cause cytotoxic reactions. The direct relining procedure that cures these materials in situ should be used cautiously.

Direct and indirect restorative materials

BACKGROUND

In recent years, dentistry has benefited from a marked increase in the development of esthetic materials, including ceramic and plastic compounds. But the advent of these new materials has not eliminated the usefulness of more traditional restorative materials such as gold, base metal alloys and dental amalgam.

OVERVIEW

This report outlines important features of direct and indirect restoratives, with an emphasis on the safety and efficacy of each material.

CONCLUSIONS AND PRACTICE IMPLICATIONS

This article was developed to help dentists explain to their patients the relative pros and cons of various materials used in dental restorations, which include fillings, crowns, bridges and inlays. The weight of the scientific evidence indicates that all of these materials are safe and effective for their intended use. Patients, in consultation with their dentists, are free to choose the most appropriate among them for their particular needs.

Cytotoxicity of modern dentin adhesives--in vitro testing on gingival fibroblasts

The present investigation was designed to test cellular toxicity of modern dentin adhesives. With the use of the products Ariston Liner, Etch & Prime 3.0, Optibond Solo, Prime & Bond NT, Scotchbond 1, and Syntac Sprint, test specimens were prepared according to the manufacturers' instructions and transferred into a culture medium. Eluates were obtained and pipetted onto fibroblast cultures, incubated, and subsequently stained. The respective cell densities and the numbers of normal, altered, and dead cells were determined and compared with control cell cultures. Statistical analysis of the data showed that all materials caused cytotoxic effects. Scotchbond 1 displayed the highest number of dead cells. The difference was statistically significant compared to Etch" 3.0, Optibond Solo, Prime&Bond NT, and the control. The lowest cell density was found for Scotchbond 1 and Ariston Liner. The difference was also statistically significant in comparison with Etch" 3.0, Optibond Solo, Prime&Bond NT, and the control. To conclude, all tested dentin adhesives caused cytotoxic reactions. Taking the limitations of an in vitro experiment into consideration, Prime&Bond NT, Optibond Solo, and Etch" 3.0 appear to be the most recommendable products, and Scotchbond 1 and Ariston Liner the least.

Induction of tolerance and cross-tolerance to methacrylate contact sensitizers

Induction of immunological tolerance to contact allergens might prevent undesired sensitization, in particular to occupational sensitizers, e.g., methacrylates (MA). Here, using a guinea pig model, we studied to which extent tolerance to one methacrylate might result in cross-tolerance to other congeners. Strong tolerance to the monomethacrylates hydroxy-ethyl MA (HEMA) and methyl MA, but not to the dimethacrylate ethylene-glycol MA (EGDMA) could be induced. The induced tolerance was stable, could not be broken by repeated sensitization attempts, and was mediated by specific suppressor cells, as demonstrated in T cell transfer experiments. In HEMA-tolerized animals, strong cross-tolerance to methacrylate congeners, including EGDMA, itself being nontolerogenic and showing the lowest cross-reactivity to HEMA, was found. Thus, oral application of contact allergens, to which skin contact cannot be avoided, e.g., in occupational settings, can induce broad cross-tolerance to related substances and might offer a promising preventive approach.

Effects of dental resins on TNF-alpha-induced ICAM-1 expression in endothelial cells

Many reports have demonstrated inflammation after the placement of dental restorations. To explain this side-effect, we studied a biomarker in the inflammatory response. The intercellular adhesion molecule-1 (ICAM-1) is a key mediator for recruitment of leukocytes to the site of inflammation. Therefore, we investigated whether methacrylates (a BISGMA-based dental resin, BISGMA, and MAA) and Cyracure UVR 6105, an epoxy monomer, could alter ICAM-1 expression in unstimulated and TNF-alpha-stimulated endothelial cells. Six-well plates with monolayers of human umbilical vein cells, ECV 304 (ATCC CRL 1998), were exposed to TNF-alpha (1 ng/mL) in the presence and absence of subtoxic and TC50 doses of chemicals for 24 hrs at 37 degrees C/5% CO2. Several doses of TNF-alpha (0.5-2 ng/mL) were coincubated with 100 microL of undiluted aqueous dental resin extracts. Cells were harvested and stained with mAB FITC-conjugated anti-human ICAM-1 (CD54). ICAM-1 expression was measured by flow cytometry. Cells expressed basal levels of ICAM-1, which was up-regulated by TNF-alpha but was not changed by all samples studied. Except for UVR 6105, the methacrylates significantly decreased ICAM-1 expression in TNF-alpha-stimulated cells. These findings suggest that methacrylates may decrease the recruitment of leukocytes to sites of inflammation.

Biocompatibility of resin-modified filling materials

Increasing numbers of resin-based dental restorations have been placed over the past decade. During this same period, the public interest in the local and especially systemic adverse effects caused by dental materials has increased significantly. It has been found that each resin-based material releases several components into the oral environment. In particular, the comonomer, triethyleneglycol di-methacrylate (TEGDMA), and the 'hydrophilic' monomer, 2-hydroxy-ethyl-methacrylate (HEMA), are leached out from various composite resins and 'adhesive' materials (e.g., resin-modified glass-ionomer cements [GICs] and dentin adhesives) in considerable amounts during the first 24 hours after polymerization. Numerous unbound resin components may leach into saliva during the initial phase after polymerization, and later, due to degradation or erosion of the resinous restoration. Those substances may be systemically distributed and could potentially cause adverse systemic effects in patients. In addition, absorption of organic substances from unpolymerized material, through unprotected skin, due to manual contact may pose a special risk for dental personnel. This is borne out by the increasing numbers of dental nurses, technicians, and dentists who present with allergic reactions to one or more resin components, like HEMA, glutaraldehyde, ethyleneglycol di-methacrylate (EGDMA), and dibenzoyl peroxide (DPO). However, it must be emphasized that, except for conventional composite resins, data reported on the release of substances from resin-based materials are scarce. There is very little reliable information with respect to the biological interactions between resin components and various tissues. Those interactions may be either protective, like absorption to dentin, or detrimental, e.g., inflammatory reactions of soft tissues. Microbial effects have also been observed which may contribute indirectly to caries and irritation of the pulp. Therefore, it is critical, both for our patients and for the profession, that the biological effects of resin-based filling materials be clarified in the near future.

Ionomeric cement in the human middle ear cavity: long-term results of 23 cases

OBJECTIVES

The long-term results of the implantation of glass ionomer cement in the human mastoid and middle ear were studied.

STUDY DESIGN

A prospective study of the survival of bone cement in the middle ear.

METHODS

Ionocem (IONOS, Medizinische Produkte Gmbh & Co., Seefeld/Obb, Germany), a two-compound bone material that forms a stable, water-proof junction with bone, was implanted in 23 middle ears of 23 patients (13 male and 10 female patients). Closure of the dehiscence of the tegmen was performed in 7 cases, obliteration of the mastoid cavity in 10 cases, and ossicular chain reconstruction in 6 cases.

RESULTS

The follow-up period was 5.1 years. Complications attributable to operation were not seen, but adverse tissue reaction with severe middle ear infection and abundant otorrhea occurred in six cases after 12 months, requiring repeat operation. In three more cases, a spontaneous extrusion of the bone cement was seen after 4 years. The bone cement was totally extruded in nine cases. The mean survival time was 28 months.

CONCLUSIONS

The use of Ionocem for obliteration of the mastoid cavity or for the closure of dehiscence of the tegmen has a high risk of extrusion. Therefore, it is not the first-choice material to use for obliteration or tegmen defect closure in the middle ear.

Dental amalgam and mercury in dentistry

Mercury in dentistry has re-emerged as a contentious issue in public health, predominantly because so many people are inadvertently exposed to mercury in order to obtain the benefits of dental amalgam fillings, and the risks remain difficult to interpret. This commentary aims to examine the issues involved in public policy assessment of the continued use of dental amalgam in dentistry. More than 30 per cent of Australian adults are concerned about mercury from dental amalgam fillings but only a small percentage report having their amalgam fillings removed. The placement of dental fillings nearly halved between 1983 and 1997, but many millions of dental amalgam fillings exist in the Australian community. These fillings release mercury (mercury vapour or inorganic ions) at a low level (about 2-5 micrograms/day in an adult). Evidence on the health effect of dental amalgams comes from studies of the association between their presence and signs or symptoms of adverse effects or health changes after removal of dental amalgam fillings. More formal risk assessment studies focus on occupational exposure to mercury and health effects. Numerous methodological issues make their interpretation difficult but new research will continue to challenge policymakers. Policy will also reflect prudent and cautious approaches, encouraging minimization of exposure to mercury in potentially more sensitive population groups. Wider environmental concerns and decreasing tolerance of exposure to other mercury compounds (for example, methylmercury in seafoods) will ensure the use of mercury in dentistry remains an issue, necessitating dentists keep their patients informed of health risks and respect their choices.

Residual monomer/additive release and variability in cytotoxicity of light-curing glass-ionomer cements and compomers

In previous studies, light-cured glass-ionomer cements have been shown to evoke cytotoxic reactions. It was the purpose of this investigation (a) to determine the nature of the ingredients released into an aqueous medium from 2 light-cured glass-ionomer cements (GICs) and 3 compomers; (b) to evaluate the cytotoxicity of these extracts; and (c) to correlate the extent of the cytotoxic effects with eluted substances. Specimens of 2 light-cured GICs and 3 compomers were prepared and extracted in distilled water or cell culture medium for 24 hrs (surface-liquid ratio 42.4 mm2/mL). The aqueous eluates were analyzed by gas chromatography/mass spectrometry (GC/MS). The relative amounts of the components released from various products were compared by means of an internal caffeine standard [%CF]. For evaluation of cytotoxic effects, permanent 3T3 fibroblasts were incubated with medium extracts for 24 hrs. In addition, the ED50 concentration of the photoinitiator diphenyliodoniumchloride (DPICl) was determined. In all extracts, several water-elutable organic substances were found: (Co)monomers (especially HEMA and ethylene glycol compounds), additives (e.g., camphorquinone and diphenyliodoniumchloride), and decomposition products. The extracts of 3 products inhibited cell growth only moderately, whereas the light-cured GIC Vitrebond and the compomer Dyract Cem revealed severe cytotoxic effects. Vitrebond liberated the initiator DPICl, whereas Dyract Cem segregated a relatively high quantity [2966 %CF] of the comonomer TEGDMA in comparison with the other products. The present data show that TEGDMA and DPICl may be regarded as the prime causes for cytotoxic reactions evoked by the investigated light-cured glass-ionomer cements or compomers. Therefore, leaching of these substances should be minimized or prevented.

Cytotoxicity of 35 dental resin composite monomers/additives in permanent 3T3 and three human primary fibroblast cultures

It was the purpose of this investigation to determine the cytotoxic effects (ED50 concentrations) of 35 monomers or additives identified in commercial dental resin composites. Monolayers of permanent 3T3 cells and three primary human fibroblast types derived from oral tissues (gingiva, pulp, and periodontal ligament) were used as test systems. All substances were tested in concentrations ranging from 0.01 to 5.0 mM. In general, ED50 values varied from 0.06 to > 5 mM. Within the groups of co(monomers), initiators, and cointiators, severe (e.g., Bis-GMA, UDMA, DMBZ, and DMDTA) or moderate (HEMA, BEMA, CQ, DMPT, and DMAPE) cytotoxic effects could be evaluated. Within the group of reaction/decomposition products, only moderate or slight effects were found (ED50: 0.7 to > 5 mM). The inhibitor BHT, the contaminant TPSb, and the photostabilizer HMBP, however, were highly cytotoxic in all cell cultures. In addition, the ED50 values of DBPO and HMBP significantly varied (0.43-3.8 mM, respectively, and 0.44-3.07 mM) with the applied cell culture. Our comprehensive screening shows that for several of the highly cytotoxic composite components, less cytotoxic alternatives are available. Furthermore, there was no cell type identified which was consistently less or more sensitive to the toxic effects of the tested compounds than the others. Primary human periodontal ligament and pulp fibroblasts, however, were found to be more sensitive than 3T3 and gingival fibroblasts to alterations from most tested substances.

Foreign body gingivitis: identification of the foreign material by energy-dispersive x-ray microanalysis

Foreign bodies identified in 61 cases of foreign body gingivitis were analyzed by energy-dispersive x-ray microanalysis. This was compared with the energy-dispersive x-ray microanalysis of 62 dental materials. Comparative analysis indicated most foreign bodies were of dental material origin, usually abrasives. It is suggested that they are factitially and iatrogenically introduced during a variety of self-administered and professionally performed dental hygiene and restorative procedures. Individual elements, and elements by class, were correlated with previously described clinical and microscopic features of the cases. There was no association between any microscopic or clinical attribute of FBG and the presence of allergenic or cytotoxic elements. It is postulated that the physical presence of foreign bodies may be sufficient for the development of foreign body gingivitis. Dentists should be aware of the potential for chronic tissue damage that can result from the unguarded use of abrasive material next to the gingiva.

Effect of two dentinal desensitizing agents on retention of complete cast coping using four cements

The cementation of artificial crowns is commonly accompanied by sensitivity, so the clinical application of desensitizing agents has become prevalent. This study investigated the effects of Imperva bonding agent and All-Bond desensitizing agent on the retention of artificial crowns. The cements selected for this study were: zinc phosphate, polycarboxylate, glass ionomer, and resin luting agents. Extracted, intact, human molars were mounted in autopolymerizing acrylic resin and prepared for complete cast copings. Thirty-two teeth were treated with All-Bond desensitizing agent, 32 teeth with Imperva bonding agent, and 32 remained untreated. Castings were cemented and tested on an Instron testing machine. The results demonstrated a significant reduction in retention when All-Bond desensitizing agent was used with polycarboxylate cement and some reduction with zinc phosphate cement. Imperva bonding agent demonstrated less retention with glass ionomer cement.

Pulpal response to a new light-activated fluoride releasing liner

The purpose of this study was to investigate the degree of pulp irritation of a newly developed light-activated fluoride-releasing adhesive resin liner using canine teeth compared to the amount caused by a negative control, zinc oxide eugenol cement (ZOE), and a positive control, silicate cement (silicate). In the cases of unexposed pulp, this experimental liner showed none, slight or moderate pulpal changes at 3 d postoperatively. At 30 and 90 d, no pulpal response to the experimental liner was detected in almost all cases. These findings were similar to the ZOE and better than the silicate. There was less evidence of pulpal irritation produced by the experimental liner. This material seems to be safe to the pulp under the conditions of this study.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.