Postoperative pulpal and repair responses

Background. Each year in the United States, the success of 10 million surgi cally restored carious lesions depends on a favorable tertiary dentin repai r response to preparation, restoration and patient factor variables. The au thors investigated the relationship between these variables and dentinal re sponse, Methods. Standardized rectangular Class V restoration preparations were cut into the buccal dentin of intact first or second premolars of 27 patients without exposing the pulp and were restored. The patients were between 9 an d 17 years of age. The treated teeth were scheduled for extraction for orth odontic reasons. After tooth extraction, the tertiary dentin was analyzed h istomorphometrically. Results. The area of tertiary reactionary dentin was found to be correlated using Linear regression analysis of variance with restoration residual den tin thickness (P = .0024), age of the patient (P = .0045), restoration floo r surface area (P = .0266) and restoration width (P = .0415). The authors d id not find a correlation with the premolar position (P = .0594), sex of th e patient (P = .650), pulpal inflammatory reaction (P = .613) or the time e lapsed since surgery (P = .531). Restoration with zinc oxide eugenol was fo und to negatively influence tertiary dentin matrix secretion (post hoc anal ysis of variance, P = .030). Conclusions. The age of a patient at treatment, the choice of restorative m aterial and the size of the restoration preparation are all factors that ca n positively or negatively affect the pulpal repair response. Clinical Implications. Age of the patient affects dentin repair capacity an d may be a factor in treatment planning decisions. Minimizing the cutting o f dentin, especially the width and base of the preparation, reduces the pro bability of recurrent pulpal complications.