Recent advances of adhesive dentistry enable clinicians to utilize bonding systems in daily clinical practice. Direct application of bonding resins to exposed pulp has been clinically tried and its successes were reported. Unfortunately, however, there is little basic science information which support the safety of this clinical procedure. This paper discusses the efficacies and precautions when this new method is applied clinically.

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Currently available adhesive bonding systems can maintain excellent marginal seal and wall adaptation, exhibiting more biocompatible. Several studies have shown that they do not inhibit successful healing when applied directly to the exposed pulp, indicating good possibilities for these materials to be used as a direct pulp capping agent. The exposed pulp capped with an adhesive resin has an ability to establish the organic repair, as long as it is kept in restful condition. However, bacterial invasion into an exposed cavity, generated by the failure of tight adaptation of a resinous material, causes pulp necrosis in most cases.
Generally, adhesive bonding systems occasionally exhibit technique-sensitivities in the clinical manipulation. In addition, there are a lot of clinical variables which affect the good adhesive properties obtained in laboratory studies. As clinicians, we should always be responsible for the reliable treatment and the control of postoperative discomfort. We should also establish the diagnosis of the exposed pulp tissue to achieve clinical success in the capping. It is necessary to improve the safety and reliability in the clinical manipulation in order to accept adhesive resin bonding systems as a direct pulp capping material.

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Direct pulp capping with an adhesive resin is proposed by the concept that the resin is not a toxic material, but a safe material serving as dentin and pulp protector. Although its clinical applications have been introduced, the histopathological fundamentals are not based on experiments simulating all possible clinical conditions, but are based on experiments simply using intact teeth with normal dental pulp. Considering varieties of clinical situations and conditions which require direct pulp capping, and also considering uncertainty of the diagnosis of the dental pulp, an adhesive resin is not an only material for direct capping to preserve vitality of dental pulp as long as possible. In order to establish direct pulp capping with an adhesive resin, criteria should be clarified about diagnosis of dental pulp, treatment of carious cavity, and technique of direct capping.

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This paper introduces a new matrix kit named “Sectional Matrices” for Class II direct restorations. It consists of a contoured, kidney-shaped matrix and the Bitine Ring. The Bitine Ring is a retaining device for the matrix, and is also a tooth separator. The pre-contoured matrix prevents flattening of proximal contours that may often occur with a overtightened Tofflemire. The Bitine Ring can hold the matrix securely to the tooth, closing the proximal line angles of the preparation to eliminate or greatly minimize excess, and bow out the band against the adjacent tooth to assure a tight contact.

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