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For many years, the dental profession worked mainly with rather inert restorative materials that had a limited contact with vital tissue, and the opportunity for local and systemic complications was minimal. However, conditions have changed in recent years where the two leading non-mercury-containing materials, resin composites and glass-ionomer cements, are chemically active compounds and can have detrimental effects on pulp tissue. With the advent of light-curing techniques with incremental layering, resin component formulae that were formerly found to be quite irritating to the pulp have become less so with the elimination of the need for matrices and pressure for good adaptation to be gained. As experience revealed the deficiencies and dangers of ultraviolet-light-curing techniques, visible-light-curing systems were developed that provided greater depth of cure, a higher degree of polymerization with less shrinkage with incremental layers, and less porosity. When glass-ionomer cements (GICs) were first introduced, with just one acid (polyacrylic), pulpal responses were classified as bland. With the addition of many more acids to enhance certain characteristics and reduce the setting time, GICs have become more irritating, especially when used as luting agents in areas where the remaining dentin thickness is 0.5 mm or less. Gold foil and amalgam are inert and innocuous restorative materials but require pressure for condensation which creates an exaggerated inflammatory response. This presentation emphasizes the pulpal responses and side-effects of these non-mercury-containing restorative materials and how to keep them within an acceptable range of biocompatibility. Despite the lack of any substantial appearance of soft tissue and systemic responses to resin composites and GICs, the results of a survey of recent literature are included.

Eight ingredients of composite materials were evaluated individually for pulp irritation. None caused significant inflammation as evidenced by its average response. No abscess formations or lesions predominating in leukocytes occurred.

The results of this study, plus those of a previous study, show that a layer of CaOH lining the floor of the tooth cavity will protect the dental pulp against toxic irritants inherent to an UV light-polymerized cavity liner and a UV light-polymerized composite restorative resin. This study also showed that a layer of CaOH lining the floor of the cavity will protect the dental pulp against acid irritants inherent in the enamel etching solution. It is recommended to restorative dentistry that all primary dentin within clinically accessible areas of the cavity preparation be covered with a layer of CaOH before the enamel is etched with the acid-conditioning solution. Precautionary protection of primary dentin in this manner affords a margin of safety should the conditioning solution inadvertently spill onto the primary dentin during the enamel-etching procedure. Second, if the conditioning solution does accidentally spill onto the previously placed protective layer of CaOH during the enamel-etching procedure, then it logically follows that this acid-contaminated layer of CaOH should be mechanically removed and a new layer of CaOH that completely lines at least the floor of the tooth cavity should be placed before the resins are applied.