title: Composite resin fillings and inlays. An 11-year evaluation Clinical evaluation of polyacid-modified resin composite posterior restorations: one-year results. Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique. A clinical study of the "open sandwich" technique in pediatric dental practice. Risk indicators for apical periodontitis. A prospective 15-year evaluation of extensive dentin-enamel-bonded pressed ceramic coverages. Carboxylesterase expression in human dental pulp cells: role in regulation of BisGMA-induced prostanoid production and cytotoxicity. Coronal and apical lesions, environmental factors: study in a modern and an archeological population Risk factors for developing apical periodontitis in a general population. Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973, 1983, and 1993. II. Review of clinical and radiographic findings. Effect of posterior resin composite placement technique on the resin-dentin interface formed in vivo. Endodontic complications after plastic restorations in general practice. Ten-year longitudinal clinical evaluation of a visible light cured posterior composite resin. The effect of various preparation designs on the survival of porcelain laminate veneers. Predictors of root canal treatment in teeth with full coverage restorations. One-year clinical evaluation of composite and ceramic inlays in posterior teeth.
abstract: The purpose of this r and omized , clinical study was to evaluate the clinical performance of composite resin material s used for fillings and indirect inlays . Twenty-eight sets of five class II restorations ( two fillings , three inlays ) were placed in 88 premolars and 52 molars in 28 adults .  Brilliant Dentin and Estilux Posterior were used for both fillings and inlays , and SR-Isosit for inlays only . After 11 years , 27 sets of restorations ( 96 % ) were evaluated clinical ly using modified United States Public Health Service criteria . Replaced or repaired restorations were observed in 16 % of the fillings and 17 % of the inlays , and a further 5 % of the restorations were replaced for reasons not related to the restoration . The remaining 107 restorations exhibited optimal ratings in 30 % of the fillings and 12 % of the inlays ( P<0.05 ) and acceptable ratings in 70 % and 88 % , respectively . The reasons for failure were fracture of restoration ( four fillings , five inlays ) , secondary caries ( two fillings , four inlays ) , fracture of tooth ( two inlays ) , loss of proximal contact ( two fillings ) , and loss of restoration ( one inlay ) . Failures were seen more frequently in molar than premolar restorations ( P<0.05 ) , with no significant difference between fillings and inlays or between the five types of restoration ( P>0.05 ) OBJECTIVE The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system , Dyract AP , placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth . METHOD AND MATERIAL S Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist . The restorations were evaluated directly , with modified US Public Health Service criteria , and indirectly , with color slides and polyvinyl siloxane impressions , at baseline and 6 months and 1 year after placement . Preoperative and 1-year postoperative bitewing radiographs were also taken . RESULTS All 82 restorations available for 1-year evaluation were in situ . No postoperative sensitivity or pulpal problems were reported . Four Class II restorations ( 4.9 % ) failed because of partial fracture or recurrent caries . The percentages of Alfa score for each criterion were color match , 95.1 % ; marginal discoloration , 57.3 % ; marginal integrity , 35.4 % ; anatomic form , 98.8 % ; and surface texture , 91.5 % . The average wear rate of Dyract AP was low ( 18.5 + /- 11.7 microns at 6 months and 35.7 + /- 13.6 microns at 12 months ) . CONCLUSION The excellent h and ling characteristics , the good clinical performance , and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas PURPOSE To report the 4-year clinical performance of  posterior resin-based composite restorations placed using the total-etch technique . MATERIAL S AND METHODS Over a period of 1 year , 726 restorations ( 248 molars , 478 premolars ; 260 Class I , 466 Class II ; 540 replacements , 186 primary decay ) were placed on conservative preparations , using the incremental placement technique in a clinical environment . Baseline data were collected , and the restorations were evaluated after 4 years . Z100 and Scotchbond Multi- Purpose ( SBMP ) ( 3 M Dental Products , St. Paul , Minnesota ) were used as the restorative system . The criteria evaluated were color match , marginal adaptation , anatomic form , cavosurface marginal discoloration , axial contour , interproximal contact , secondary caries , postoperative sensitivity , and tooth vitality . RESULTS At baseline , 24 % of the teeth restored presented postoperative sensitivity ; 86 % of the sensitive teeth were from the replacement group . At 4 years , all teeth were vital to cold test . Eighteen restorations ( 2.5 % ) presented clinical ly detectable marginal fracture . The shade was acceptable in all restorations . Cavosurface marginal discoloration was observed in 47 restorations ( 6.5 % bravo scores ) . Axial contour , interproximal contact , and marginal adaptation received 100 % alfa scores . No secondary caries was diagnosed in any of the teeth examined . None of the examined restorations required replacement . CLINICAL SIGNIFICANCE Under controlled clinical conditions , posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years . None of the examined restorations required replacement , and there was no clinical ly detectable wear in any of the restorations . Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations PURPOSE This study evaluated the clinical efficacy of the " open s and wich " restoration for pediatric dental practice . METHODS Three pediatric dentists used a st and ardized preparation and restorative technique to place the restorations . The prepared tooth was etched with a phosphoric acid semigel and rinsed . A resin modified glass ionomer ( Fuji II LCor Photac-Fil ) was placed short of the margins and then light cured . The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite ( Aeliteflo or Flow-it ) . The same preparation for the experimental restorations was used for the control conventional amalgam ( Tytin ) restorations . The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey ( USPHS ) scale as follows : Alfa : No discernible marginal opening or stain ; Beta : Slight opening of margin discernible with dental explorer , but without stain ; Charlie : Open margin and stain ; Delta : Recurrent caries or restoration failure . Restoration failures were categorized according to etiology , pulpal necrosis , bruxism , marginal leakage , isthmus fracture , or adhesive failure . RESULTS All recalled experimental restorations , except 8 , were rated as either Alpha or Beta . Six failed due to isthmus fracture and 2 due to pulpal necrosis . Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer . The use of the " open s and wich " technique compared favorably with a similar study using adhesive amalgam restorations . CONCLUSIONS The " open s and wich " technique can be successfully used in a pediatric dental practice OBJECTIVES The aim of the study was to identify risk indicators for  apical periodontitis ( AP )  in the individual . A parameter was defined as a ' risk indicator ' when its presence increased the individual 's risk of exhibiting AP . Risk indicators may , but need not be directly associated with the disease . METHODS The study included full-mouth surveys of 613 r and omly selected individuals , who were 20 - 60 years old and living in Aarhus County .  Logistic regression analyses were performed . The outcome variable was > or=1 AP/no AP . The independent variables were obtained from information on socioeconomic and dental status . RESULTS It was found that smoking , no usage of services from the dentist , > or=2 secondary caries lesions , > or=3 inadequate coronal fillings and the presence of root filling(s ) were statistically associated with AP . A separate analysis for individuals with no previous root fillings showed that individuals with regular dental visits as well as individuals who had all their teeth ( third three molars excluded ) were less likely to have AP , whereas individuals who had > or=3 inadequate coronal fillings were more likely to have AP . CONCLUSIONS The results from the present study of a Danish population showed that the most important risk indicator of having AP in the individual was the radiographic evidence of root fillings . The presence of several caries lesions , the quality of the dental treatment , the regularity of dental visits and smoking were also statistically associated with AP . Further , the socioeconomic status of the individual did not provide much additional information on the periapical status OBJECTIVES The purpose of this study was to investigate the durability of extensive dentin-enamel-bonded posterior ceramic coverages  in a 15 years follow-up . METHODS All extensive dentin-enamel-bonded posterior partial and complete all-ceramic coverages placed during the period November 1992-December 1998 were included . In 121 patients , 252 coverages ( IPS Empress ) were placed . The adhesive bonding to dentin and enamel was performed with three 3-step and one 2-step etch and rinse bonding . In 106 restorations the classic Syntac was used in combination with the dual-cured resin composite Variolink . The other restorations were luted with the chemically cured resin composite Bisfil 2B and bonded with 3-step etch and rinse systems , classic Gluma ( 37 ) , Allbond 2 ( 57 ) , Syntac ( 32 ) or the 2-step etch and rinse system , One step ( 20 ) . The ceramics were evaluated yearly by modified USPHS criteria during 15 years . RESULTS Postoperative sensitivity was registered in 4 patients during bite forces lasting for 2 - 4 weeks . Fifty-five of 228 coverages ( 24.1 % ) failed . The mean observation period of the acceptable coverages was 12.6 years ( range 11 - 15 years ) . The main reasons for failure were lost restorations ( 18 ) , ceramic fracture ( 16 ) , and secondary caries ( 11 ) . Significant differences in failure rate were observed between the dentin bonding agents but not between the two luting agents . Ceramic  coverages placed on non-vital teeth failed in 39 % and on vital teeth in 20.9 % ( p=0.014 ) . Logistic regression indicated three significant predictors for failure of the coverages : gender and parafunctional habits of the patient and non-vitality of the tooth . SIGNIFICANCE The technique investigated showed advantages like less destruction of healthy tissue , and avoiding of endodontic treatment and /or deep cervical placement of restoration margins to obtain retention Biocompatibility of  dentin bonding agents ( DBA ) and composite resin  may affect the treatment outcome ( e.g. , healthy pulp , pulpal inflammation , pulp necrosis )  after operative restoration .  Bisphenol-glycidyl methacrylate ( BisGMA ) is one of the major monomers present in DBA and resin . Prior studies focused on salivary esterase for metabolism and degradation of resin monomers clinical ly . This study found that human dental pulp cells expressed mainly carboxylesterase-2 ( CES2 ) and smaller amounts of CES1A1 and CES3 isoforms . Exposure to BisGMA stimulated CES isoforms expression of pulp cells , and this event was inhibited by catalase . Exogenous addition of porcine esterase prevented BisGMA- and DBA-induced cytotoxicity . Interestingly , inhibition of CES by bis(p-nitrophenyl ) phosphate ( BNPP ) and CES2 by loperamide enhanced the cytotoxicity of BisGMA and DBA . Addition of porcine esterase or N-acetyl-l-cysteine prevented BisGMA-induced prostagl and in E(2 ) ( PGE(2 ) ) and PGF(2α ) production . In contrast , addition of BNPP and loperamide , but not mevastatin , enhanced BisGMA-induced PGE(2 ) and PGF(2α ) production in dental pulp cells . These results suggest that BisGMA may induce the cytotoxicity and prostanoid production of pulp cells , leading to pulpal inflammation or necrosis via reactive oxygen species production . Expression of CES , especially CES2 , in dental pulp cells can be an adaptive response to protect dental pulp against BisGMA-induced cytotoxicity and prostanoid release . Resin monomers are the main toxic components in DBA , and the ester group is crucial for monomer toxicity Apical periodontitis ( AP ) are frequent findings in contemporary dental practice in association with dental pathology or dental care . They have also been studied from an anthropological background . The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population , and to evaluate the influence of environmental factors . Both the archaeological sample group and dental practice subjects were from southern France . The study included full mouth surveys of 252 individuals ( 2,780 teeth ) from a historic necropolis and 223 subjects ( 5,678 teeth ) r and omly selected from the Gard area .  Tooth wear , caries , and AP were accounted for clinical ly and radiographically according to specific indexes . Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP . Antemortem teeth loss and dental wear had been reduced , whereas caries rates and AP had increased between archaeological and modern population . The AP ratio was associated with the level of dental care in the modern population . Although significant variations could be observed between archaeological periods , the rupture in E3 ( sixteenth and seventeenth centuries ) leads to consider the associated population as a premodern . However , it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population , dental care seemed to have a strong influence on AP ratio in modern ones AIM To identify and describe individual and tooth-specific factors associated with the incidence or the persistence of apical periodontitis ( AP ) in a general population . METHODOLOGY In 1997 , 616 r and omly selected individuals had a full-mouth radiographic survey . In 2003 , 77 % of the participants returned for a new full-mouth radiographic examination .  All teeth were assessed individually and data recorded for caries , marginal bone level , and tooth restorations .  Multiple logistic regression analyses were performed to identify predictors of AP in the individual . Conditional logistic regression analyses were used to identify risk factors for development of AP in a tooth . Independent variables included a number of individual and tooth-specific variables . RESULTS Root fillings , coronal restorations , primary carious lesions , and reduced marginal bone level were associated with the incidence of AP in the individual . In teeth , the quality and presence of a coronal restoration was associated with the incidence of AP , and presence of a root filling also increased the risk of developing AP . Furthermore , an increased risk of developing AP was seen in relation to primary carious lesions , reduced marginal bone level , and molar teeth . The quality of the root filling was not associated with the incidence of AP , but the results suggest an association between the quality of the root filling and the healing of AP . CONCLUSIONS Results from the present study demonstrate that it is important to provide high quality dental restorations to minimize the risk of pulpal infection . The clinical focus , in relation to the incidence of AP , should be on improving the quality of the coronal restoration . The quality of a root filling was not associated with the incidence of AP , but may be of importance in relation to healing of AP The aim of this epidemiological study was to analyse various clinical and radiographic data on oral health and compare the results to those of two cross-sectional studies carried out in 1973 and 1983 . In 1973 , 1983 , and 1993 a r and om sample of 1000 , 1104 , and 1078 individuals , respectively were studied . The individuals were evenly distributed in the age groups 3 , 5 , 10 , 15 , 20 , 30 , 40 , 50 , 60 , and 70 years . In 1983 and 1993 80-year-olds were also included . All subjects were inhabitants of the community of Jönköping , Sweden . The clinical and radiographic examination assessed edentulousness , removable dentures , implants , number of teeth , caries , restorations and overhangs , oral hygiene , calculus , periodontal status , endodontic treatment , and periapical status . The number of edentulous individuals was reduced by half from 1973 to 1993 and is now 8 % in the age groups 40 - 70 years . The mean number of teeth has increased and up to the age of 50 years the individuals had more or less complete dentitions . During the 20-year period there was generally decreasing number of carious lesions and restorations . In the 15- and 20-year-olds , however , there was an increasing number of decayed/filled tooth surfaces in 1993 compared to 1983 . Furthermore , after the age of 50 there was an increase in number of restored tooth surfaces . As regards secondary caries there was an increase for the 10- and 15-year-olds between 1983 and 1993 . For all other age groups there were only minor differences . Generally restorations exhibited a high quality and 85 - 90 % had no proximal overhangs . In 1973 this figure was about 60 % . Concerning the frequency of tooth surfaces exhibiting plaque and gingival inflammation there was a considerable decrease from 1973 to 1983 , but during the period from 1983 to 1993 there seems to be no improvement . In some age groups there was even a significant increase in plaque ( 15-year-olds ) and gingivitis ( 3- , 5- , 15- , 20- , and 60-year-olds ) . The frequency of individuals with one or more periodontal pockets ( > 4 mm ) increased with age . In 1993 the bone level at the age of 40 years corresponded to the bone level at the age of 20 years in 1973 . The percentage of endodontically treated teeth was lower in 1993 in all age groups than in 1973 and 1983 . The percentage of endodontically treated teeth with periapical or juxtaradicular destructions  was unchanged in all three studies . The comparison of the three studies from 1973 , 1983 , and 1993 shows that there has been a great improvement in oral health over this 20-year period . In 1993 , however , the increasing number of decayed/filled tooth surfaces in the 15- and 20-year-olds and an increase in plaque and gingivitis in some younger age groups calls for special attention OBJECTIVE The aim of this study was to evaluate the morphology of the resin-dentin interface formed in vivo with two posterior resin composite placement techniques ( incremental and bulk ) . METHOD AND MATERIAL S After approval from the patients , 12 Class II cavities with margins in enamel ( 2.5 x 2.5 x 4.5 mm ) were prepared in caries-free premolars scheduled to be extracted for orthodontic reasons ( n = 6 ) . The cavities were restored with Single Bond + Filtek P60 as a bulk condensable technique or Single Bond + Filtek Z250 as an oblique incremental technique . After 1 week , the teeth were extracted with minimal trauma to the restored area . After the teeth were sectioned , a polyvinyl siloxane impression was taken from the resin-dentin interface to control for artifacts created during preparation for scanning electron microscopy . The specimens were subsequently processed for and observed under a scanning electron microscope to assess gap formation . RESULTS The mean percentage of gap formation was 6.1 % for teeth restored with the incremental placement technique and 18.7 % for teeth restored with the bulk placement technique . The difference was statistically significant . CONCLUSION The incremental placement of posterior resin composites may still provide better seal than the new bulk condensable technique AIM To test the hypothesis that dentine and pulp protection by conditioning- and -sealing is no less effective than using a conventional calcium hydroxide lining . METHODOLOGY A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practice s. All procedures received local Ethics Committee approval . Exclusion criteria included signs and symptoms of pulp necrosis or inflammation , and patients unable to commit to a long-term trial . Cavity preparations were r and omized to receive a calcium hydroxide lining or conditioning- and -sealing with a smear-removing bonding system . Choice of bulk restorative material ( composite resin or amalgam ) was at the discretion of the dentist . The key outcome measure was evidence of pulpal breakdown identified at unscheduled ( emergency ) or scheduled recall examinations . Postoperative sensitivity was recorded on 100 mm VAS at 24 h , 4 days and 7 days . Pulp status was assessed at 6 , 12 , 24 and 36 month recall , and at any emergency recall appointment . The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression ( P = 0.05 ) . RESULTS A total of 602 teeth were recruited , with comparable numbers of cavities lined ( 288 , 47.8 % ) or conditioned and sealed ( 314 , 52.2 % ) . The majority ( 492 , 81.7 % ) were replacement restorations , and amalgam was the most common bulk restorative material ( 377 , 62.6 % ) . A total of 390 ( 64.8 % ) restored teeth were review ed at 6 months , 307 ( 51 % ) at 12 months , 363 ( 60.3 % ) at 24 months , and 279 ( 46.3 % ) at 36 months post-restoration . Sixteen cases of pulp breakdown were identified within 36 months of restoration placement , 11 presenting as emergencies and five detected at routine recall examination . Logistic regression showed that preoperative pain , cavity treatment by lining or conditioning- and -sealing and the use of rubber dam isolation had no association with pulp breakdown . Pulp breakdown was associated with deep or pulpally exposed cavities ( P < 0.001 , odds ratio 7.8 ) and with composite rather than amalgam restorations ( P = 0.001 , odds ratio 2.13 ) . Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes ( P < 0.0001 , odds ratio 28.4 ) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam ( P = 0.017 , odds ratio 3.92 ) . CONCLUSIONS Considered within the context of routine primary dental care : Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning- and -sealing with adhesive resins .  Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment . In deep and pulpally exposed cavities in posterior teeth , composites were associated with more pulpal breakdown than amalgams Using modified USPHS criteria , we evaluated annually for ten years 91 cases restored with visible light cured posterior composite resin LFP ( Base resin : UDMA ; filler : micro crushed type , alumino-silicate , barium glass and silica , 85 wt% , 74 vol% ) . The 91 cases restored with LFP decreased to 68 in ten years . Of the 23 cases that were lost , one result ed from a pulpal reaction immediately following restoration , four were extracted owing to periodontal disease or extrusion of third molars , two became abutments owing to loss of an adjacent tooth , eight had recurrent caries , and eight were lost owing to caries on a surface having no relationship to the composite resin restoration . Because we observed comparatively little wear , good marginal adaptability , and no discoloration , we concluded that the ten-year clinical success of LFP was on the whole very good , and that this resin has adequate clinical merit as a restorative material for posterior teeth when restricted to restorations covering comparatively small areas PURPOSE The aim of this clinical study was to observe the service duration of  porcelain laminate veneers ( PLVs )  and to estimate the influence of the categorical covariates such as location , tooth vitality , preparation depth , incisal , gingival and proximal finishing lines , and peripheral tissue type on the survival rates of event-free and overall service duration . MATERIAL S AND METHODS A total of forty patients ( 26 women , 14 men ; age range : 16 to 50 ) who had received 200 PLVs were evaluated in this study . Median follow-up time was 67.25 weeks with a range of 12 to 72 weeks . Fifteen of the restored teeth were nonvital , while the remaining 185 were vital . Categorical covariates related to the restoration design ( localization , vitality , preparation depth , incisal , proximal , and gingival finishings , and surrounding tissue type ) were recorded in order to estimate their influence on the survival rates . Survival rates of the event-free and overall service duration were calculated with the Kaplan-Meier analysis and Mantel log rank test . RESULTS Twelve failures were observed . The most frequent failure type ( 11 units ) was debonding of the restoration from the abutment tooth . Nine of them were rebonded and the remaining 2 were remade with a different preparation design . The last failure was observed as a coronal fracture at the cervical level . The overall survival rates were 99.5 % , 99 % , 97.5 % , 94.9 % , 94.4 % and 93.8 % at weeks 8 , 9 , 11 , 15 , 16 , and 34 , respectively , with a mean estimate of 68.45 weeks . CONCLUSION PLVs exhibited good clinical results with their conservative specifications and high survival rates . The preparation and design specifications affect the service duration of PLVs This case-control study sought to identify variables predictive of subsequent root canal therapy ( RCT )  in teeth receiving full coverage restorations . The University of North Carolina School of Dentistry 's computerized treatment data base was used to identify all patients receiving a single-unit crown on a nonendodontically treated permanent tooth from January 1 , 1998 through December 31 , 2002 . These patients then were classified either as cases ( those whose crowned teeth received RCT before July 1 , 2004 ) or controls ( those whose crowned teeth did not ) . Computerized data , chart entries , and dental radiographs were examined to determine pre- , intra- , and postoperative factors of interest . In the final multivariable logistic regression model that included 66 cases and 71 controls , younger age ( p = 0.005 ) and greater extent of coronal and root destruction ( p = 0.020 ) remained statistically significant predictors of case status , though many potentially important predictors were unavailable through chart review . Patients could benefit if prospect i ve studies were conducted to identify factors predictive of subsequent endodontic involvement in newly crowned teeth STATEMENT OF PROBLEM There are only a few studies available that deal with the clinical behavior of composite and ceramic inlay systems as potential substitutes for amalgam restorations . PURPOSE This prospect i ve clinical trial evaluated composite and ceramic inlay systems for clinical acceptability as restorative material s in single or multisurface cavities of posterior teeth and provided 1-year results . MATERIAL AND METHODS Forty-seven composite inlays ( Tetric , Blend-a-lux , Pertac ) and 24 heat-pressed ceramic inlays ( IPS Empress )  were placed in 45 patients by 7 student operators under the supervision of an experienced dentist . The first clinical evaluation was performed 11 to 13 months after placement of the restorations and used modified United States Public Health Services criteria . RESULTS Satisfactory results over this period were found , as 100 % of ceramic inlays and 94 % of composite inlays were assessed to be clinical ly excellent and acceptable . Only 3 composite inlay restorations were scored delta ( unacceptable ) . Two inlays exhibited secondary caries and 1 demonstrated loss of pulp vitality . For the criteria " anatomic form of the surface " and " marginal integrity , " ceramic inlays were significantly better than composite inlays . CONCLUSION Posterior tooth-colored inlays provided acceptable and excellent clinical service , even if they are placed by relatively inexperienced student operators
target: The included studies reported few , if any , endodontic complications .
  Little or no differences emerged between teeth restored with  composite resins  and those restored with amalgam .
background: Composite resin is used extensively for restoration of teeth with vital pulps .
  Although cell culture studies have disclosed harmful effects on pulpal cells , any untoward clinical effects , manifest as adverse pulpal responses , have yet to be determined .
  This study comprises a systematic review , design ed to address the question of whether the risk of endodontic complications is greater with  composite resin restorations  than with  other restorative material s  , such as  amalgam .