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 .
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 .
Carboxylesterase expression in human dental pulp cells: role in regulation of BisGMA-induced prostanoid production and cytotoxicity.
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
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 .
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 .