No-Liner Composites Kept More Pulps Vital After Selective Caries Removal in 3-Year RCT

Edited by Dentaltown staff

Placing a glass ionomer liner under composite after selective caries removal to soft dentin did not improve restoration survival, and teeth restored without a liner kept pulp vitality more often, according to a randomized controlled trial published Nov. 5 in Clinical Oral Investigations.

The trial treated 144 deep dentin caries lesions in the permanent posterior teeth of 98 participants aged 9 to 55. After selective removal to soft dentin, lesions were randomly assigned to composite resin bonded with a universal adhesive in selective enamel etch mode, placed either directly over the remaining dentin or over a conventional glass ionomer liner.

Of the 144 lesions, 117 were evaluated at 30 to 36 months. Restoration survival, the primary outcome, was 96.0% without a liner and 92.4% with one, a difference that was not significant (P = .37).

Pulp vitality, the secondary outcome, favored the no-liner approach at 97.5% vs. 87.3% (P = .01). In an adjusted Weibull regression model, the no-liner group had a lower risk of pulp vitality failure. Restoration failure was also strongly associated with pulp vitality failure.

The authors concluded that routine liner placement after selective caries removal to soft dentin may not be necessary. Composite placed directly over the remaining dentin with a universal adhesive in selective enamel etch mode showed favorable restorative and biological outcomes, they wrote.

Cecilia Muñoz-Sandoval, Karla Gambetta-Tessini, and Rodrigo A. Giacaman of the University of Talca in Chile and Juliana J. Jardim and Marisa Maltz of the Federal University of Rio Grande do Sul in Brazil conducted the trial. It was registered at ClinicalTrials.gov as NCT04250142, and the authors declared no competing interests.

Sources:
Clinical Oral Investigations, “Clinical outcomes of composite restorations with or without a glass ionomer liner after selective caries removal to soft dentin: a 36-month randomized controlled trial,” published online Nov. 5, 2026: link.springer.com/10.1007/s00784-026-07209-8