The Effect of Adhesive and Flowable Composite on Postoperative Sensitivity: 2-Week Results
Howard E. Strassler, DMD
Perdigao J, Anauate-Netto C, Carmo AR, Hodges JS, Cordeiro HJ, Lewgoy HR, Dutra-Correa M, Castilhos N, Amore R. Quintessence Int. 2004 Nov-Dec; 35(10):777-784.
OBJECTIVES: To measure 2-week post-operative sensitivity in Class II composite restorations placed with a self-etching adhesive (Clearfil SE Bond) or a total-etch adhesive (Prime&Bond NT) with or without a flowable composite as cervical increment. MATERIAL AND METHODS: Upon approval by the University of Guarulhos Committee on Human Subjects, 100 restorations were inserted in 46 patients who required Class II restorations in their molars and premolars. Enamel and dentin walls were conditioned with a self-etching primer (for Clearfil SE Bond) or etched with 34% phosphoric acid (for Prime&Bond NT). A 1- to 2-mm-thick increment of a flowable composite (Filtek Flow) was used in the proximal box in 50% of the restorations of each adhesive. Preparations were restored with a packable composite (Surefil). The restorations were evaluated preoperatively and 2 weeks postoperatively for sensitivity to cold, air, and masticatory forces using a visual analog scale. Marginal integrity of the accessible margins was also evaluated. Statistical analysis used a mixed linear model with subject as a random effect. RESULTS: Ninety-eight teeth from 44 subjects were observed at 2 weeks. The type of adhesive and use of flowable composite had no significant effects or interaction for any of the four outcomes of interest, ie, change from baseline to 2 weeks in sensitivity and response time for cold or air stimulus. For the air stimulus, the overall average change from baseline was not significant for either sensitivity or response time. For the cold stimulus, the overall average change from the baseline was significant for both sensitivity and response time. No case of sensitivity to masticatory forces was observed. CONCLUSION: No differences in postoperative sensitivity were observed between a self-etch adhesive and total-etch adhesive at 2 weeks. The use of a flowable composite did not decrease postoperative sensitivity.
This clinically relevant study compared a self-etching adhesive to a total-etch adhesive and their effects on several parameters of postoperative sensitivity. The authors prepared and restored posterior teeth with Class II restorations: 82% were replacement restorations, while 18% were primary carious lesions. Postoperative sensitivity when restoring posterior teeth with composites has been a recurring problem expressed by clinicians. Although the cause and effect is not clear, a variety of solutions have been offered. This study demonstrates that there may not be a connection between postoperative sensitivity and the type of adhesive: self-etch vs. total-etch. In this study, the potential of gingival margin leakage due to adaptation of a packable composite was also evaluated based upon other studies that have described leakage resulting from difficulty in adapting packable composites. The fact that no statistical differences were found in any of the parameters of postoperative sensitivity evaluated suggests that the practitioner whose patients experience postoperative sensitivity may need to look introspectively at potential technique faults that occur when placing posterior composites. Further, although this study demonstrates no differences, based upon anecdotal evidence described by other papers and clinicians, practitioners should consider self-etching systems or glass ionomer or flowable composite liners to reduce postoperative sensitivity, even though the causes are not clear.
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Howard E. Strassler, DMD