Influence of Adhesive Type and Placement Technique on Postoperative Sensitivity in Posterior Composite Restorations

Abstract

The overall risk of immediate postoperative sensitivity was 20.3% and was not affected by either the adhesive strategy (etch-and-rinse/self-etch) or the filling technique (incremental/ bulk).

The Phenomenon of Postoperative Sensitivity and Composite Restorations – A Review

“…14 Table 1 summarizes the results of different clinical studies on silorane based composites and postoperative sensitivity. [15][16][17][18][19][20][21][22][23][24][25] Bulkfill composites with shrinkage stress relievers and polymerization modulators have been introduced to counter the development of shrinkage stress and in vitro studies have shown these materials exhibit less shrinkage stress than conventional composite resins. 26 The results of clinical studies evaluating the postoperative sensitivity associated with the use of bulkfill composites are shown in Table 1.…”

“…The risk of postoperative sensitivity and development of "hybridoid layer" has been regarded higher with etch and rinse adhesives as compared to self-etch adhesives due to the elimination of the smear layer in the former and the simultaneous demineralization and resin infiltration in the latter. 43 The results of clinical trials investigating the role of adhesive strategy in causing postoperative sensitivity have shown mixed results with some studies 24,43,44,45 claiming no association between the two while others 46,47 have reported a statistically significant difference in the postoperative sensitivity and adhesive approach. However, meta-analysis and systematic reviews have found no significant association of bonding strategy with the risk and intensity of postoperative sensitivity.…”

“…However, modern bulkfill composites have demonstrated a promising degree of polymerization in relation to conventional composites 55,56 and clinical studies on comparison between bulk and incremental filling show no significant difference in the occurrence of reported postoperative sensitivity. 22,23,24,25 In terms of the biological properties of the composite resins, the process of polymerization is not complete in the set material; 25-50% of the monomer double bonds remain unreacted and this monomer has the potential to irritate the pulp. 57 Monomer elution from the set composites has been investigated under different conditions and it may take place either due to incomplete polymerization and/or material degradation, thus highlighting the importance of adequate polymerization to minimize the adverse effects from residual JPDA Vol.…”

“…61 However, clinical studies fail to demonstrate this association of C-factor or cavity type with postoperative sensitivity. 24,52 The frequency of postoperative sensitivity as reported in different clinical studies in relation to the type of cavity is shown in Table 3. 4,5,23,29,52,62 Another possible reason for postoperative sensitivity could be the increased cavity depth or reduced thickness of residual dentin.…”

“…63 The higher percentage of postoperative sensitivity reported in multi surface restorations as seen in Table 3 could be explained by the greater removal of tooth structure and reduction in residual dentin thickness. 24 The placement of composite restorations in close proximity to the pulp without an appropriate bonded liner/base would increase the risk of postoperative sensitivity in case of a compromised adhesion resulting from a failure in the hybridization process. Clinical studies on the other hand observed that a reduction of the residual dentin thickness in deep cavities was found to be associated with greater postoperative sensitivity irrespective of the presence or absence of a cavity liner.…”