Restoration variables and postoperative hypersensitivity in Class I restorations: PEARL Network findings. Part 2.
BACKGROUND: This study investigated postoperative hypersensitivity at 1, 4, and 13 weeks following resin-based composite restoration of occlusal caries as well as the relationship to materials and technique employed by PEARL Network Practitioner Investigators (P-Is).
METHODS: PEARL P-Is (n = 45) enrolled patients with early occlusal caries lesions deemed to require treatment and placed restorations using their routine technique. Data on 485 restorations at 4 weeks included: baseline sensitivity; ranking of dentin caries activity; post-preparation use of antimicrobials, liners, and dentin bonding agent; type of resin-based composite (RBC) employed; whether layer or bulk fill was used; and patient demographics. Patients anonymously reported at 1, 4, and 13 weeks any sensitivity to hot, cold, sweets, clenching, and chewing as well as quality of life (QOL) related to the restoration(s).
RESULTS: Appreciable hypersensitivity (AH)--ie, sensitivity of 3 or greater on an 11-point anchored scale--was reported in 30% of all 668 eligible carious teeth at baseline. Among them, 10% of study teeth with no baseline AH had developed AH at 4 weeks post-treatment. With restoration, 63% of teeth with baseline AH no longer had AH, while the remainder had no improvement. Neither change in AH nor change in greatest sensitivity was associated with use of a liner, use of flowable or hybrid RBC, or bulk or layer technique. With use of an antimicrobial, at 1 week, there was a significant but transient effect on AH (P = 0.006), which was generally not present at 4 weeks, although it continued for one product. At 4 weeks, the change in greatest sensitivity was associated with the type of dentin bonding agent, total etch or self etch, (P = 0.004). Using similar materials and techniques, P-Is had widely differing patient-reported outcomes.
CONCLUSION: Patient self-reported post-restoration AH-either acquired or remaining-at 4 weeks was generally not related to the materials or techniques recorded in these small- to moderate-sized occlusal restorations. However, the change in greatest sensitivity was associated with the type of dentin bonding agent used; but the clinical significance of this difference is questionable.
CLINICAL IMPLICATIONS: The post-restoration levels of AH in early and moderate-sized posterior RBC restorations provide no justification for the use of a liner (CaOH, GI/RMGI, or flowable composite) as compared to the use of a dentin-bonding agent alone. Use of an antimicrobial had an effect on AH at 1 week that was generally transient.