Postoperative sensitivity associated with low shrinkage versus conventional composites

Abstract

Introduction. Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives' ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage. Objective. The study assessed possible reduction in postoperative sensitivity with low shrinkage compared to conventional composites using different bonding agents and the influence of the operator skill on the incidence of postoperative sensitivity. Methods. Nine hundred and sixty permanent premolars and molars with primary carious lesions from patients 21 to 40 years old were used. Cavities 2 to 3 mm deep and with margins in enamel were prepared by four operators. Two operators had five years (A and B) and two had over 20 years (C and D) of clinical experience. Teeth were divided into eight groups each contained 120 restorations: (1) Els®+James-2 (original formula), (2) Els®+James-2 (new formula), (3) Els®+Excite, (4) InTenSe®+James-2 (original formula), (5) InTenSe®+James-2 (new formula), (6) InTenSe®+Excite, (7) Tetric Ceram®+Excite, and (8) Point 4®+OptiBond Solo Plus. At 14 days postoperatively, two independent operators, who did not take part in the clinical procedure, assessed postoperative teeth sensitivity using special questionnaires. Data were analyzed using non-parametric chi-square, Mann-Whitney and ANOVA tests. Results. Group 8 showed significantly higher score than the other groups. Less postoperative sensitivity was reported with two low-shrinkage composites (groups 2, 3, and 5) but with no significant difference. There was no statistical difference between groups 1, 2, 3, 4, 5, 6 and 7. Operator A had the highest postoperative sensitivity score compared to the other three. Conclusion. Conventional composite material Point 4® with its bonding agent caused significantly more postoperative sensitivity than low shrinkage composites combined with different adhesives. Operator skill influenced the incidence of postoperative sensitivity.

Uvod. Posle postavljanja kompozitnih ispuna može da se javi postoperaciona osetljivost izazvana preparacionom traumom, sposobnošću adhezivnog sistema da hermetički zatvori dentinske kanaliće, deformacijom pod okluzalnim opterećenjem ili prodorom bakterijskih toksina. Cilj rada. Cilj istraživanja je bio da se ispita da li je osetljivost zuba manja kod kompozita s malom kontrakcijom u poređenju s konvencionalnim kompozitima i odgovarajućim adhezivnim sistemima, kao i uticaj veštine stomatologa na incidenciju postoperacione osetljivosti zuba. Metode rada. Na 960 premolara i molara stalne denticije s primarnim karijesom, pacijenata starosti od 21 godine do 40 godina, preparisani su kaviteti dubine 2-3 mm s rubovima u gleđi. Čitavu proceduru su obavila četiri specijalista stomatologije, od kojih su dva imala pet (A i B), a druga dva više od 20 godina kliničkog iskustva (C i D). Zubi su svrstani u osam grupa od po 120 uzoraka prema korišćenom kompozitnom i adhezivnom sistemu: 1) Els®+James-2; 2) Els®+James-2 (nova formula); 3) Els®+Excite; 4) InTenSe®+James-2; 5) InTenSe®+James-2 (nova formula); 6) InTenSe®+Excite; 7) Tetric Ceram®+Excite; i 8) Point 4®+OptiBond Solo Plus. Dve nedelje posle intervencije dva nezavisna stomatologa (koja nisu učestvovala u kliničkoj proceduri) ocenjivala su posebnim upitnicima postoperacionu osetljivost zuba. Podaci su analizirani neparametrijskim c2, Man-Vitnijevim (Mann-Whitney) i ANOVA testom. Rezultati. U osmoj grupi utvrđena je statistički značajno češća postoperaciona osetljivost nego u ostalim grupama zuba. Nije bilo statistički značajne razlike između grupa 1, 2, 3, 4, 5, 6 i 7. Kompoziti sa nižom polimerizacionom kontrakcijom izazvali su manju postoperacionu ostetljivost, ali bez statističke značajnosti razlika (grupe 2, 3 i 5). Kod stomatologa A javljala se statistički značajno češće postoperaciona osetljivost nego kod ostala tri. Zaključak. Tip kompozitnog materijala s odgovarajućim adhezivnim sistemom i spretnost stomatologa utiču na učestalost pojave osetljivosti zuba posle restauracija srednje dubokih kaviteta II klase.