Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations

Abstract

Background The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH. Methods PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes. Results P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes. Conclusions Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.

Use of lining materials under posterior resin composite restorations in the UK

“…More recent research corroborates the hypothesis that placing a cavity liner in a posterior tooth does not reduce the incidence of post-operative sensitivity in moderately deep and deep cavities restored with resin composite [33,34].…”

Development and status of resin composite as dental restorative materials

“…The main reason related to hypersensitivity lies in polymerization shrinkage, monomer dissolution, and acidic fluid accumulation between the restoration and dentin . Clinical studies on postoperative hypersensitivity focused on the use of cavity lining, material formulations, and bonding systems, but lack a standardized measurement and consistent reporting system for postoperative hypersensitivity …”

<p>Cavity Bases Revisited</p>

“…There is evidence that no difference exists in postoperative sensitivity when a resin composite is “bonded” or “based”. 34 , 35 The findings of a 2016 Cochrane review state that there is inconsistent, low-quality evidence regarding the difference in postoperative hypersensitivity after placing a dental cavity liner under Class I and Class II posterior resin-based composite restorations in permanent posterior teeth in adults or children 15 years or older. Furthermore, no evidence demonstrates a difference in the longevity of restorations placed with or without dental cavity liners.…”