Postoperative Hypersensitivity and Its Relationship to Preparation Variables in Class I Resin - Based Composite Restorations : Findings from the Practitioners Engaged in Applied Research and Learning ( PEARL ) Network . Part 1

Abstract

Background This study investigated postoperative hypersensitivity at 1, 4, and 13 weeks following resin-based composite (RBC) restorations of occlusal caries and its relationship with prepreparation (baseline) sensitivity and preparation-related variables, including dentin caries activity, cavity dimension and volume, and lesion radiographic visibility. Methods Investigators in a practice-based research network enrolled patients with occlusal caries deemed to require operative treatment. The 45 dental practitioners then placed restorations using their preferred techniques. Complete baseline data on 665 restorations from 602 patients included patient-reported sensitivity (pre-preparation); dentists’ ranking of dentin caries on opening the enamel; measurements of preparation depth, width, and length; and patient demographics. At 1, 4, and 13 weeks post-treatment, patients anonymously reported any sensitivity to hot and cold stimuli, sweets, clenching, and chewing, as well as quality-of-life indicators related to the restorations. Results At baseline, 30% of teeth had reported sensitivities of ≥3 on an anchored scale from 0 to 10 points and were designated as appreciable hypersensitivity (AH). Appreciable hypersensitivity at baseline was related to lesion radiographic visibility and patient age but not to dentin caries activity ranking, type of posterior tooth, gender, or race/ethnicity. Patients reported on 491 restorations at 4 weeks post-treatment—18% had AH. Of those who had AH, 39% (34 of 87) had no baseline AH. With restoration, 63% of teeth with baseline AH no longer had AH. Changes in AH were not associated with preparation depth, length, width, or volume. Conclusion Patient-reported occlusal caries tooth sensitivity was high at baseline and eliminated by RBC restoration in 63% of cases; however, new sensitivity after restoration was reported in 10% of lesions that had none at pretreatment. Sensitivity was not related to preparation dimensions, volume, tooth type, or patient demographics (other than age) in these early lesions.

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

“…In study teeth with AH at baseline, only about 63 percent experienced elimination of AH after restoration. 2 On further analysis, the study investigators found no relationship in AH outcomes between materials, including consideration of types of liners and bonding agents, and techniques used by the 45 dental practices involved. 3 On the basis of these findings, PEARL clinicians were eager to determine whether including an RMGI liner would reduce POH more than would use of a dentin bonding agent (DBA) alone in RBC restorations.…”

“…The PEARL Network executive management team trained P-Is through use of videos, animated slide presentations and online quizzes in the identification of lesions, caries classification, 15,16 measurement of hypersensitivity to air and cold, SB evaluation, 17 DCA ranking 18 and measurement of preparation dimensions and depth, 2 as well as in treatment procedures. Study participants at baseline and at each recall appointment rated their hypersensitivity to air and cold stimuli by using the Numeric Pain Assessment Scale (NPAS) 19 and completed questionnaires about stimuli that cause hypersensitivity and how the condition affects their QoL.…”

“…The P-I recorded the preparation’s depth (deepest and shallowest), width and length to the nearest millimeter. 2,22 He or she inspected the pulpal floor and the axial wall for cracks, reporting findings by indicating “yes” or “no.”…”

“…They cured DBA and RBC materials by using a calibrated light source (minimum 400 mW/cm 2 radiometer [Demetron L.E.D. Radiometer, Kerr], supplied to all practices).…”

“…The results of a recent PEARL study showed substantial POH in patients queried anonymously after receiving an RBC restoration. 2 At four weeks after restoration placement, approximately 18 percent of study teeth had appreciable hypersensitivity (AH) (as measured by the patient’s indication of 3 or higher on a 0- to 10-point pain scale), and 10 percent of study teeth with no baseline hypersensitivity developed AH after restoration. In study teeth with AH at baseline, only about 63 percent experienced elimination of AH after restoration.…”