Class I RBC restoration-related postoperative hypersensitivity: PEARL Network findings

Methods: Practitioner-Investigators (45) enrolled 609 patients with early/shallow caries (<½ dentin thickness radiographic) and restored lesions (n = 675, 88% molars) using their preferred technique. Before restoration and at 1, 4 and 13 weeks postoperatively, patients completed a tooth hypersensitivity questionnaire (various stimuli with 0-10 anchored VAS pain scale). Appreciable hypersensitivity (AH) was defined as scoring ≥3 on any VAS question, and overall sensitivity as the highest reported to cold, hot and sweet. Dentists reported dentin caries activity (DCA), preparation depth, volume, and restorative materials/techniques. Polytomous logistic regression was used for change in AH with generalized estimating equations (GEEs) adjusting for 68 4-week patients with two teeth restored. Linear regression with GEEs evaluated change in overall hypersensitivity to cold, hot and sweet stimuli. Results: Preoperatively 26% of teeth had AH, reduced by 38% 4 weeks after RBC restoration. Four week AH occurred in 16% (77/492) of teeth with 48% (37/77) of these with no baseline AH. AH to stimuli was similar at baseline and 4 weeks, with reported scores cold > sweets = heat. Baseline AH was not correlated with cavity depth, volume, or DCA, yet associated (p<0.05) with radiograph visibility. AH was not different (p>.05) with use or type of a liner (59% RMGI) compared to DBA only. Self-etching DBA (49%) vs. total-etching reduced overall sensitivity (p=0.02) but not change in AH. Caries activity was also associated with overall sensitivity (p<0.05) but not change in AH.

Conclusions: Reduction in overall sensitivity 4 weeks following restoration was associated with DCA and type of DBA, but not cavity depth or volume, nor use of a liner. A multi-practitioner RCT is ongoing to investigate liner use and sensitivity changes. Supported by NIDCR U01-DE016755.