Avaliação da sensibilidade pós-operatória em restaurações posteriores aplicando adesivo em dentina úmida vs dentina seca: ensaios clínicos randomizados e duplo-cegos

Abstract

Objectives: To evaluate the influence of dentin moisture on posterior tooth restorations on the clinical behavior of a universal adhesive and a conventional adhesive after acid etching, mainly regarding postoperative sensitivity (POS) and to investigate the restorations for marginal discoloration, marginal adaptation, fracture and recurrent caries. Methods: For this study two randomized controlled trials (RCTs) were performed. The RCTs were double-blind, split mouth. Sixty-six volunteers who had at least one tooth in each hemiarch with indication for posterior restoration, whether or not involved in the proximal box, participated in the study, provided that the cavity was at least 3 mm deep. 180 class I / II restorations were performed, being 90 restorations in each clinical trial. Prior to the restorative procedure, patients were evaluated for spontaneous and provoked sensitivity. The composite resin used was Filtek Bulkfill (3M Oral Care, St. Paul, MN, USA) and the adhesives used were Single Bond Universal (SBU) (3M Oral Care, St. Paul, MN, USA) (RCT1) and Single Bond 2 (SB2) (3M Oral Care, St. Paul, MN, USA) (RCT2). Participants were assessed for absolute risk and intensity of spontaneous and provoked POS caused by visual analog scales (VAS: 0-10 cm) and numerical rating scale (NRS: 0-4) and also according to modified FDI (World Dental Federation) criteria at 6 and 12 months for postoperative sensitivity, marginal discoloration and marginal adaptation, fracture, and recurrent caries. The risk of postoperative sensitivity between groups was compared by chi-square test and Fisher's exact test (α = 0.05). Results: 56 women and 36 men participated in the study. The distribution of the restorations was 142 class I cavities and 38 class II cavities. The absolute risk of spontaneous postoperative sensitivity within 48 hours in RCT1 for the dry dentin group was 20% (95% CI [10.9-33.2]) and in the wet dentin group it was 22.2% (95% CI [12.54-36.2]). In RCT 2, the risk was 18.6% (95% CI [9.74-32.6]), for both groups. In 12 months of evaluation there was no presence of secondary caries in both RCTs and the restorations were evaluated as mostly satisfactory. Report of spontaneous POS at 12 months was recorded in only 1 restoration of RCT 1 and there was no report of spontaneous POS at 12 months in RCT 2. Conclusion: The adhesive systems on dry or wet dentin did not influence the spontaneous and provoked postoperative sensitivity, as well as any other parameters after 12 months of clinical evaluation.