ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 9 - Issue 5 | Sep - Oct 2017

Post-Operative Sensitivity in Restorative Type Glass Ionomer versus

Resin Composite Restoration in Class V Carious Cavity
Ghulam Sarwar Jamari1, Zahid Iqbal2

ABSTRACT

OBJECTIVE: To compare postoperative sensitivity between restorative type glass ionomer and resin composite restoration in Class (V)
carious cavity.
STUDY DESIGN: A Cross sectional comparative study.
PLACE AND DURATION: At Department of Operative Dentistry, Isra Dental College Isra University Hyderabad from 1st March 2013 to
30th September 2013.
METHODOLOGY: Patients presented with class V carious lesion were restored in two groups. Group-I, patients were treated with
restorative type glass ionomer. Group-II, patients were treated with Resin composite. Post-operative sensitivity was determined in
with Ethyl chloride (cold test) and Electric pulp tester (EPT).
RESULTS: The results showed that postoperative sensitivity after 2 days for group-I were 8% mild sensitivity, 92% no sensitivity on
Electric pulp tester and 8% mild sensitivity, 92% no sensitivity on cold. Postoperative sensitivity for group-II were 12% mild sensitivity,
88% no sensitivity on Electric pulp tester and 12% mild sensitivity, 88% no sensitivity on cold. Postoperative sensitivity after 7 days for
group-1 were 4% mild sensitivity, 96% no sensitivity on Electric pulp tester and 8% mild sensitivity, 92% no sensitivity on cold.
Postoperative sensitivity for group-II were 12% mild sensitivity, 88% no sensitivity on Electric pulp tester and 4% mild sensitivity, 96%
no sensitivity on cold. Postoperative sensitivity between two groups revealed no significant results with p-value greater than
0.05(p>0.05).
CONCLUSION: There was no difference of postoperative sensitivity in both class V restorations on Electric pulp tester and cold after 2
and 7 days.
KEY WORDS: Postoperative sensitivity, Class V, Glass ionomer, Resin composite, Carious cavity.

HOW TO CITE THIS:

Jamari GS, Iqbal Z. Post-Operative Sensitivity in Restorative Type Glass Ionomer versus Resin Composite Restoration in Class V Carious
Cavity. Isra Med J. 2017; 9(5): 293-96.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License
(http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

INTRODUCTION movement or contraction of fluid in the gap due to cold or other

Postoperative sensitivity is the discomfort associated with
restoration placement.1 A number of reasons have been
postulated for the occurrence of postoperative sensitivity but
the most commonly accepted theories related to
polymerization shrinkage results in formation of a gap, which
allows bacterial penetration and fluid flow with in it.2 The
entrance of bacteria or their noxious products into the dentinal
tubules cause inflammation in pulp and tooth sensitivity.2 The
1. Lecturer of Operative Dentistry
2. Associate Professor of Operative Dentistry
Institute of Dentistry
Isra University, Hyderabad, Pakistan
Correspondence to:
Zahid Iqbal
Associate Professor of Operative Dentistry
Institute of Dentistry
Isra University, Hyderabad, Pakistan
Email: zahidig@hotmail.com,
Received for Publication: 28-02-17
Accepted for Publication: 31-10-17
stimuli and rapid outflow of tubular fluid are the reasons that
pulp interprets as pain or sensitivity.3
Class V carious lesions occur in smooth facial and lingual
surfaces in the gingival third of teeth. Class V caries lesion are
produced by bacterial plaque attaching to the surface of the
teeth and producing acids that cause demineralization.4 The
aesthetic restorative materials are normally used for restoration
of Class V small carious cavities. These materials include
restorative type glass ionomer cements, resin modified glass
ionomer, compomer and resin composite respectively.5
The Glass ionomers are a restorative material and have unique
features. They are able to bond with tooth structure due to self
adhesive and ionic bonding to the tooth structure.4 However,
GIC has several disadvantages as well, such as sensitivity to
desiccation and moisture contact during the early setting
stages.6 The developments of new restorative techniques and
materials like composite resin restoration help to minimize this
problem.7 Conservative cavity preparations is the major benefit
during composite restorations. The strong bonds formed with
enamel and dentin in composite restorations showed reduce
post operative complications and less weakening of tooth
structure.8 Polymerization shrinkage is a major disadvantage of
for composite restoration occurs during polymerization.9

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Ghulam Sarwar Jamari et al.
The most common cause of postoperative sensitivity in
restorative type glass ionomer restoration is the air void that is
present in the interface between the traditional glass-ionomer
cements and dentin.6 Most challenging problem in composite
restoration of class V small carious cavity is post operative
sensitivity due to polymerization shrinkage. The gap under the
restoration is formed due to polymerization shrinkage and this
gap is then filled with dentinal fluid within the first 24–36 h.10
The hot or cold stimulus on interaction with restored teeth
causes fluid expansion and contraction in gap, which causes
fluid movement within the dentinal tubules that leads to
postoperative sensitivity.10
Previous study have evaluated the incidence of postoperative
sensitivity in class V carious restored teeth but there was
limitations in methodology as they used different variables and
assessment methods.7,11 Previous researcher normally recorded
subjective symptoms and they didn't used any standard tools.
Therefore this study aims to use the qualitative approach in
order to find out the best possible dental restorative material
between restorative type glass ionomer and resin composite to
decrease a postoperative sensitivity after restoration in class V
carious cavity. The result of this study will help the dental
practitioner in selection of dental material for class V carious
cavity with less postoperative sensitivity and comfortable
restorations for the patient. So the aim of the study was to
compare the post-restorative sensitivity in restorative type
glass ionomer as compare to resin composite restoration in
class V carious cavity.
METHODOLOGY
This cross sectional comparative study was conducted at the
Department of Operative Dentistry/College of Dentistry Isra
University, Hyderabad Pakistan from 1st March 2013 to 30th
September 2013. Local ethical committee approval was
obtained before the study start from the local research ethical
committee, Isra University Hyderabad.
Hundred patients of either gender having teeth with class V
small carious lesions without history of sensitivity presented in
Dental OPD for restoration were selected. The patients of aged
20 to 65 years were included. The patients that presented with
non carious lesions, gingival recession and using desensitizing
agents regularly were excluded. An informed consent was taken
from every patient. Hundred patients with class V small carious
lesion were restored in two groups. Group-I, 50 patients of
restorative type II glass ionomer (Type II Fuji Made in Japan).
Group-II, 50 patients of Resin composite master fill
(Biodinamica Made in Brazil). In group I Patients were given
local anesthesia, Shade was selected and isolation with rubber
dam was done. The high speed hand piece with round diamond
burrs ¼ (Dentsuply), cooled with a water spray was used for
class v cavity preparation
The preparation was only extended into dentin when the defect
need such extension and at this initial stage was prepared no
deeper than 0.2 mm into dentin because no groove retention
form was used. Restorative type glass ionomer (Type II Fuji
Made in Japan) powder was mixed with one drop of the liquid
ISRA MEDICAL JOURNAL | Volume 9 - Issue 5 | Sep - Oct 2017
on a mixing pad and mix quickly with plastic mixing spatula. 10%
polyacrylic liquid was applied cavity to condition the dentin and
then the cement was applied, using conventional instrument.
Water proof varnish (Nupro fluorid varnish dentsply) was
applied and restoration was polished with soft abrasive rubber
cups and slurry of fine grain alumina. In group-II cavity was
prepared as in previous group .The enamel and dentine walls on
the tooth was etched with 37% phosphoric acid etching gel
(Biodinamica) for 15 sec, washed, dried and then lined with of
master bond (Biodinamica Made in Brazil) and finally cured. The
lined cavity was restored with increment layers of resin
composite master fill. (Biodinamica Made in Brazil) For the
evaluation of post-operative sensitivity patients was contacted
after 2 and 7 days to determine postoperative sensitivity. The
electric pulp tester and cold stimulus application using ethyl
chloride were used to check the patient's response for
sensitivity at follow-ups.
At each of these appointments, the patients classified the
sensitivity in restored teeth on cold and EPT as No, mild,
moderate and severe sensitivity accordingly. Following
sensitivity scale was used to determine to marks the sensitivity
by patients.
0=No sensitivity 1=Mild sensitivity
2=Moderate 3=Severe sensitivity
DATA ANALYSIS: Statistical package for social sciences (SPSS 20)
was used to calculate the mean age, frequency of teeth and
gender distribution. Frequency or percentage of qualitative
variables (no, mild, moderate and severe sensitivity) was
determined in each group on clod test and EPT at different time
intervals. The test Chi-square was applied to find out significant
difference between two groups in this study with 0.05 level of
significance.
RESULTS
Total of hundred patients took part in the study, twenty four
patients (72%) were female and twenty six (28%) were male.
The mean age of the patients was 33.2 with standard deviation
of ± 7.18. Out of 100 permanent teeth 32 maxillary central
incisors, 34 maxillary lateral incisors, 8 maxillary canines,
similarly 2 mandibular central incisors, 2 mandibular lateral
incisors, 20 mandibular canines and 2 maxillary first premolar
were selected.
The study showed postoperative sensitivity on EPT after two
days for Group I (n=50), there was mild sensitivity in 4 (8 %)
cases and 46 (92 %) cases evaluated with no sensitivity after 2
days on EPT. For Group II (n=50), there was mild sensitivity in
6(12%) cases while 44 (88%) cases evaluated no sensitivity after
2 days on EPT as shown in Table - I. The Chi-square test revealed
no significant results (p= 0.50) greater than p-value (p > 0.05) as
shown in Table-I. Similarly, the study showed postoperative
sensitivity on EPT after seven days for Group-I (n=50), there was
mild sensitivity in 2 (4 %) and 48 (96%) evaluated with no
sensitivity after 7 days on EPT. For group-II (n=50), there was
mild sensitivity in 6 (12%) and 44 (88%) evaluated with no
sensitivity after 7 days on EPT as shown in Table - I. The Chi-
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square test revealed no significant results (p=0.14) greater than
p-value (p > 0.05) as shown in Table-I.
The study showed postoperative sensitivity on cold after two
days for Group-I (n=50), there was mild in 4 (8%) and 46 (92%)
evaluated with no sensitivity after 2 days on cold test. For
Group-II (n=50), there was mild sensitivity in 6 (12%) and 44
(88%) evaluated with no sensitivity after 2 days on cold test as
shown in Table II. The Chi-square test revealed no significant
results (p=0.50) greater than p-value (p>0.05) as shown in
TABLE-I: FREQUENCY OF POSTOPERATIVE SENSITIVITY ON EPT AFTER 2, AND 7 DAYS AND DIFFERENCE OF POSTOPERATIVE
SENSITIVITY BETWEEN GROUP-I & II (N=100).
TABLE - II: FREQUENCY OF POSTOPERATIVE SENSITIVITY ON COLD AFTER 2, AND 7 DAYS AND CHI-SQUARE TEST DIFFERENCE OF
POSTOPERATIVE SENSITIVITY BETWEEN GROUP-I & II. (N=100)
DISCUSSION
There are several reasons for postoperative sensitivity after
restorations have been documented in literature. The adverse
effects of cavity preparation, such as dentine dehydration and
excessive heat reach the pulp more easily when the greater
numbers of dentinal tubules are open and expanded.12 The
treatment of dentine with acid etchants further increased the
problem. The removal of smear layer and widening of dentinal
tubules due to the application of acid etchant break the physical
seal and all outside stimuli can easily reach to the pulp.12 The gap
between the restoration and cavity intensify the presence of
bacteria in the cavity after restoration. The bacteria can easily
invade the pulp through a gap due to any failure in the
restoration and opening of dentinal tubules and may cause
pulpal inflammation and post restorative sensitivity
complications.12
The reason of post operative sensitivity after glass ionomer
restoration is also documented in literature. The common
microscopic observation and possible cause of postoperative
sensitivity is the presence of micro porosities as resemblance to
bubbles into glass-ionomer cement matrices. The porosities are
formed due to inclusion of air during mixing of the material and
the air becomes entrapped as voids into the matrix during the
maturation phase of glass-ionomer cements. As the materials
ISRA MEDICAL JOURNAL | Volume 9 - Issue 5 | Sep - Oct 2017
Table-II. Similarly the study showed postoperative sensitivity on
cold after seven days for Group-I (n=50), there was mild
sensitivity in 4 (4 %) and 46 (96%) evaluated with no sensitivity
after 7 days on cold test. For group-II (n=50), there was mild
sensitivity in 2(4%) and 48(96%) evaluated with no sensitivity
after 7 days on cold test as shown in Table II. The Chi-square test
revealed no significant results (p=0.39) greater than p-value
(p>0.05) as shown in Table-II.
were protected with varnish, the reason of water diffusion
could be the movement of the dentin fluid across the bonded
interface from the underlying dentin.13
The new developments in dental adhesives greatly reduce the
incidence of postoperative sensitivity after composite
restoration. New developments, formulations and
incorporation of new molecules in dentine bonding agent or
adhesives has contributed greatly towards reducing the
incidence of postoperative sensitivity. Dental adhesives bond
the restorative materials with the tooth structure more
effectively by using new formulations in dental adhesives.
Dental adhesives obliterate open dentinal tubules.14
Several restorative techniques have been applied to minimize
the postoperative sensitivity and other consequences of
polymerization shrinkage in Class V cavities.15 Postoperative
sensitivity after placing class V restorations has been a problem
experienced by clinicians for past long years. This study has
reported postoperative sensitivity on cold test and EPT in
Group-I and Group-II and no significant difference was found
between the two groups at 2 days and 7 days follow up.
A thorough comparison of the results of this study with previous
study has shown similar results. In the previous study out of the
124 Class V composite restorations that were placed, only one
showed postoperative sensitivity that was in the mild
categories.5 In previous study postoperative sensitivity in class V
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restorations was compared between the two treatment groups
(Self Etch Versus Total Etch Adhesive) on application of cold
stimulus after 24 hours and 1 week follow up.16 The results of
previous study showed significant difference of postoperative
sensitivity in class V restorations at 24 hours. That result of our
study is inconsistent with the result of previous study; because
previous study reported milder to moderate sensitivity in class V
restorations at 24 hours with significant difference between Self
Etch Versus Total Etch groups. However, no statistically
significant difference was observed at 1 week follow-up in
previous study. Our study has same findings as previous study
and found no difference of postoperative sensitivity at 7 days
follow up.
This study used the postoperative sensitivity level of mild to
severe level and the results of this study reported only mild and
moderate sensitivity in our patients in both groups.
This findings of mild and moderate sensitivity is consistent with
previous carefully controlled international and local clinical
study on postoperative sensitivity in class v restorations.11,17
However only few clinical studies focused on postoperative
sensitivity of class V restoration so further comparisons cannot
be done and there is need of further clinical studies on
postoperative sensitivity and long term clinical outcome of class
V restorations placed with different restorative materials or
from the different technique.
CONCLUSION
There were no difference between two groups in postoperative
sensitivity on Electric pulp tester and cold after 2 and 15 days.
CONTRIBUTION OF AUTHORS:
Iqbal Z: Conceived Idea, Designed Methodology, Manuscript
Writing.
Sarwar G: Data Collection, Literature Review, Data Analysis.
Critical analysis
Disclaimer: None.
Conflict of Interest: None.
Source of Funding: None.
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