Sensitivity after a composite restoration is common, usually short-lived and mostly preventable. This review summarises what the evidence says about its causes and what to do at the chair.

How common, and for how long

Across the trials that measured it, between one in ten and one in three patients report some sensitivity in the first week after a posterior composite, and most are free of it within a month.1 The rate depends more on the technique than on the material.

The mechanism is hydrodynamic: a gap at the dentine, a bubble under the restoration or an over-dried surface lets fluid move in the tubules when the tooth is loaded or cooled.

A sensitive tooth after a restoration is a tooth telling you where the gap is.

Clinical principleAdhesive dentistry
Prevention

What lowers the rate

  • Keep the dentine moist

    Blot, do not blast. A chalky surface is a desiccated one.

  • Layer thin

    Increments of two millimetres cure through; a thick increment shrinks away from the floor.

  • Line the deepest point

    A flowable or a glass ionomer at the floor reduces stress and seals the tubules.

  • Check the occlusion twice

    Once with the patient upright, once biting normally: a high spot is the commonest cause of pain on biting.

At the chair, when it happens

Ask when it hurts. Cold alone points to the dentine seal; biting points to occlusion or a crack. Adjust first, desensitise second, and remake only when a radiograph or a transillumination shows why.23

Most cases resolve with time and a desensitising varnish. The ones that do not are the ones that were never sealed.

Clinical tip

Before the patient leaves, cool the restored tooth with the air syringe for a second. A sharp response now predicts a call tomorrow, and it is easier to adjust while the anaesthesia is still working.

Further reading

References

  1. Briso ALF, Mestrener SR, Delício G, et al. Clinical assessment of postoperative sensitivity in posterior composite restorations. Operative Dentistry. 2007;32(5):421–426.
  2. Reis A, Dourado Loguercio A, Schroeder M, et al. Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations? A systematic review and meta-analysis. Dental Materials. 2015;31(9):1052–1067.
  3. Costa T, Rezende M, Sakamoto A, et al. Influence of adhesive type and placement technique on postoperative sensitivity in posterior composite restorations. Operative Dentistry. 2017;42(2):143–154.
Glossary

The terms in this article

2 terms of this event, each marked where it first appears.

hydrodynamic theory hydrodynamic
The explanation of dentine sensitivity as fluid moving in the tubules and stimulating the nerve.
smear layer
The film of cut debris left on dentine by a bur.