References
Post-operative sensitivity and posterior composite resin restorations: a review
From Volume 45, Issue 3, March 2018 | Pages 207-213
Article
In many countries the use of amalgam to restore posterior teeth is declining, with composite resin replacing it as the material of choice.1 As composite resin replaces amalgam as the material of choice for restoring posterior teeth, the incidence of post-operative sensitivity has increased, with the highest incidence in posterior composite restorations.2 The more complex the restorative procedure required for the placement of a composite resin restoration, including etching of enamel and dentine and the application of acidic adhesive monomers, may be related to the higher incidence of pain.
Post-operative sensitivity can be difficult to manage. Patients often complain of sensitivity at different levels and intensities, often with no evidence of failure of the restoration.3
Brännström first explained the physiology of pulpal pain in 1962,4 and in 1963 he described in his thesis the hydrodynamic fluid movement theory.5 Pain results from indirect innervations caused by dentinal fluid movement in the tubules, which then stimulates mechanoreceptors near the odontoblast processes. The response of the pulpal nerves is proportional to the fluid flow generated. The A-delta fibres respond to stimulation of dentinal tubules (eg airblast), whereas pulpal C-fibres respond to bradykinin or capsaicin. This study has implicated pulpal A-delta fibres in mediating dentinal sensitivity and pulpal C-afferent fibres in mediating pulpal inflammation.
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