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Glass Ionomer Liners May Not Prevent Dental Sensitivity

By August 30, 2013 December 1st, 2013 No Comments

Resin-modified glass ionomer liners under moderately deep dental restorations may not reduce postoperative sensitivity, a new study shows.

Four weeks after treatment, patients whose restorations had the liners under them reported a mean worst pain score of 1.8 on a scale of 0 to 10, whereas patients whose restorations did not have the liners reported a score of 2.1. However, the difference was not statistically significant.affordable cosmetic dentistry london

“The outcome of the study shows that you don’t need liners,” coauthor Frederick A. Curro, DMD, PhD, a professor at New York University in New York City, told Medscape Medical News. One exception might be for deep restorations near the pulp, he said. That type of restoration was not included in the study.best implant dentist london

The researchers estimated that the average dentist who uses the liners could save $2000 a year by leaving them out of their restorations.

The study was published in the August issue of the Journal of the American Dental Association…An earlier survey of PEARL patients showed that 18% of teeth had hypersensitivity after restorations were placed on them (defined by scores of 3 or above on a pain scale from 0 – 10). Of those teeth with sensitivity before treatment, 37% were still sensitive after the restorations were placed.

Many clinicians use resin-modified glass ionomer linings in hopes of preventing sensitivity by stopping moisture from penetrating dentin tubules. In the earlier PEARL study, 46% of restorations were placed with liners, whereas most of the remaining 54% were placed with a dental bonding agent, but not liners.best cosmetic dentist london

To determine whether the liners are effective, the practitioners in the network recruited patients who needed class 1 or class 2 restorations. The authors excluded lesions judged on radiographs to be more than half the distance from the dentinoenamel junction to the pulp.affordable dental implants london

They tested the sensitivity of the lesions in 2 ways: They blasted them with air from syringes for 5 seconds or until the patients indicated a sensation, and they placed cotton pellets with frozen crystal of a refrigerant on the occlusal surfaces of the teeth for 10 seconds or until the patients indicated a sensation.

For class 2 lesions, they tested occlusal and interproximal cold-stimulated pain scores as well as occlusal and interproximal air-stimulated pain scores.

Only patients who rated their pain a 3 or higher on a scale of 0 to 10 in any of these tests were eligible to participate in the study…The greatest sensitivity the patients reported to either air or cold was 5.3 (standard deviation [SD], 1.71) at baseline for the no-liner group and 5.2 (SD, 1.70) for the liner group, a difference that was not statistically significant (P > .05). One week after the restorations were placed, the greatest sensitivity in the no-liner group declined to 2.6 (SD, 2.37), and to 2.4 (SD, 2.08) in the liner group.

The researchers found no association between sensitivity and lesion depth, sleep bruxism, caries stage, dentin caries activity ranking, or radiographic visibility (P > .18).

However, Gary Stafford, DMD, chair of the Department of General Dental Science at Marquette University in Milwaukee, Wisconsin, told Medscape Medical Newshe considers the liners useful in deep lesions…”Personally, I place resin-modified glass ionomer restorations under deep restorations and not under the shallow restorations that were the focus of this study.”

To reduce sensitivity in shallow restorations, Dr. Stafford says he places the composite resin in small increments, which decreases shrinkage. Sensitivity typically occurs in this type of restoration when it shrinks, creating a gap underneath that accumulates moisture.root canal treatment london

Amalgam restorations do not shrink, he said, but they conduct changes in temperature more than composite resin restorations….read more

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