Title Postoperative Sensitivity of High-Viscosity Resin Composite Restorations Is Not influenced by Bulk Fill vs. Incremental Fill Technique
Clinical Question In patients requiring resin-based composite restorations for class 1 or 2 carious lesions, does high-viscosity bulk fill versus incremental fill reduce the chances of postoperative sensitivity?
Clinical Bottom Line For patients requiring posterior resin composite restorations, the use of high-viscosity bulk fill composite over high-viscosity incremental fill composite does not affect the intensity or risk of postoperative sensitivity. This is shown in a split-mouth double-blind randomized controlled trial comparing these two filling techniques using a packable high-viscosity bulk fill composite, Tetric N-Ceram Bulk Fill. Neither of the filling methods contributed to postoperative sensitivity. The number of surfaces filled, however, influenced the risk of postoperative sensitivity.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27892839Costa/201772 participants aged 18 years or older requiring restorations on 2 or 4 posterior teeth with a cavity depth of at least 3 mmRandomized controlled trial
Key resultsThe filling technique (bulk fill composite versus incrementally placed composite) did not influence the postoperative sensitivity experienced. The overall risk (p > 0.49) of postoperative sensitivity following treatment was 20.3% (95% Confidence Interval 15.7%-25.9%). Postoperative sensitivity was not influenced by cavity depth or tooth type. The intensity of the sensitivity that was experienced was not influenced by the filling method. The number of restored surfaces (C-factor) was significant (p = 0.01) in influencing postoperative sensitivity.
Evidence Search ("postoperative period"[MeSH Terms] OR ("postoperative"[All Fields] AND "period"[All Fields]) OR "postoperative period"[All Fields] OR "postoperative"[All Fields]) AND ("sensitivity and specificity"[MeSH Terms] OR ("sensitivity"[All Fields] AND "specificity"[All Fields]) OR "sensitivity and specificity"[All Fields] OR "sensitivity"[All Fields]) AND ("dietary fiber"[MeSH Terms] OR ("dietary"[All Fields] AND "fiber"[All Fields]) OR "dietary fiber"[All Fields] OR "bulk"[All Fields]) AND fill[All Fields] AND composite[All Fields]
Comments on
The Evidence
Participants were selected under very specific criteria to be similar for valid comparison. The operators were all experienced, calibrated for equalization, and used the same equipment and restorative techniques. All participants and evaluators were blinded, limiting bias in analysis. While the number of Class 1 and Class 2 restorations tested was approximately equal, there was a much greater number of women than men involved in the study, possibly influencing results. Sensitivity is a subjective response that can be due to many variables. Although precautions were taken to limit confounding variables, more tests could be performed to further enforce these results. Ultimately the C-factor, or the number of restored surfaces relative to unrestored surfaces, was significant in influencing the risk of postoperative sensitivity.
Applicability The results of this trial are relevant to dentists performing posterior restorations. The bulk fill composite technique provides a method of filling that can be beneficial to both the patient and practitioner without increasing the risk of postoperative sensitivity. Consideration should be given to the placement technique and number of surfaces bonded when focusing on bulk fill composite restorations.
Specialty (General Dentistry) (Restorative Dentistry)
Keywords Bulk fill, incremental fill, high viscosity composite, posterior resin composite, composite filling technique, postoperative sensitivity
ID# 3156
Date of submission 03/28/2017
E-mail chaveleh@livemail.uthscsa.edu
Author Andrea Chaveleh
Co-author(s) e-mail
Faculty mentor Kevin Gureckis, DMD
Faculty mentor e-mail gureckis@livemail.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available