Over the years many advances in knowledge and technology have decreased the incidence of postoperative sensitivity and pain. However, some of our best advancements when not used correctly can actually lead to astounding sensitivity and pain. Two of the most common causes for increased postoperative sensitivity following restorative procedures are problems with bonding and occlusion.
Fortunately there a several simple things we can do to curb these causes. It pains me when I hear others repeat the myth that it is normal to have significant sensitivity or pain after routine restorative treatment; this is just not the case. If you are having issues with postoperative sensitivity read on and try some of these simple steps and know you and your patients don't have to live with it.
When done successfully, bonding can be wonderful at decreasing sensitivity; however, small missteps can have just the opposite effect leading to tremendous sensitivity. Proper bonding comes down to two things:
- Proper preparation of the surfaces to be bonded
- Proper application of the bonding material or agents
In regard to the proper preparation of the surfaces to be bonded we must follow the instructions for our chosen materials. There are a few basic principles that ring true across all systems and materials. First, proper isolation is critical; two excellent ways to achieve this are with the traditional rubber or a device such as an Isodry.
Generally I have found that not only is a device such as an Isodry easier for me to use, my patients prefer it as well. Another universal requirement is to have the freshest surfaces possible prior to conditioning them; something that I have found to be excellent for this is light air abrasion with a "soft" material such as CoeJet 30.
If the system you are using requires that you etch the dentin, it's critical that the dentin not be left too wet or dry. One way to find this "sweet spot," is to use a self-etching bonding system.
The proper application of the bonding materials really comes down to reading and following the instructions for your system. The biggest universal principle here is to be sure to not dispense the materials until the moment you are ready to use them and once you have done so immediately put the cap(s) back on. This is important because many of these materials are volatile and the makeup and composition of them can change quickly if the caps are left off. One way to decrease this risk is to use a unidose delivery version of your desired system.
Some recent materials such as Lithium Disilicate (e.max) can be very hard to mark and it's easier to leave areas of hyper occlusion or excursive interferences, which of course can cause significant postoperative sensitivity or pain.
Should you find yourself having difficulty marking the occlusion on your restorations don't be afraid to try different films or papers. If you are using a plastic-based film try coating it with a bit of Vaseline which will greatly improve it's marking.