Clinical Outcome Of Different Adhesive Approaches In Indirect Pulp Capping

Objective: The aim of this in vivo study was to evaluate the influence of the adhesive system on post-operative sensitivity and pain in deep cavities restorations. The null hypothesis is that the self-etch approach induces a lower post-operative sensitivity and pain compared to total-etch adhesives in deep cavities.

Method: Sixty patients were selected for deep carious lesions treatment. Exclusion criteria were: general health problems, lack of proper oral hygiene, bruxism, pregnancy, altered sensitivity, previous restorations, enamel-dentin fractures or crack, periodontal problems, absence of pulpal vitality, abutment of a fixed or removable prosthesis. Carious lesions closed 1mm or less from the pulp were included in the study. They were randomly divided into three groups according to the adhesive system used: total-etch 3 step (Optibond FL, Kerr), self-etch 2 step (Adper SE,3M ESPE) and self-etch one step (Clearfil S3 Bond, Kuraray). VAS questionaire was given to assess the post-operative pain and thermal sensitivity during the 2 weeks after treatment and 18 month follow-up was performed. The data were analyzed by cross-tabulation analysis and Pearson Chi-square test (p <0.05).

Result: Statistical analysis showed a statistically significant difference between groups (p=0.02) only for post-operative sensitivity. At 18 month total-etch group showed better clinical results, above all for marginal ditching and sensitivity.  

Conclusion: The null hypotesis is partially rejected because post-operative pain was not influenced by the adhesive system; instead thermal sensitivity showed lower values with the self-etch approach, probably because total-etch adhesives induced a reversible pulp inflammation caused by acid conditioning. The 18month follow up showed that total-etch 3step adhesives still are the gold standard for clinical success