Quintessence Journals - Sandra Kalil Bussadori

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Table 2 Number of teeth according to allocation to the different cavity depth groups, the use of
calcium hydroxide liner, and the kind of restorative material
Calcium hydroxide liner Restorative material Cavity depth group
shallow medium deep
Not for Publication
Wegehaupt et al
Quintessence
for
Not
by
Yes buildup 6 8 9
definitive filling 14 21 17
No buildup 5 5 7
definitive filling 16 5 10
Table 3 Percentages (absolute number) of pain incidence or hypersensitivity of the buildup and definitive
restorations placed in either shallow, medium or deep cavities after use of a calcium hydroxide lining
or not
Calcium hydroxide liner Restorative material Cavity depth group
shallow medium deep
yes buildup 17% (1) 0% (0) 11% (1)
definitive filling 14% (2) 14% (3) 11% (2)
no buildup 40% (2) 0% (0) 29% (2)
definitive filling 13% (2) 40% (2) 40% (4)
On the basis of the RDTMD results, the cavities were divided
into three different groups (shallow, medium, or
deep cavity) of 40 teeth each. Cavities with RDTMD scores
1 to 5 (1.5 to 3.0 mm, green or yellow LEDs) were allocated
to group “shallow”, cavity scores 6 and 7 (0.9 to 1.5
mm, orange LEDs) were allocated to group “medium”, and
with results 8 to 10 (< 0.9 mm, red LEDs) to group “deep”.
In each group, cavities were treated either with or without
use of calcium hydroxide liner (Kerr Life, KerrHawe; Bioggio,
Switzerland). The decision to use a calcium hydroxide
liner or not was made by tossing a coin. This resulted in
20 liners being placed in the shallow group, 29 in the
medium-depth group, and 26 in the group of deep cavities
(Table 2).
To make the calcium hydroxide liner, a small drop of
Kerr Life was placed on the deepest part of the cavity and
allowed to set until its surface was hard upon probing.
The restoration of the teeth was performed either with a
buildup composite (n = 40) (LuxaCore, DMG; Hamburg,
Germany) or a hybrid composite (n = 83) (Spectrum,
Dentsply DeTrey; Konstanz, Germany). For the buildup
composite restorations, a self-etching nonrinse adhesive
system was used (Clearfil Liner Bond 2V, Kuraray Dental).
The buildup composite was used when a large amount of
dental hard tissue was lost and an indirect restoration was
required (crown or partial crown) later to stabilize the integrity
of the tooth or when the cervical margin was located
subgingivally. An etch-and-rinse adhesive
(Prime&Bond NT, Dentsply) was used in the remaining cavities
that were restored with the hybrid composite Spectrum.
These were Class I and II restorations (O, OM/OD,
and MOD) with the cervical margin located para- or
supragingivally. During the restoration, steel matrices were
used and fixed with wooden wedges. The hybrid composite
for the definitive restorations was applied in the cavities in
small horizontal increments with a maximum height of 1
mm. Application protocols for the two kinds of adhesives
and restorative materials are given in Table 1.
The patients were not told to which cavity-depth group
their tooth was allocated and if calcium hydroxide was
used or not. The patients were asked to record whether
any hypersensitivity, pain, or discomfort occurred following
treatment.
During a second appointment 6 months later, the patients
were re-examined by one dentist evaluating the following
criteria:
• Vitality test (yes/no): vitality testing was performed with
a cold foam pellet pressed on the buccal surface of the
tooth. The patients were asked to report whether they
felt the cold.
• Occurrence of hypersensitivity (yes/no): the patients
were asked if they had noticed any pain, hypersensitivity,
or discomfort in the teeth after the application of
the filling.
Reacting negative to the vitality test and reported pain
or hypersensitivity were ranked as failure.
To evaluate the influence of the three different variables
“cavity depth”, “calcium hydroxide liner”, and “resto-
Vol 11, No 2, 2009 139