Influence of Adhesive Type and Placement Technique on Postoperative Sensitivity in Posterior Composite Restorations. The effect of adhesive and flowable composite on postoperative sensitivity: 2-week results. Composite resin restoration and postoperative sensitivity: clinical follow-up in an undergraduate program. Three-year clinical evaluation of a self-cured posterior composite resin. Self-etching adhesives and postoperative sensitivity. A clinical evaluation of a resin composite and a compomer in non-carious Class V lesions. A 3-year follow-up. Postoperative sensitivity: a comparison of two bonding agents. Short- and long-term clinical evaluation of post-operative sensitivity of a new resin-based restorative material and self-etching primer. Short-term clinical evaluation of post-operative sensitivity with bonded amalgams. Clinical evaluation of polyacid-modified resin composite posterior restorations: one-year results. Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique. Total-etch versus self-etch adhesive: effect on postoperative sensitivity. Effect of glass-ionomer cement lining on postoperative sensitivity in occlusal cavities restored with resin composite--a randomized clinical trial. Clinical evaluation of packable and conventional hybrid posterior resin-based composites: results at 3.5 years. A randomized controlled three year evaluation of "bulk-filled" posterior resin restorations based on stress decreasing resin technology. Class I occlusal composite resin restorations: in vivo post-operative sensitivity, wall adaptation, and microleakage. Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive.
PURPOSE This double blind , r and omized clinical trial compared the postoperative sensitivity of the placement technique ( incremental and bulk fill ) in posterior composite resin restorations bonded with two different adhesive strategies ( self-etch and etch- and -rinse ) . METHODS Posterior dental cavities of 72 participants ( n=236 ) , with a cavity depth of at least 3 mm , were r and omly divided into four groups . The restorations were bonded using either the etch- and -rinse Tetric N-Bond ( Ivoclar Vivadent ) or the self-etch Tetric N-Bond SE ( Ivoclar Vivadent ) . The composite resin Tetric N-Ceram Bulk Fill ( Ivoclar Vivadent ) was placed either incrementally or using the bulk-fill technique . Two experienced and calibrated examiners evaluated the restorations using World Dental Federation criteria after one week of clinical service . Spontaneous postoperative sensitivity was assessed using a 0 - 4 numerical rating scale and a 0 - 10 and 0 - 100 visual analog scale up to 48 h after the restorative procedure and after one week . RESULTS The risk ( p>0.49 ) and intensity of spontaneous postoperative sensitivity ( p>0.38 ) was not affected by the adhesive strategy or the filling technique . The overall risk of postoperative sensitivity was 20.3 % ( 95 % confidence interval 15.7 - 25.9 ) and typically occurred within 48 hours after the restorative procedure . CONCLUSIONS The overall risk of immediate postoperative sensitivity was 20.3 % and was not affected by either the adhesive strategy ( etch- and -rinse/self-etch ) or the filling technique ( incremental/ bulk ) OBJECTIVE To measure 2-week postoperative sensitivity in Class II composite restorations placed with a self-etching adhesive ( Clearfil SE Bond ) or a total-etch adhesive ( Prime&Bond NT ) with or without a flowable composite as cervical increment . METHOD AND MATERIAL S Upon approval by the University of Guarulhos Committee on Human Subjects , 100 restorations were inserted in 46 patients who required Class II restorations in their molars and premolars . Enamel and dentin walls were conditioned with a self-etching primer ( for Clearfil SE Bond ) or etched with 34 % phosphoric acid ( for Prime&Bond NT ) . A 1- to 2-mm-thick increment of a flowable composite ( Filtek Flow ) was used in the proximal box in 50 % of the restorations of each adhesive . Preparations were restored with a packable composite ( Surefil ) . The restorations were evaluated preoperatively and 2 weeks postoperatively for sensitivity to cold , air , and masticatory forces using a visual analog scale . Marginal integrity of the accessible margins was also evaluated . Statistical analysis used a mixed linear model with subject as a r and om effect . RESULTS Ninety-eight teeth from 44 subjects were observed at 2 weeks . The type of adhesive and use of flowable composite had no significant effects or interaction for any of the four outcomes of interest , ie , change from baseline to 2 weeks in sensitivity and response time for the cold or air stimulus . For the air stimulus , the overall average change from baseline was not significant for either sensitivity or response time . For the cold stimulus , the overall average change from baseline was significant for both sensitivity and response time . No case of sensitivity to masticatory forces was observed . CONCLUSION No differences in postoperative sensitivity were observed between a self-etch adhesive and a total-etch adhesive at 2 weeks . The use of flowable composite did not decrease postoperative sensitivity OBJECTIVES To analyze the relationship between the cavity depth and liners with postoperative sensitivity of  resin composite restorations .  METHODS A clinical follow-up was conducted on 319 resin composite restorations made in the final year of an undergraduate program over a 3-year period . Along with the analyses of cavity type , cavity depth , type of pulpal protection and the material s used , the postoperative sensitivity was also examined on each restoration . RESULTS Thirty-nine percent of the restorations had no protective layer ( Group 1 ) . As the depth of the prepared cavities increased , the restorations received one of the three pulpal protection methods ; a calcium hydroxide base ( Group 2 ) , glass ionomer cement ( Group 3 ) , or protection with a calcium hydroxide base in combination with glass ionomer cement ( Group 4 ) . The incidence of postoperative sensitivity showed no significant difference among Groups 1 , 2 and 3 , but was significantly lower in Group 1 than in Group 4 . The restorations made in shallow and medium depth cavities demonstrated significantly less-postoperative sensitivity than those made in deep cavities . The newer generation dentine-bonding agents showed a significantly lower incidence of postoperative sensitivity than the early generation group . CONCLUSIONS Postoperative sensitivity in resin  composite restorations was not related to the absence of protective layers but increased with the depth of cavities restored with the resin composite . The type of dentine-bonding agents could also be responsible for postoperative sensitivity A study was conducted to determine whether the wear resistance of a posterior composite could be improved by maximizing filler particle-to-particle contacts . This was expected to reduce stress concentrations on the resin matrix and thus reduce occlusal wear . A self-curing quartz-filled composite with this design , P-10 , was used to restore 90 Class I and II cavity preparations in adult teeth . Restorations were recalled after baseline at six months , one year , two years , and three years to measure wear by direct and indirect evaluation methods . There was no apparent advantage for this material compared with other previously evaluated posterior composites . The average cumulative wear for P-10 after three years was 145 microns . In addition , the restorations were evaluated for color-matching , interfacial staining , secondary caries , marginal adaptation , surface texture , and postoperative sensitivity . This material was not significantly different in those ways from other posterior composite products except in terms of more rapid color change , because it is self-cured PURPOSE To test the hypothesis that the prevention of postoperative sensitivity in resin-based composite restorations is better achieved with a self-etching/self-priming ( SE/SP ) dentin bonding system without lining than with an early generation total-etch ( TE ) bonding system . METHODS Over a 4-year period , clinical follow-ups were conducted on patients who had received composite restorations .  The depth of each cavity was categorized as being shallow , medium or deep , and an evaluation was made regarding the need for pulpal protection for each restoration . Three different self-etching/self-priming ( SE/SP ) adhesive systems were compared to three different total-etch ( TE ) adhesive systems . The incidences of postoperative sensitivity ( IPS ) were examined by a st and ardized procedure 1 week after placement of the restoration . Patients ' ages varied between 16 - 83 years . RESULTS The  total number of restorations placed in vital teeth were 330 for 150 patients in the SE/SP group , and 126 for 70 patients in the TE group .  Incidences of IPS in the total number of restorations stratified for depth were 14 % in deep cavities , 6 % in medium depth cavities and 5 % in shallow cavities in the SE/SP group , and 35 % in deep cavities , 16 % in medium and 4 % in shallow cavities in the TE group . Fisher 's exact test showed the incidence of IPS was significantly higher in cases of deep ( P < 0.05 ) and medium ( P < 0.05 ) cavities . The test also revealed that in restorations placed with the SE/SP adhesive systems , the presence or absence of a protective liner or base made no significant difference in the IPS in medium and shallow cavities , while the use of such protective layers produced a significantly higher IPS ( 21 % ) , compared with no protection ( 0 % ) , in deep cavities ( P < 0.05 ) . The absence of protective liners or bases did not result in postoperative sensitivity in deep cavities , when the SE/SP dentin bonding systems were used PURPOSE To compare the clinical performance of a resin composite and a polyacid-modified resin composite ( compomer ) in non-carious cervical lesions using a one-step self-etch adhesive . METHODS Thirty patients , each with two non-carious cervical lesions ( 60 restorations ) , received one composite ( Pertac-II ) restoration and one compomer ( Hytac ) restoration , both used in conjunction with a self-etch adhesive ( Prompt L-Pop ) and placed following the manufacturer 's instructions . Evaluations were at baseline , 6 , 12 and 36 months after placement for retention , margin adaptation , marginal discoloration , anatomic form , secondary caries and postoperative sensitivity . Statistical analysis with the Pearson Chi-square test was undertaken . RESULTS Retention rates were 86.6 % for composite and 86.7 % for compomer at 36 months . 3.3 % of composite and 6.7 % of compomer restorations showed a deficiency in marginal adaptation . Both material s showed a slight marginal discoloration of 7.7 % . More deterioration in anatomic form occurred with the compomer ( 11.5 % ) than the composite ( 3.8 % ) . None of the restorations exhibited secondary caries or postoperative sensitivity problems . There was no significant difference in performance between the material s in any of the categories evaluated Historically , postoperative pain associated with temperature was considered a thermal conduction problem . More recently , pulpal hydrodynamics has been used to explain this sensitivity . Relative to restorations placed with dentin bonding agents that require a separate etching step , agents that include an acidic primer are believed to result in a better seal of the dentinal tubules . This study compared pain associated with a st and ardized cold stimulus in two groups of restorations . One group was placed with a self-priming resin that required a separate etch step , the other with a self-etching , self-priming dentin bonding agent . This was a community-based , r and omized , double-blind clinical trial . Two hundred and nine restorations were placed for 76 participants . All teeth were asymptomatic at the start of the trial . Immediately following application of a st and ardized cold stimulus , participants rated the pain for each restored tooth using a Visual Analog Scale ( VAS ) . For each group of restorations , VAS scores at 13 weeks were compared to preoperative scores . In addition , the preoperative score was subtracted from the 13-week score , and the two groups of restorations were compared . For both groups of restorations , the median scores were significantly reduced at 13 weeks . This decrease in the VAS score reflects a reduction in sensitivity below that which existed preoperatively . There was no significant difference between the two groups of restorations in terms of change in sensitivity at 13 weeks This study evaluated the post-operative sensitivity of posterior restorations restored with a resin-based restorative material and a self-etching primer .  Forty-six restorations , 28 Class I and 18 Class II were placed by two clinicians in 25 patients . After cavity preparations were completed under rubber dam isolation , they were restored using a self-etching primer ( Fluorobond , Shofu Inc , Kyoto , Japan ) and a resin-based restorative material ( Beautifil , Shofu Inc , Kyoto , Japan ) . Patients were contacted on days 2 and 7 post-operatively and question ed regarding the presence of sensitivity , the stimuli that created sensitivity , the length of time the sensitivity lasted and its intensity using a rating scale from slight to severe . If sensitivity was experienced on day 7 , patients were also contacted on days 14 , 30 and 90 to assess the degree of sensitivity . All patients were recalled after 6- , 12- and 24-months for further evaluation of any sensitivity experienced . Chi-Square and Fisher 's Exact Test were used for statistical analysis . At day 2 , six restorations were sensitive to cold with no statistical difference ( p > 0.05 ) from the restorations that were not sensitive . At day 7 , only two restorations were sensitive . No sensitivity was present after day 14 , which was also confirmed at the six-month recall . No correlation could be established among the duration of the sensitivity , the degree of pain and the causes that initiated sensitivity ( p > 0.05 ) . At one-year recall , one restoration was replaced due to post-operative sensitivity that started after the six-month recall . No sensitivity was noted at the 24-month recall . No correlation ( p > 0.05 ) was found between sensitive restorations and those with a normal response throughout the study . The study showed that Fluorobond self-etching primer and Beautifil resin-based restorative material , when placed in posterior restorations , do not result in long-term post-operative sensitivity PURPOSE To compare the in vivo short-term post-operative sensitivity of teeth restored with amalgam using a  bonded resin liner vs. teeth restored using a copal varnish liner . MATERIAL S AND METHODS 20 patients received Class I or Class II contralaterally paired restorations which were placed at the same appointment . All restorations were placed by the same operator using an identical technique except that , in each r and omized pair , one was lined with an adhesive resin ( Scotchbond Multi- Purpose Plus ) while the other was lined with copal varnish . ( Plastodent ) Patients were provided visual analog scale response forms , instructed in their use , and requested to complete and return a form reporting their degree of sensitivity at baseline and on days 1 , 3 , 7 , 14 , and 30 post-operatively . Data from the response forms were analyzed for differences using a paired t-test . RESULTS A response rate of 90 % ( 18/20 ) was achieved for the complete 30-day assessment . Increases in thermal sensitivity beyond baseline were seen in 13 of the 18 subjects involving 12 restorations lined with copal varnish and 10 lined with adhesive resin . Typically , sensitivity peaked on day 1 or day 3 and diminished to pre-operative levels by day 30 . Only three subjects reported greater sensitivity at day 30 than at baseline . No significant difference in post-operative sensitivity was found between the two cavity lining material s at any post-operative interval OBJECTIVE The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system , Dyract AP , placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth . METHOD AND MATERIAL S Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist . The restorations were evaluated directly , with modified US Public Health Service criteria , and indirectly , with color slides and polyvinyl siloxane impressions , at baseline and 6 months and 1 year after placement . Preoperative and 1-year postoperative bitewing radiographs were also taken . RESULTS All 82 restorations available for 1-year evaluation were in situ . No postoperative sensitivity or pulpal problems were reported . Four Class II restorations ( 4.9 % ) failed because of partial fracture or recurrent caries . The percentages of Alfa score for each criterion were color match , 95.1 % ; marginal discoloration , 57.3 % ; marginal integrity , 35.4 % ; anatomic form , 98.8 % ; and surface texture , 91.5 % . The average wear rate of Dyract AP was low ( 18.5 + /- 11.7 microns at 6 months and 35.7 + /- 13.6 microns at 12 months ) . CONCLUSION The excellent h and ling characteristics , the good clinical performance , and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas PURPOSE To report the 4-year clinical performance of  posterior resin-based composite restorations placed using the total-etch technique . MATERIAL S AND METHODS Over a period of 1 year , 726 restorations ( 248 molars , 478 premolars ; 260 Class I , 466 Class II ; 540 replacements , 186 primary decay ) were placed on conservative preparations , using the incremental placement technique in a clinical environment . Baseline data were collected , and the restorations were evaluated after 4 years . Z100 and Scotchbond Multi- Purpose ( SBMP ) ( 3 M Dental Products , St. Paul , Minnesota ) were used as the restorative system . The criteria evaluated were color match , marginal adaptation , anatomic form , cavosurface marginal discoloration , axial contour , interproximal contact , secondary caries , postoperative sensitivity , and tooth vitality . RESULTS At baseline , 24 % of the teeth restored presented postoperative sensitivity ; 86 % of the sensitive teeth were from the replacement group . At 4 years , all teeth were vital to cold test . Eighteen restorations ( 2.5 % ) presented clinical ly detectable marginal fracture . The shade was acceptable in all restorations . Cavosurface marginal discoloration was observed in 47 restorations ( 6.5 % bravo scores ) . Axial contour , interproximal contact , and marginal adaptation received 100 % alfa scores . No secondary caries was diagnosed in any of the teeth examined . None of the examined restorations required replacement . CLINICAL SIGNIFICANCE Under controlled clinical conditions , posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years . None of the examined restorations required replacement , and there was no clinical ly detectable wear in any of the restorations . Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations BACKGROUND Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations . The authors tested a twofold hypothesis : a self-etch , or SE , adhesive would result in less postoperative sensitivity than a total-etch , or TE , adhesive ; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive . METHODS Patients were selected on the basis of requiring Class I and II restorations in molars and premolars . The authors placed 30 restorations with the SE material ( Clearfil SE Bond , Kuraray America , New York ) and 36 restorations with Prime & Bond NT ( Dentsply Caulk , Milford , Del. ) , which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously . Preparations were of st and ard design , with all margins in enamel without beveling . Upon rubber dam isolation , the authors conditioned the enamel and dentin walls with the self-etching primer ( for Clearfil SE Bond ) or etched with the proprietary 34 percent phosphoric acid ( for Prime & Bond NT ) , followed by application of the corresponding dentin adhesive . Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations : Clearfil AP-X for Clearfil SE Bond or Esthet-X Micro Matrix Restorative for Prime & Bond NT . The restored teeth were evaluated preoperatively and at two weeks , eight weeks and six months postoperatively for sensitivity to cold ( ice ) , air and masticatory forces , as well as for marginal discoloration . RESULTS Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE material s at any recall time . Marginal discoloration was rated as " absent " for all restorations at six months . Only one tooth displayed sensitivity to occlusal forces at six months . CONCLUSION The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration . CLINICAL IMPLICATION S Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used This study investigated the ability of a glass-ionomer cement ( GIC ) lining to reduce postoperative sensitivity in occlusal cavities restored with resin composite . In addition , the effects of a total-etch and self-etch adhesive on postoperative sensitivity were also compared . Patients who had moderate to deep occlusal caries of at least one molar were recruited . Overall , 103 restorations were placed in 70 participants , with an average age of 22.8 + /- 3.8 years . Preoperatively , each tooth was evaluated for cold-stimulated tooth sensitivity using a visual analog scale . If present , tooth sensitivity induced by cold/hot drinks or occlusal function was also noted . Caries was stained with a caries detector dye , then removed using slow-speed burs and h and excavators . The cavity was restored with one of four r and omly allocated restorative procedures : 1 ) bonded with a two-step , total-etch adhesive ( Single Bond 2 ) ; 2 ) lined with a resin-modified GIC liner ( Fuji Lining LC ) , then bonded with total-etch adhesive ; 3 ) bonded with a two-step , self-etch adhesive ( Clearfil SE Bond ) and 4 ) lined with the GIC liner , then bonded with self-etch adhesive . The cavities were incrementally filled with a nanofilled hybrid resin composite . At recall , postoperative sensitivity was evaluated at one week and one month . Overall , postoperative sensitivity in daily function was rare . No significant difference in postoperative sensitivity , either in daily function or in response to a cold stimulus , was observed between the restorative procedures with or without the GIC liner , regardless of the adhesive used ( p > 0.05 ) . In addition , no difference in postoperative sensitivity was noted between use of the self-etch and total-etch adhesive BACKGROUND The authors evaluated clinical performances of a packable and a conventional hybrid resin-based composite used with a self-etch adhesive system . METHODS Three dentists placed 105 posterior restorations in 65 adults . They placed a packable ( SureFil , Dentsply DeTrey GmbH , Konstanz , Germany ) and a conventional ( Spectrum , Dentsply DeTrey GmbH ) resin-based composite using a self-etch resin adhesive system . The authors evaluated the restorations using Ryge modified criteria , photographs and die stone replicas . RESULTS After 3.5 years , six large SureFil and two Spectrum restorations had failed from bulk fracture and secondary caries , result ing in cumulative survival rates of 81.3 and 92.0 percent , respectively . Failed  SureFil restorations generally were larger than the remaining intact restorations . Other ratings were satisfactory , with no significant differences between the two material s for any restoration parameter . Alfa ratings for both material s were approximately 80 percent or greater for marginal discoloration , anatomical form , surface texture and surface staining . Lower percentages of restorations were rated Alfa for color match , marginal integrity and gingival health . No postoperative sensitivity was reported . Net mean occlusal wear ( + /- st and ard deviation ) was 28.9 ( + /- 32.9 ) micrometers for SureFil and 33.8 ( + /- 29.6 ) microm for Spectrum restorations ; the difference was not statistically significant . CONCLUSIONS When used with a self-etch adhesive , the 3.5-year clinical performances of both composites were similar and satisfactory for the restoration of Class I and moderate-sized Class II cavities . Clinical Implication s. The two composites placed in this study have an increased risk of bulk fracture when placed in large intracoronal Class II molar preparations OBJECTIVE The objective of this r and omized controlled prospect i ve clinical trial was to evaluate the efficacy of a flowable resin composite ( SDR ) bulk fill technique in posterior restorations and to compare it intraindividually with a conventional 2 mm resin composite curing technique in a 3-year follow up . MATERIAL S AND METHODS Thirty-eight pairs Class II and 15 pairs Class I restorations were placed in 38 patients with a mean age of 55.3 years ( range 32 - 87 ) . Each patient received at r and om at least two , as similar as possible , Class II or Class I restorations of two restorative techniques . In all cavities a single step self-etch adhesive ( Xeno V ) was applied . In one of the cavities of each pair , a flowable resin composite ( SDR ) was placed , in bulk increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface . The occlusal part was completed with a nano-hybrid resin composite ( Ceram X mono ) layer . In the second cavity , the hybrid resin composite was placed in 2 mm increments . The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 3 years . Caries risk and parafunctional habits of the participants were estimated . RESULTS After three years , 76 Class II and 28 Class I restorations could be observed . One molar resin composite-only tooth showed post-operative sensitivity during 3 weeks for temperature changes and occlusal forces . Two failed Class II molar restorations in the resin composite-only group were observed during the first year , one cusp fracture and one resin composite fracture . An annual failure rate of 1.3 % was found for the resin composite only restorations and of 0 % in the bulk-filled restorations ( n.s . ) . Ten participants were estimated as having high caries risk and eleven showed active bruxing habits . SIGNIFICANCE The 4 mm bulk-fill technique with the flowable resin composite SDR showed highly clinical effectiveness , which was comparable during the 3-year follow-up with the 2 mm resin composite layering technique PURPOSE To investigate the effect of restoration technique and adhesive system on the post-operative sensitivity and marginal adaptation of Class I occlusal composite resin restorations placed in vivo . MATERIAL S AND METHODS 48 Class I cavities were restored in vivo according to one of three protocol s : ( 1 ) Scotchbond Multi- Purpose /P50 placed in increments ; ( 2 ) Scotchbond Multi- Purpose /P50 placed in bulk , and ( 3 ) Clearfil Liner Bond 2/Clearfil Ray Posterior placed in bulk . Post-operative sensitivity and sensitivity on loading were recorded 5 - 7 weeks after placement of the restorations ; the teeth were cautiously extracted , immersed in a dye solution and sectioned . SEM observations were made from epoxy resin replicas . Microleakage and gap formation was assessed . RESULTS No differences among adhesive systems or restoration procedures were found for microleakage . Post-operative sensitivity was reported in 14 % of all teeth but was absent in the Clearfil Liner Bond 2 group . Sensitivity on loading was experienced by patients in 56 % of the restorations . Group 1 : nine teeth ; Group 2 : 15 teeth ; Group 3 : three teeth . Differences were statistically significant for all three groups . The SEM analysis showed that restorations placed in two layers showed less gaps than restorations placed in bulk OBJECTIVE The objective of this prospect i ve clinical trial was to evaluate the 4-year clinical performance of an ormocer-based nano-hybrid resin composite ( Ceram X ; Dentsply/DeTrey ) in Class II restorations placed with a one-step self-etch ( Xeno III ; Dentsply/DeTrey ) and two-step etch- and -rinse adhesive ( Ivoclar Vivadent ) . METHODS Seventy-eight participants received at r and om at least two , as similar as possible , Class II restorations of the nano-hybrid resin composite bonded with either a single step self-etch adhesive or a control 2-step etch- and -rinse adhesive . The 165 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 4 years . RESULTS 162 restorations were evaluated at 4 years . Postoperative sensitivity was observed in 6 patients ( 3 Xeno III , 3 Exite ) between 1 and 3 weeks . Eleven failed restorations ( 6.8 % ) were observed during the follow up . Seven in the one-step self-etch adhesive group ( 7.7 % ) and four in the 2-step etch- and -rinse group ( 5.6 % ) . This result ed in non-significant different annual failure rates of 1.9 % and 1.4 % , respectively . Fracture of restoration was the main reason for failure . CONCLUSION The ormocer-based nano-hybrid resin composite showed a good clinical performance in Class II cavities during the 4 year evaluation . No significant difference was seen in overall clinical effectiveness between the two adhesives
No overall effect was revealed in the meta-analyses , meaning that no influence of the  ER or SE strategy on POS .
SIGNIFICANCE The type of adhesive strategy ( ER or SE ) for posterior resin composite restorations does not influence the risk and intensity of POS .
OBJECTIVES A systematic review and meta- analysis were performed on the risk and intensity of postoperative sensitivity ( POS ) in posterior resin composite restorations bonded with self-etch ( SE ) and etch- and -rinse ( ER ) adhesives .