Evaluation of Post-Operative Sensitivity of Nano Filled Composite Versus Bulk Filled Resin Composite in Posterior Class 2 Restoration

pain and fail. Objective: To compare and evaluate the post-operative sensitivity between nano resin composite using incremental technique and bulk �lled resin composite using bulk �lled technique in class 2 posterior restorations by assessing the post-operative pain and sensitivity. Methods: Two hundred and twenty patients who satis�ed inclusion and exclusion criteria were lottery-divided into groups A and B. Nano resin composite was placed via incremental technique in Group A and bulk �lled in Group B. Post-operative pain was assessed using Visual Analog Scale 0-10 at 24 hours and 7 days. Results: Male patients were 47 (42.7%) and 48 (43.6%), female patients were 63 (57.3%) and 62 (56.4%). Mean of pain was 2.39 ± 0.97 and 2.32 ± 0.81 at 24 hours postoperatively and 0.14 ± 0.63 and 0.00 at 7 days in group A and group B respectively. Pain level was mild in 97 (88.2%) and 105 (95.5%) patients, moderate in 13 (11.8%) and 5 (4.5%) after 24 hours, no pain in 105 (95.5%) and 110 (100.0%) and mild in 5 (4.5%) and 0 (0.0%) at 7 days in group A and group B, respectively. Conclusion : Bulk �lled resin composite using bulk �lled technique is more effective in class 2 posterior restorations as compared to nano resin composite using incremental technique.


M E T H O D S
the potential of contamination [8]. Recently, bulk lled resin with better mechanical and chemical properties have been introduced [4]. Bulk lled composites are a single component, uoride-containing, clearly light cured radiopaque resin component that may be easily adapted to cavities in restoration [6]. It has conventional owable composite handling properties, but it can be inserted in 4mm increments with minimum polymerization stress and increased curing depth [9]. According to certain research, placing composite resins in 4mm or 5mm thick increments might produce cuspal deformation and tension at the tooth-adhesive junction, which can manifest clinically as increased post-operative discomfort [7]. The viscosity of bulk ll composite resins is divided into two categories: high viscosity and low viscosity ( owable) compounds. Higher amounts of ller particles are present in highviscosity bulk ll composites as compared to low-viscosity bulk ll composites. Thus, owable composite resins conform more readily to cavity walls, but they exhibit more polymerization shrinkage and worse mechanical proper ties [10]. The ndings of several in vitro investigations revealed that bulk ll composites do not increase marginal adaptation in class II cases; rather, the presence or lack of enamel at the restorative edge is a more relevant predictor of marginal adaptation [3]. Bulk-Fill resin has increased in popularity over the years because to its excellent characteristics, success in clinical performance, and exibility of handling, and has therefore become the material of choice for dentists. Furthermore, its longevity indicates mechanical properties and resilience to tooth structure [11]. In one clinical research, the owable bulk-ll composite technique was compared to the incremental composite technique in posterior restorations. They found no statistically signi cant difference between groups in the frequency of postoperative sensitivity following restoration procedure [12]. The purpose of this study is to compare the clinical effect of post-operative sensitivity between Bulk lled composite and incremental Nano resin composite. By comparing the Nano composite and Bulk lled composite we will be able to recommend the choice of restoration in class 2 posterior teeth with minimal post-operative sensitivity. Patients. Patients that not exhibit any signs of deliberate/continuous dental pain with primary carious lesions and having shallow (2 to 3 mm) and mid-sized (3 to 5 mm) cavity depths were enrolled in the research. Patients who had class II molars and premolars in their maxilla and mandibles and needed resin composite restorations as well as those who occluded natural or crown-covered oppositional teeth were also considered. Patients having un-erupted tooth or partially erupted tooth, fractured or visibly cracked teeth patients with poor hygiene and having heavy bruxism habits, periodontal problems and pathologic pulpal diagnosis with pain (Non vital) were excluded from study. Before beginning treatment, all patients provide written informed consent. A brief explanation of the examinations was provided to participants. To evaluate the pulp condition, sensitivity tests with ethyl chloride were performed. For each selected tooth, periapical radiographs were taken to assess the cavity's proximity to the pulp. Local anaesthesia was applied (Inferior alveolar nerve block/in ltrate). Cotton rolls and a saliva aspirator were used to insulate the working eld during the procedure. Cavity preparations were done using round-ended carbide bur was used to help create a rounded cavo surface. Using a (CPITN) periodontal probe against the mesial and distal marginal ridges, the depth of each cavity preparation was determined to be 3 mm and 5 mm, correspondingly. On the enamel edge and then the dentin walls of each cavity, 37 percent phosphoric acid was applied for 15 seconds, washed off, and then gently dried. Dentsply, Detrey, Germany's Prime and Bond was used, and it was exposed to light for 20 seconds to cure. Before to the restorative operations, sectional matrices (Palodent plus, Dentsply) were used. The lottery approach was used to split the patients into two groups. Nano resin composites were put in group A using an incremental approach, while bulk lled resin composites were inserted in group B using a bulk lled technique. Using a VAS of 0 to 10, the post-operative pain level was assessed at 24 hours and seven days after surgery. (0: no pain; 1-3: minor discomfort; 4-7: medium discomfort; 8-10: severe discomfort). Every patient received instructions to complete a VAS scale at home. The Statistical Package for Social Science (SPSS) software, version 23.0, was used to analyse the data. For qualitative factors including gender, post-operative discomfort, tooth type, and e cacy, frequencies and percentages were determined. Chi square test was used to compare the e cacy of the two groups, In the period from January 2022 to December 2022, a comparative cross-sectional study using a non-probability convenience sampling method was carried out at the outpatient department ( Post-operative pain after 24 hours was distributed into; mild pain in 97 (88.2%) and 105 (95.5%) patients and moderate pain in 13 (11.8%) and 5 (4.5%) patients in group A) and group B) respectively (Table 4). Post-operative sensitivity has increased with the introduction of posterior composite resin restorations and is now a common clinical issue [13]. Managing postoperative sensitivity may be challenging. Individuals frequently complained of sensitivity at various degrees and intensities, frequently without any obvious signs of the restoration's inadequacy [14,15]. Technologies for composite resins and adhesives has advanced quickly. Considering these advancements, composite restorations' post-operative sensitivity remains a problem for clinicians [16]. Different studies from the world reports the different results regarding sensitivity associated with Resin Composite in Posterior Class 2 Restoration. When Opdam NJ [17] looked at premolar restorations that were planned for extraction utilizing two bonding agents and two composite implantation procedures, post-operative sensitivity was added as a secondary endpoint of concern. 14% of restorations showed sensitivity during the rst recall, which lasted between 5 and 7 weeks, whereas 56% of restorations showed occlusal loading ( Post-operative pain after 7 days was distributed into; no pain in 105 (95.5%) and 110 (100.0%) patients and mild pain in 5 (4.5%) and 0 (0.0%)patients in group A) and group B) respectively (Table 5).

R E S U L T S
with p=0.05 being seen as a signi cant value. With strati cation, cofounders like gender and tooth type will be managed.

C O N C L U S I O N S
restorations while employing the same dentin bonding agent [21]. Most recently, post-operative sensitivity caused 3% (1 each) of 35 Class I restorations of micro hybrid, packable, or nano lled composite restorations to be changed within six months (evaluated at baseline, 2 weeks, and 6 months post-operatively) [22]. Logistic regression revealed that the three variables used in the study-cavity depth, calcium hydroxide liner, and restorative material-had no statistically substantial impact on the emergence of pain or sensitivity in another study that included arbitrary utilization of a CaOH liner in 123 patients with 1 restoration each [23]. According to a research by A et al, utilizing total-etch adhesive approach and self-etch adhesive approach, there was no statistically substantial difference between the two kinds of resin composites (bulk ll resin composite and incremental nano resin composite) after one day, one week, or one month [24]. Additionally, there was no statistically signi cant difference between the two adhesive systems after one day, one week, and one month when the two adhesive methods were tested utilizing incremental Nano resin composite and Bulk Fill resin composite. The reduced post-operative sensitivity was ascribed by Asghar et al to the bulk-ll composites' lesser post-gel shrinkage [25]. Nonetheless, it was noted that post-operative sensitivity is patient related, with variations in individuals' pain thresholds and levels of unpleasantness.
It was concluded from the study that bulk lled resin composite using bulk lled technique is more effective in class 2 posterior restorations in management of postoperative sensitivity as compared to nano resin composite using incremental technique measured post-operatively, at 24 hours and on 7th day post-operatively using Visual Analog Scale.

C o n  i c t s o f I n t e r e s t
The authors declare no con ict of interest.

S o u r c e o f F u n d i n g
The authors received no nancial support for the research, authorship and/or publication of this article. [3]