Direct Composite Resin Restorations Research Articles

Clinical evaluation of direct resin composite restorations of endodontically treated molars using dual cured self-adhesive system with bulk fill composite versus incremental packing technique

Restoration after endodontic treatment is as important as root canal therapy for clinical success. Evolution of adhesive dentistry strongly aided in the conservation of tooth structure and reinforcement of the restored teeth. Self-etch adhesives has evolved aiming to reduce the technique sensitivity and simplifying the steps needed for bonding (one or two steps). Dual cured self-etch adhesives were also introduced to be more chemically compatible with the resin composite restorations. Bulk-fill resin composites has also achieved great popularity due to the ease of application and being more time saving. These materials made the direct restoration of endodontically treated teeth more conservative, time saving and reliable. This research was performed to assess the clinical success of the restorations of the endodontically treated molars with remaining three walls restored using self-etch adhesives and bulk fill resin composite in comparison to conventional nanohybrid resin composite at a time intervals of 1week (baseline) , 3 ,6 and 12 months. In a randomized clinical trial, 40 patients with endodontically treated molars with remaining three walls received a restorative intervention with either (Xtra-Fil) bulk fill resin composite or (Grandio) nano hybrid resin composite applied in incremental technique.

Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias andcertainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Youtube as an Information Source for Practitioners on Direct Diastema Closure Procedures

Background: The aim of the study was to analyze the content and quality of clinical diastema closure videos related to the direct resin composite restoration technique available on YouTubeTM. Materials and Methods: The videos were determined using the words “diastema closure,” “teeth gap fill,” and “teeth gap close” in the YouTube™ search section. 300 videos were reviewed, and 55 of them were included in the study. Demographics of videos, interaction index, and viewing rates were evaluated. The videos were analyzed in three parameters in terms of content score (CS), technical features (TF), and global quality scale (GQS). Results: The dentist accounts took the first place (51%) in the distribution of those who uploaded the videos. The mean values of the videos from the evaluation criteria were 8.3/15p for CS, 3.1/5p for TF, and 2.7/5p for GQS. There was a statistically significant positive correlation between the viewing rates, TF, and GQS values (P < 0.05). Conclusion: Operational videos of diastema closure with direct composite resin restoration treatments should be uploaded to YouTube™ after approval by experts. In addition, the TF of operational videos needs to be better. Students should be warned about videos which contain insufficient information.

3-Year Survival of direct composite resin restorations of permanent first molars with excessive material loss in children

Aim: The aim of this retrospective study was to determine survival rates of direct composite resin (DCR) restorations of permanent first molars (PFMs) with excessive material loss at the end of 3 years. Material and methods: Children between the ages of 7-14 whose PFMs had 3-surfaced DCR restoration were included in the study. In restorations Ionofil Molar glass ionomer cement (VOCO,Cuxhaven,Germany) as base material, Clearfil SE Bond adhesive agent and Clearfil Majesty Posterior composite resin (Kuraray Noritake Dental Inc.,Okayama,Japan.) were used. Survival rates of the restorations after 3 years were evaluated using The United States Public Health Service criteria and the presence of symptoms indicating irreversible pulp damage and the need for root canal treatment such as provoked or spontaneous pain, percussion, abscess, fistula in the related teeth were examined clinically and radiographically. Chi-square and Kruskal Wallis analyzes were used for the statistical analysis. Results: Totally 58 DCR restorations of PFMs of 34 patients who agreed to come for the control visit at the end of 3 years were examined. The survival rate of restorations was 70.69% and findings indicating irreversible pulp damage were found in 15.5% of the restorations examined. Conclusion: Survival rate of DCR restorations applied to PFMs with excessive material loss is not satisfactory after 3 years, however it is thought that DCR applications will continue in PFMs with excessive material loss thanks to the developments in adhesive systems and composite resins. Therefore, long-term randomized controlled clinical studies on this subject should be continued.

Longevity of Direct Resin Composite Restorations in Maxillary Anterior Crown Fractures: A 4-year Clinical Evaluation.

To investigate the longevity of direct composites for Class IV restorations and the possible reasons of failure. The longevity of 168 Class IV restorations in 50 adult patients was evaluated, in terms of modified United States Public Health Service criteria, for 4 years. Restorations were performed using a monochromatic layered microhybrid, resin-based composite (RBC) (Essentia, Universal Shade, GC Corporation, Japan; n=76) and polychromatic layered micro/nanohybrid (MD and LE shades, Essentia, GC Corporation, Japan; n=92) RBCs, by a single operator. The majority of the teeth (n=156) remained acceptable at the end of 4 years, and the overall survival (OS) rate was considered as 92.86%. Survival rates for the monochromatic layering technique (MLT) and polychromatic layering technique (PLT) were 90.8% and 94.6%, respectively. Mean survival was 46 months for MLT and 47 months for PLT, indicating no significant difference (p=0.343). Fracture of the restoration was the most common reason for failure (4.2% out of 7.1% of general failures) for both the layering techniques. Under the conditions of this mid-term clinical study, MLT and PLT as well as microhybrid and nanohybrid resin composite materials, showed similar clinical durability. In terms of simplicity, monochromatic layering can be preferred for Class IV restorations, when the right indication criteria are met.

Operators' Ease and Satisfaction in Restoring Class II Cavities With Sectional Matrix Versus Circumferential Matrix System at Qassim University Dental Clinics.

Objectives: This study aimed to investigate the operator’s ease, satisfaction, and comfort of using a circumferential matrix system and sectional matrix system on the proximal contact points and contours when restoring class II cavities in posterior teeth.Materials and methods: This cross-sectional study was performed at the clinics in the Department of Conservative Dental Sciences, College of Dentistry, Qassim University. A total of 105 dental students randomly participated in this study to restore a class II cavity with direct composite resin restoration. Operators' comfort and satisfaction were evaluated according to their assessment of the contact points they reproduced and the emergence profiles of restorations, using a circumferential matrix system and sectional matrix system.Results: Out of 105 operators, 57 were satisfied with using circumferential matrix bands for most of their cases while 78 of the operators were satisfied with sectional matrix bands. There were no significant differences between operator satisfaction and the use of circumferential matrix band system (P > 0.05) and sectional matrix band system (P = 0.134) but there was a significant difference between difficulty levels in the use of both matrix band systems (P < 0.05; P = 0.000).Conclusion: Circumferential and sectional matrix band systems showed no significant differences with operators' satisfaction during restoring class II cavities in posterior teeth but using a sectional matrix band system was considered easier than using a circumferential matrix band system.

Comparative Evaluation of Microshear Bond Strength of Adhesive Resin Incorporated with Inorganic Nanofillers Cerium Dioxide: An In-vitro Study

Introduction: Dental adhesives are used for a wide range of clinical applications in dentistry. Bonding is required in direct composite resin restorations. In clinical situation, resin to dentin bonds are less resistant than resin to enamel bonds. Because of varying structure and composition of dentin the failure of resin-dentin bonding resulting in staining, caries recurrence microleakage. These set of circumstances can hasten the failure and degradation of resin to dentin bonding hence inorganic fillers can be added to improve the bond strength. Cerium dioxide (CeO2 ) is a rare earth oxide has been increasingly used as a nanotherapeutic material and can be successfully used in adhesive resin to improve the physical properties of adhesive resin. Aim: To evaluate and compare microshear bond strength of adhesive resin after incorporation of inorganic nanofillers cerium dioxide. Materials and Methods: This in-vitro study was conducted in Department of Preventive and Paediatric Dentistry at School of Dental Sciences, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from February 2022 to April 2022. The unfilled dental adhesive was used as a control (group A) and dental adhesives formulated with nanosized Cerium dioxide (CeO2 ) as the inorganic filler (group B). Total 24 samples were prepared 12 samples each group and adhesives were evaluated for microshear bond strength. Intragroup comparison between experimental and control group was done using Unpaired t-test. Results: The mean microshear bond strength of the adhesive system containing nanosized cerium dioxide at a concentration of 2% was 6.89±2.22 MPa (group B), which was significantly greater than that of the adhesive system without additives (group A) 4.37±1.22 MPa. Conclusion: Microshear bond strength of the dental adhesives with nanosized CeO2 particles, was significantly higher than the unfilled adhesive.

Direct and Indirect Stamp Technique for Composite Restorations

For direct composite resin restorations, the "stamp technique" aids in achieving accurate occlusal topography. Stamp is an index that mimics the structure of a natural tooth. The cavity is produced after stamp manufacture on an unprepared occlusal surface, and the resulting stamp is then applied to the last composite increment prior to final curing to create a precise duplicate of the pre-operative structure. For patients desiring pre-treatment occlusal anatomy even for posterior teeth, the aesthetic restoration has become standard practice in modern dentistry and offers an appropriate reference for replicating both aesthetic and proper function. In Class I and Class II preparations, where the occlusal surface is undisturbed prior to treatment, the stamp approach is recommended. Light-cure composites, self-cure acrylate resin, polyvinylsiloxane bite registration material, liquid dam material, clear silicon mould, and occlusal transfer devices are some of the materials utilized to make the occlusal mimics. The stamp technique is a quick process that requires less chairside time for polishing and finishing as well as for rebuilding the occlusal morphology. Because the matrix duplicates the occlusal architecture, contouring the restoration does not involve manual labor, specialized tools, or excessive amounts of material. Severely carious teeth cannot be rebuilt with this method, and examination prior to restoration is necessary to guarantee appropriate occlusion.

The Effect of Radiotherapy on the Marginal Adaptation of Class II Direct Resin Composite Restorations: A Micro-computed Tomography Analysis.

This laboratory study was designed to evaluate the marginal adaptation of Class II mesio-occlusodistal (MOD) restorations at the cervical region with micro-computed tomography (micro-CT). Two groups of restorations were compared: 1) those that had been exposed to radiotherapy before restoration was performed using a universal adhesive in etch-and-rinse and self-etch modes; and 2) those that had previously been restored using a universal adhesive in etch-and-rinse and self-etch modes and had subsequently undergone radiotherapy. Sixty intact human molars were randomly divided into groups according to irradiation status: no radiotherapy (control group); radiotherapy followed by restoration (radiotherapy-first group); and restoration followed by radiotherapy (restoration-first group). These three groups were then subdivided into two groups each on the basis of adhesive application type (etch-and-rinse and self-etch modes), for a total of six groups (n=10/group). Standardized Class II MOD cavities were prepared. A universal adhesive (Clearfil Universal Bond Quick, Kuraray, Okayama, Japan) was applied. The teeth were restored with resin composite (Estelite Posterior Quick, Tokuyama, Tokyo, Japan). The radiotherapy protocol was conducted with 60 gray (Gy) at 2 Gy/day, five days a week for six weeks. Adhesive defects were analyzed in distal and mesial views and evaluated with micro-CT (SkyScan 1174v2, Kontich, Antwerp, Belgium) on the basis of the volume of black spaces between the cavity walls and the restorative materials (mm3). The data were analyzed using the Kruskal-Wallis, Mann Whitney U and Wilcoxon tests (p<0.05). The radiotherapy protocol did not affect the marginal adaptation of the universal adhesive at the cervical regions. Regarding the application modes, for the radiotherapy-first group, the self-etch mode caused significantly higher adhesive defects than the etch-and-rinse mode at the dentin margin. For the no-radiotherapy group, the adhesive defects at the dentin margin were significantly higher than at the enamel margin with the application of the etch-and-rinse mode.

Replacement of Two Failed Indirect Restorations with Direct Bonded Restorations Using Minimally Invasive Strategy

Deciding on what treatment (repair or replacement) to provide for a failed indirect restoration can be challenging. Notably, the strength of the residual tooth structure could be improved after replacing the failed indirect restoration using a minimally invasive strategy. Objective: To describe the use of a minimally invasive strategy for the successful clinical replacement of two failed indirect metal restorations with direct composite restorations and the attainment of bonded restoration. Case Report: Case 1. A 52-year-old male patient came to the dental hospital complaining of discomfort when drinking cold beverages and food impaction on the proximal area of the upper left first molar. Case 2. A 45-year-old female patient complained about her debonded metal onlay and secondary caries in the upper right second molar. Both of these indirect restoration failures were treated with direct resin composite restoration. Both patients were highly satisfied with the results. Conclusion: This report presents the benefits of adopting a minimally invasive strategy approach for replacing failed indirect restorations (inlays and onlays) with direct-bonded composite restorations. Minimally invasive direct restorations are designed to maximize the preservation of tooth structure, thereby ensuring a long-term bonded restoration and leaving future options open when a failure occurs.

Bonding States of In Vitro Class 2 Direct Resin Composite Restoration Applied by Various Incremental Techniques.

Incremental techniques are always required for clinical cases of deep and/or large cavities restored with resin composite materials. The purpose of this study was to examine the bonding states of class 2 direct resin composite restoration applied by various incremental techniques after cyclic loading to simulate the intra-oral environment to define the appropriate technique. Three types of resin composites, namely, bulk-fill (B), flowable (F), and conventional resin composite (C), were applied to standardized class 2 cavities by incremental techniques with single- or bi-resin restoratives. After cyclic loading, the micro-tensile bond strength (μ-TBS) of the dentin cavity floor was measured. The Weibull modulus and Weibull stress values at 10%/90% probability of failure were analyzed. Single-resin incremental restorations with B or F and bi-resin incremental restorations with F + B and F + C demonstrated superior μ-TBS (quantitative ability), bonding reliability, and durability (qualitative ability) compared with the single-resin restoration with C (as control). Furthermore, F + B and F + C restoration yielded an excellent performance compared with the single-resin restorations with B, F, and C. In particular, the F + C restoration, which indicates not only the maximum mean µ-TBS, but also the highest values of the Weibull parameters, may be the optimal restoration method, including the esthetic benefits.

Fracture resistance of endodontically treated teeth with cervical defects using different restorative treatments

Background/purposeThe restoration of endodontically treated teeth (ETT) with cervical defects has been a challenge for dentists. The purpose of this study was to evaluate the effect of restorative treatment on the fracture resistance of ETT with cervical defects. Materials and methodsOne hundred and twenty freshly extracted human intact straight-single-root maxillary premolars were randomly divided into 6 groups. Group 1 remained untreated. Cervical defects of 4 mm-depth and 3 mm-height were created in groups 2–6. Group 3–6: root canal treatment. Group 4: direct composite resin restoration. Group 5: 2-mm full-cusp-coverage composite resin restoration. Group 6: fiber-post-supported composite resin restoration. A static fracture test was used to determine the fracture resistance of teeth under axial (n = 10) and palatal (30°) (n = 10) loading. Fracture modes were categorized as restorable and unrestorable. ResultsCompared with intact teeth, the axial fracture resistance of teeth with cervical defects decreased by approximately 39%, and endodontic procedures resulted in 10% more reduction. When ETT with cervical defects were restored using direct composite resin filling, the axial fracture resistance recovered to 72% of that of intact teeth, but no significant change occurred under oblique loading. After full-cusp-coverage or fiber-post-supported restoration, fracture resistance showed complete recovery to the value of intact teeth (P > 0.05). Sixty percent of fractures were unrestorable for fiber-post-supported teeth, while in the full-cusp-coverage restoration group, 80–90% of fractures were restorable. ConclusionFull-cusp-coverage restoration or fiber-post-supported restoration could improve the fracture resistance of ETT with cervical defects, whereas unrestorable fractures easily occurred in fiber-post-supported restorations.

Proximal contact tightness for Class II direct composite resin restorations: a literature review

This article reviews the literature regarding factors that affect proximal contact tightness (PCT) when restoring Class II cavities with direct composite resin. The PCT between two adjacent teeth is an important factor in maintaining oral health by ensuring that tooth positions remain stable, food is deflected away during mastication, dental papillae are maintained and to facilitate hygienic cleaning. If open contacts are created, there is a greater chance that the patient will experience periodontal problems or caries. Using sectional matrix systems with separation rings, and using materials with less polymerization shrinkage are effective methods to increase PCT and create significantly tighter contacts compared with using circumferential matrix systems. CPD/Clinical Relevance: Understating the clinical factors that affect proximal contact tightness between adjacent teeth is important to achieve optimal contacts in direct composite resin restorations to maintain oral health.

Utilizing Dahl Concept and Composite Build-Up for Anterior Tooth Surface Loss

This case report describes the technique of composite build-up for tooth surface loss using direct composite resin restoration. This technique has the advantages of being conservative while improving aesthetics and restoring function for the patient.

COMPOSITE RESIN RESTORATION WITH FIBER REINFORCED COMPOSITE AFTER ROOT CANAL TREATMENT OF NECROTIC PULP TOOTH WITH GUMBOIL

Gumboil is inflammation reaction in the gum caused by pulp infection. Gumboil is seen as an oral lesion characterized by a soft erythematous papule where a periapical abcess is draining into the oral cavity. An adequate root canal treatment can cure gumboil and remove bacteria from the root canal. To support the success of root canal treatment, final restoration used in this case is composite resin restoration with reinforcing fiber (short fiber reinforced composite). The purpose of this treatment was to restore the functions of tooth in mastication and preserving the supporting tissue. A female patient age 23 years old came with complaints of pain in the lower right mandibular molar accompanied by swelling of the gums around the teeth since a week ago. Swelling is intermittent since last 3 months. The tooth have been restored for about 3 years ago. Clinical examination showed a positive percussion, positive palpation, negative vitality, and negative mobility. Radiographic examination showed bifurcation and periapical lesions. Root canal treatment is performed with crown down preparation technique and followed by direct composite resin restoration with short fiber reiforced composite. The success of root canal treatment followed by composite resin restoration with short fiber reinforced fiber is marked by the absence of complaints as well as the dissappearance of gumboil.

Parafunctional habits and their relationship with fractures of composite resin restorations

Parafunctional habits are characterized by the repetition of acts that are not related to the normal functions of the stomatognathic system. This research aims to verify the parafunctional habits practiced, perceived and reported by patients and to verify the relationship with the fractures of direct composite resin restorations. Information from 205 patients, seen at the University Dental Clinic of the State University of Londrina, was collected. After data collection, a survey and synthesis of reported parafunctional habits was performed and correlated with the fracture of composite resin restorations. The information and data were tabulated and analyzed using descriptive statistics, COUNTIF function, and the results were expressed in tables. The most frequent parafunctional habits were bruxism, followed by onychophagia, occurring in greater quantity in females. A greater number of fractured restorations were found in patients with parafunctional habits. Among the parafunctional habits verified, it was concluded that bruxism was the most frequent, related mainly to the fracture of class V restorations.

Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results.

ObjectivesTo evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation. MethodsA convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05). ResultsAnnual failure rates (for all levels of failure, ‘Level 3- ‘) of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations. ConclusionsAt 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure. Clinical significanceDirect resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

Aesthetic restoration of posterior teeth using different occlusal matrix techniques.

The occlusal matrix technique appears as an alternative to the conventional restorative technique. The aim of this study is to present treatment options for the decayed occlusal surface of posterior teeth by means of an occlusal matrix made with different materials, for an accurate reproduction of the tooth surface. This paper presents five clinical cases using five different materials, such as Bite-Perf, flowable composite, self-curing acrylic resin, silicone and thermoforming foil. Before light-curing, the last layer of composite resin, the matrix, is repositioned and firmly pressed so the replication of the original occlusal anatomy can be achieved. When using an occlusal matrix, minimal or no finishing and polishing procedures are needed and the offered aesthetics are clearly an advantage. Moreover, this technique makes up for the additional chairside work time. The occlusal matrix technique is demonstrated to be effective for direct composite resin restorations in posterior teeth, allowing a reliable and predictable reproduction of the occlusal anatomy and clinical adjustment. For this purpose, a clear material is preferable since it allows light transmission.

The effect of pre-treatment levels of tooth wear and the applied increase in the vertical dimension of occlusion (VDO) on the survival of direct resin composite restorations.

ObjectivesTo investigate the effects of the level of pre-treatment tooth wear and increasing the VDO on the performance of direct resin composite restorations for the rehabilitation of pathological tooth wear. MethodsFull-mouth (pre-treatment) grading was performed on digital greyscale scan records for 34 participants (35.3 ± 8.4 years) with signs of moderate-to-severe generalised tooth wear, using the Tooth Wear Evaluation System and the Basic Erosive Wear Examination. Each participant received full-mouth direct resin composite restorations, with increased VDO. The post-treatment increase in the VDO was determined. Recalls were planned after 1 month, and after 1, 3, and 5 years. Three ‘levels’ of restoration failure were described. The effects of the variables on the frequencies of restoration failure were calculated with a multivariable Cox regression, (p < 0.05). Results1269 restorations were placed with a mean observation period of 62.4 months. Increasing the VDO by 1 mm significantly reduced the risks of all levels of anterior restoration failure (HR ≤ 0.62, p ≤ 0.025). A higher anterior BEWE surface score was associated with increased risks of Level 2- & 3- failures, (HR ≥ 1.29, p ≤ 0.019). Premolar restorations showed lower risks of Level 2- & 3- failure, compared to the molar restorations, (HR ≤ 0.5, p ≤ 0.005). ConclusionLevels of pre-treatment wear and the applied change in the VDO significantly affected failure risk. Clinical relevanceDirect resin composite restorations for the rehabilitation of wear should be made as voluminous as possible, respecting the presenting biological, functional, and esthetic constraints.

Clinical effectiveness of direct resin composite restorations bonded using one-step or two-step self-etch adhesive systems: A three-year multicenter study

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I-V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.