Reducing the risk of sensitivity and pulpal complications after the placement of crowns and fixed partial dentures

Sensitivity after cementation of a crown with glass-ionomer cement is often attributed to an adverse effect on the pulp by the luting agent. Most permanent restorative materials in common use today do not tend to irritate the pulp; the main cause of pulpal damage is infection, the bacteria originating in the smear layer or deep in the dentinal tubules, inaccessible to caries-excavating procedures. A poorly fitting provisional crown may expose cut dentin to the oral fluids, and mechanical trauma caused by frictional heat during preparation may also damage the pulp. The following precautions are recommended during precementation procedures to reduce the risk of an inflammatory response in the pulp: (1) The provisional crown should be well fitting, covering cervical dentin but not impinging on the periodontal tissues. The permanent crown should be cemented as soon as possible. (2) The superficial smear layer should be removed and the dentinal surface should be treated with an antibacterial solution before the provisional crown is placed. (3) To decrease dentinal permeability under the provisional crown, the dentinal surface should be covered with a liner that can be easily removed before final cementation. (4) To ensure optimal micromechanical bonding, the dentinal surface should be thoroughly cleaned, and the dentin should be kept moist until cementation. (5) The occlusion should be carefully checked before cementation of the crown.