J Ayub Med Coll Abbottabad 2018;30(2) http://www.jamc.ayubmed.edu.pk 163 ORIGINAL ARTICLE COMPARISON OF FREQUENCY OF POST OPERATIVE SENSITIVITY IN AMALGAM RESTORATIONS USING COPAL VARNISH AND DENTIN ADHESIVE LINER Kiran Saba, Anser Maxood, Saeeda Abdullah, Amna Riaz, Shahab-ud-Din Department of Operative Dentistry, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad-Pakistan Background: Micro leakage around the margins of a restoration is believed to be one of the main causes of postoperative sensitivity. Dental amalgam is a non-insulating material and has the potential to transfer heat and cold causing irritation of the pulp. Different dentin tubule sealers are used under amalgam restoration to compensate for this post-operative sensitivity. This study was conducted to compare the frequency of sensitivity in amalgam restorations using copal varnish and dentin adhesive liner (dentin bonding agent). Methods: A total of 60 patients of either gender, aged 18–40 years having class 1 carries in posterior teeth were included. Teeth with restorations, dentinal sensitivity and patients taking analgesic drugs for chronic pain conditions were excluded. The selected patients were placed randomly into Group A (copal varnish) & Group B (dentin adhesive liner), by using computer generated table of random numbers. Restored teeth were evaluated 1-month post operatively for sensitivity. Results: Mean age was 25.63±5.42 years. Out of 60 patients, 68.0% were females and 32.0% were males with a female to male ratio of 2:1. The mean post-operative pain score was 2.83±2.79 in Group A and in Group B, it was 1.43±2.14 with a p-value of 0.03. There was no pain on application of a cold stimulus in 14 (46.7%) patients in Group A (copal varnish) while in Group B (Dentin adhesive), no pain was seen in 23 (76.7%) patients with p-value of 0.02. Conclusion: This study concluded that dentin adhesive liner (dentin bonding agent) is better than copal varnish in reducing postoperative sensitivity in amalgam restorations. Keywords: Dental caries; Amalgam; Microleakage; Dentin adhesive liner; Copal varnish; Postoperative sensitivity Citation: Saba K. Comparison of frequency of post-operative sensitivity in amalgam restorations using copal varnish and dentin adhesive liner. J Ayub Med Coll Abbottabad 2018;30(2):163–6. INTRODUCTION Dentin sensitivity is seen as a result of dentinal tubules exposed to external stimuli. It is characterized by pain of short duration but sharp in nature when a stimulus is applied. 1 Microleakage at the tooth-restoration interface is believed to be one of the main causes of postoperative sensitivity following placement of restorations. 2 The most accepted explanation for tooth sensitivity is the hydrodynamic theory. According to this theory, fluid movement in the dentinal tubules is interpreted as pain by pulpal mechanoceptors. 3 Amalgam is a non- insulating material and has the potential to transfer heat and cold causing irritation of the pulp. 2 Postoperative sensitivity following the routine placement of an amalgam restoration is not unknown. 3 A variety of sealers are used to protect pulp, seal the dentinal tubules and compensate for postoperative sensitivity. Cavity varnishes have been routinely used under amalgam restorations. 3 They were thought act as a barrier against bacteria and toxins and a two-coat application was theorized to reduce the dentin permeability by 69%. 4 But these cavity varnishes have been criticized for providing an uneven film, poor insulation, lack of biologic properties, lack of adhesion between tooth and amalgam and high solubility over time. 5 More recently, dentine bonding agents (DBA) have gained popularity and are introduced as a new way of sealing dentinal tubules. 3 DBA are thought to have a superior sealing ability as compared to varnishes. 6 Amalgam restorations are commonly done in general dental practice and sensitivity is a common sequel of these restorations especially in the immediate post restoration period. It is quite distressing to the patients and has an adverse impact on patient’s satisfaction. Although varnishes have been used as dentin sealers in the past, they are thought to degrade over time and hence do not provide any sealing effect for greater than one month. This effect is beneficial with low copper alloys in which corrosion products formed after one month seals the microleakage gap reducing the post sensitivity. The high copper alloys used nowadays take twice as long for the corrosion products to seal the microleakage gap compared to the low copper alloys. Hence the search for a better sealing agent under amalgam continues. Dentin bonding agent has the benefits of bonding to enamel and dentin as well as amalgam, if proven to be effective in the treatment of postoperative sensitivity, it will be a more suitable material for sealing the tubules under amalgam restorations than copal varnish. This study was