Effect of Snow-plow Technique on the Postoperative Pain Following Direct Composite Restoration

NCT07212413 | Active Not Recruiting

• 1 other identifier: 2/5/1/200
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

This study is designed to compare two modern techniques used to restore decayed back teeth with tooth-colored filling materials. Some patients experience temporary discomfort or sensitivity after these types of dental treatments. The purpose of this study is to learn whether one technique may help reduce this short-term sensitivity compared to the other. Adults who need fillings on both sides of their mouth are invited to participate. Each patient will receive one filling using each technique, placed in different teeth during the same appointment. The procedures will be performed using standard clinical methods and materials. After treatment, participants will be contacted by telephone to report any discomfort at several time points during the first week. The interviewer will not know which technique was used for each tooth to ensure unbiased reporting. This information will help dentists better understand how these techniques affect patients' comfort in the days following treatment.

Conditions

Postoperative Tooth Sensitivity Following Class II Composite Restorations

Keywords

Postoperative sensitivity; Class II composite restoration; Snow-plow technique; Resin coating technique; Pain assessment

Outcome Measures

Primary Outcomes (1)

• Postoperative pain intensity after Class II composite restorations

  Postoperative pain intensity will be assessed using a 0-10 Visual Analog Scale (VAS) at baseline (before treatment), 24 hours, 72 hours, and 1 week following restorative procedures. Each treated tooth will be evaluated individually using structured telephone interviews conducted by a blinded examiner. VAS scores will be recorded and analyzed to compare pain trajectories between the snow-plow and resin coating restorative techniques.

  Baseline, 24 hours, 72 hours, and 1 week after restorative treatment

Study Arms (2)

Snow-plow technique

EXPERIMENTAL

Class II posterior cavities were restored using the snow-plow technique. After adhesive application, a thin layer of uncured flowable bulk-fill resin was placed on the gingival floor. A packable bulk-fill composite was then immediately inserted, displacing the flowable resin, and both were light-cured simultaneously. The occlusal anatomy was completed with packable composite, followed by finishing and polishing. Rubber-dam isolation and selective enamel etching with a universal adhesive were applied in all cases.

Procedure: Snow-plow restorative technique

Resin coating technique

EXPERIMENTAL

Class II posterior cavities were restored using the resin coating technique following immediate dentin sealing. After adhesive application, a thin layer of flowable bulk-fill resin was applied and light-cured to create a stress-absorbing layer on the dentin surface. Packable bulk-fill composite was then used to restore the remaining cavity, followed by occlusal sculpting, finishing, and polishing. All procedures were performed under rubber-dam isolation with selective enamel etching and universal self-etch adhesive on dentin.

Procedure: Resin coating restorative technique

Interventions

Snow-plow restorative technique PROCEDURE

The snow-plow technique involves placing a thin layer of uncured flowable bulk-fill resin on the gingival floor of a Class II cavity, immediately followed by placement of a packable bulk-fill composite. Both materials are light-cured simultaneously, allowing the flowable resin to fill voids and improve marginal adaptation.

Also known as: Snowplow technique

Snow-plow technique

Resin coating restorative technique PROCEDURE

The resin coating technique involves applying and light-curing a thin layer of flowable bulk-fill resin after adhesive application to create a stress-absorbing layer on dentin (resin coating), followed by restoration with packable bulk-fill composite. This approach aims to protect the dentin, enhance bond stability, and reduce postoperative sensitivity

Also known as: Resin coating, Immediate dentin sealing with flowable liner

Resin coating technique

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Adult patients aged 18-50 years.
• Systemically healthy individuals.
• Presence of two posterior teeth in different quadrants or contralateral sides of the same arch requiring Class II composite restorations.
• Teeth diagnosed with reversible pulpitis and vital pulps, confirmed clinically and radiographically.
• Teeth without previous restorations or carious lesions limited to dentin.
• Ability to provide informed consent and comply with study procedures and follow-up assessments.

You may not qualify if:

• Non-vital teeth, teeth with signs of irreversible pulpitis, periapical pathology, or extensive loss of tooth structure.
• Patients with systemic conditions or medications that may influence pain perception, healing, or sensitivity (e.g., chronic pain syndromes, analgesic use, immunosuppressive therapy), or very poor oral hygiene.
• Pregnant or breastfeeding women.
• Known allergy to dental materials used in the study.
• Inability to respond to follow-up calls or provide reliable pain assessments.
• Teeth with previous restorations, endodontic treatment, or cracks.

Sponsors & Collaborators

• University of Jordan: lead

Study Sites (1)

Univeristy of Jordan Hospital, Dental Department

Amman, Jordan

Location

Related Publications (6)

• Afifi SMH, Haridy MF, Farid MR. Evaluation of Post-Operative Sensitivity of Bulk Fill Resin Composite versus Nano Resin Composite: A Randomized Controlled Clinical Study. Open Access Maced J Med Sci. 2019 Jul 26;7(14):2335-2342. doi: 10.3889/oamjms.2019.656. eCollection 2019 Jul 30.

  PMID: 31592052 BACKGROUND

• Lehmann A, Nijakowski K, Jankowski J, Donnermeyer D, Ramos JC, Drobac M, Martins JFB, Hatipoglu O, Omarova B, Javed MQ, Alharkan HM, Bekjanova O, Wyzga S, Alkhawas MAM, Kudenga R, Surdacka A. Clinical Difficulties Related to Direct Composite Restorations: A Multinational Survey. Int Dent J. 2025 Apr;75(2):797-806. doi: 10.1016/j.identj.2024.06.012. Epub 2024 Jul 23.

  PMID: 39048490 BACKGROUND

• Tee R, Vach K, Schlueter N, Jacker-Guhr S, Luehrs AK. High C-Factor Cavities: How Do "Snowplow Technique", Adhesive Application Mode and Aging Influence the Microtensile Bond Strength to Dentin? J Adhes Dent. 2024 Jan 15;26:1-10. doi: 10.3290/j.jad.b4835909.

  PMID: 38224111 BACKGROUND

• Putignano A, Tosco V, Monterubbianesi R, Vitiello F, Gatto ML, Furlani M, Giuliani A, Orsini G. Comparison of three different bulk-filling techniques for restoring class II cavities: muCT, SEM-EDS combined analyses for margins and internal fit assessments. J Mech Behav Biomed Mater. 2021 Dec;124:104812. doi: 10.1016/j.jmbbm.2021.104812. Epub 2021 Sep 3.

  PMID: 34500356 BACKGROUND

• Tardem C, Albuquerque EG, Lopes LS, Marins SS, Calazans FS, Poubel LA, Barcelos R, Barceleiro MO. Clinical time and postoperative sensitivity after use of bulk-fill (syringe and capsule) vs. incremental filling composites: a randomized clinical trial. Braz Oral Res. 2019 Sep 16;33(0):e089. doi: 10.1590/1807-3107bor-2019.vol33.0089.

  PMID: 31531552 BACKGROUND

• Miletic V, Komlenic V, Bajuk-Bogdanovic D, Stasic J, Petrovic V, Savic-Stankovic T. Preheating and "snow-plow" composite application technique affect double bond conversion but not bond strength to dentine. J Esthet Restor Dent. 2024 Jun;36(6):951-961. doi: 10.1111/jerd.13218. Epub 2024 Mar 18.

  PMID: 38497672 BACKGROUND

Study Officials

• Alaa Al-Haddad, PhD

  University of Jordan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The outcomes assessor was blinded to the restorative technique used on each tooth. Telephone interviews were conducted using standardized scripts, and the interviewer was unaware of the allocation, referring to teeth by quadrant/side to minimize bias. The operator is not blinded due to the nature of the restorative procedures.
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assisstant profossor in restorative dentistry

Model Details: A randomized split-mouth clinical trial with two intervention arms (snow-plow and resin coating techniques) allocated to contralateral Class II cavities in the same patient. This crossover model minimizes inter-individual variability by enabling within-subject comparison under identical clinical conditions.

Study Record Dates

• First Submitted: September 30, 2025
• First Posted: October 8, 2025
• Study Start: January 12, 2025
• Primary Completion: September 24, 2025
• Study Completion: October 6, 2025
• Last Updated: October 8, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF

Locations

JO (1)