UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2025.e4587
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
This is an Open Access article distributed under the terms of the Creative Commons Attribution license (https://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Evaluation of desensitizing agents for the control of sensitivity in
conventional fixed restorations
Avaliação de agentes dessensibilizantes para o controle da sensibilidade em restaurações fixas convencionais
José Giancarlo TOZO BURGOS1 , Marco Antonio SÁNCHEZ TITO1 , Nelly Antonieta Bernarda KUONG GÓMEZ1 ,
Aracy Diana ZARATE MAQUERA1 , Wilfredo Gustavo ESCALANTE OTÁROLA2
1 - Universidad Privada de Tacna, Facultad de Ciencias de la Salud. Tacna, Peru.
2 - Universidad Catolica de Santa Maria, Escuela de Odontologia. Arequipa, Peru.
How to cite: Tozo Burgos JG, Sánchez Tito MA, Kuong Gómez NAB, Zarate Maquera AD, Escalante Otárola WG. Evaluation of
desensitizing agents for the control of sensitivity in conventional xed restorations. Braz Dent Sci. 2025;28(1):e4587.
https://doi.org/10.4322/bds.2025.e4587
ABSTRACT
Objective: To evaluate and compare the effectiveness of the desensitizing agents Shield Force Plus, Fluor
Protector S and Mi Paste Plus, in reducing post-tooth preparation sensitivity in conventional xed restorations.
Material and Methods: A randomized single-blind, controlled clinical experimental study was conducted with
32 participants requiring xed metal-ceramic restorations. The participants were divided into four groups: SF
(Shield Force Plus), FP (Fluor Protector S), MP (Mi Paste Plus), and Control. The desensitizing agents were
applied three times: one day after tooth preparation, during the metal framework trial, and during the bisque trial.
Sensitivity was assessed using a visual analog scale (VAS) by applying blasts of cold air in four visits at two-day
intervals. To compare the perception of sensitivity between the quotes, the Friedman test was used followed by
the Nemenyi Post hoc Test. Decreased sensitivity between desensitizing agents was assessed with the Kruskal-
Wallis test, followed by Dunn’s post hoc test. The level was set at 5%. Results: Shield Force Plus reduced tooth
sensitivity similarly to Fluor Protector S (p > 0.05) in teeth prepared for xed prostheses. Additionally, Shield
Force Plus was statistically more effective in reducing tooth sensitivity compared to Mi Paste Plus (p < 0.05).
Signicant differences in tooth sensitivity were noted between the evaluation sessions for all desensitizing agents
(p < 0.05). Conclusion: In this study, Shield Force Plus was the most effective desensitizing agent for reducing
post-tooth preparation sensitivity, followed by Fluor Protector S.
KEYWORDS
Desensitizing agents; Fixed restoration; Tooth sensitivity; Visual analogue scale; Vital dental preparation.
RESUMO
Objetivo: Avaliar e comparar a ecácia dos agentes dessensibilizantes Shield Force Plus, Fluor Protector S e Mi Paste
Plus na redução da sensibilidade pós-preparo dental em restaurações xas convencionais. Material e Métodos:
Um ensaio clínico experimental controlado, randomizado e simples-cego foi conduzido com 32 participantes que
necessitavam de restaurações xas metalocerâmicas. Os participantes foram divididos em quatro grupos: SF (Shield
Force Plus), FP (Fluor Protector S), MP (Mi Paste Plus) e Controle. Os agentes dessensibilizantes foram aplicados
três vezes: um dia após o preparo dental, durante a prova da infraestrutura metálica e durante a prova da cerâmica.
A sensibilidade foi avaliada utilizando uma escala visual analógica (EVA) através da aplicação de jatos de ar frio
em quatro visitas com intervalos de dois dias. Para comparar a percepção da sensibilidade entre as avaliações,
o teste de Friedman foi utilizado, seguido pelo teste post hoc de Nemenyi. A diminuição da sensibilidade entre
os agentes dessensibilizantes foi avaliada com o teste de Kruskal-Wallis, seguido pelo teste post hoc de Dunn. O
nível de signicância foi denido em 5%. Resultados: Shield Force Plus reduziu a sensibilidade dental de forma
semelhante ao Fluor Protector S (p > 0,05) em dentes preparados para próteses xas. Além disso, Shield Force
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
INTRODUCTION
Effective pain management during and
after dental treatment is crucial for both the
patient and the clinician. Properly addressing
dentin sensitivity can signicantly enhance the
psychological acceptance of dental procedures,
leading to increased patient satisfaction and an
improved quality of life [1]. Modern dentistry
employs minimally invasive techniques, which
reduces the likelihood of dentin sensitivity [2,3].
However, traditional prosthetic treatments,
such as crowns and bridges, are still commonly
performed. It is noted that tooth wear from these
treatments can expose one to two million dentinal
tubules to the oral environment [4], increasing
the risk of bacterial leakage and potential
sensitivity following tooth preparation [5].
Various studies have demonstrated the
effectiveness of desensitizing agents in cases of
gingival recession [6], tooth whitening [7], and
periodontal therapy [8]. However, due to the
limited documentation reported so far, its use
in dental preparations for xed restorations still
requires further investigation. In a clinical trial
conducted by Sayed et al. [9], the effectiveness of
three desensitizing agents in dental preparations
for xed restorations was evaluated. The trial
involved three separate applications of the agents
at different times, and the results showed that
both Gluma Desensitizer and Shield Force Plus
were more effective from their rst application.
Another study by Abdollahi and Jalalian [10]
reported that uorinated varnish (Biuride 10)
effectively reduced sensitivity in teeth prepared
for fixed restorations, with the effectiveness
lasting even after the cementation process.
The scientic literature strongly supports
the use of uoride varnishes to control dentin
sensitivity. Nardi et al. [11] highlight the
prolonged effectiveness of these varnishes, noting
positive results 30 and 90 days after application.
In their study, the Fluor Protector S product
showed superior efficacy compared to other
desensitizing agents.
On the other hand, there are also
remineralizing products that contain potassium
nitrate (KNO3) or casein phosphopeptide-
amorphous calcium phosphate (CPP-ACP).
Mahesuti et al. [12] demonstrated the
effectiveness of these compounds in reducing
dentin sensitivity, with effects lasting between 30-
and 60-days post-application. Similarly, Yassin
and Milly [13] corroborated this efcacy using
the Mi Paste Plus agent, observing a signicant
decrease in postoperative sensitivity after teeth
whitening procedures, with favorable results
noted just three days after application.
The sensitivity experienced after placing
fixed prostheses is one of the most common
issues encountered during the rst three years
of follow-up. This is often accompanied by
recurrent caries and periodontal problems [14].
These findings emphasize the importance of
implementing preventive strategies to ensure the
longevity of these treatments. However, access to
effective desensitizing agents for xed prostheses
is limited in several Latin American countries.
This limitation highlights the need to explore
alternative solutions that can achieve similar
outcomes in managing post-treatment sensitivity.
Therefore, the current study aimed to
assess the effectiveness of two desensitizing
agents, Fluor Protector S (Ivoclar Vivadent,
Schaan, Liechtenstein) and Mi Paste Plus (GC
Corporation, Tokyo, Japan), in comparison to
Shield Force Plus (Tokuyama Dental America
Inc., San Diego, CA, USA) for use in dental
preparations for conventional xed prostheses.
MATERIAL AND METHODS
Ethical considerations
This study adhered to the CONSORT
guidelines [15]. The study received approval from
the Research Ethics Committee of the Faculty of
Health Sciences at the Private University of Tacna
(FACSA-CEI/070-07-2023). It was conducted in
Plus foi estatisticamente mais ecaz na redução da sensibilidade dental em comparação com Mi Paste Plus (p <
0,05). Diferenças signicativas na sensibilidade dental foram observadas entre as sessões de avaliação para todos
os agentes dessensibilizantes (p < 0,05). Conclusão: Neste estudo, Shield Force Plus foi o agente dessensibilizante
mais ecaz para reduzir a sensibilidade pós-preparo dental, seguido por Fluor Protector S.
PALAVRAS-CHAVE
Agentes dessensibilizantes; Restauração xa; Sensibilidade dental; Escala visual analógica; Preparo dental vital.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
accordance with the ethical principles outlined
in the Declaration of Helsinki and the guidelines
proposed by Emanuel et al. [16].
All participants who agreed to take part in
the study signed an informed consent form that
detailed the associated risks of their participation.
Study design
This research was conducted using a
randomized, single-blind, parallel-controlled
exploratory clinical experimental design.
Participants
The number of participants was calculated
using a one-way xed effects ANOVA model with
the G*Power software version 3.1.9,7 (Heinrich-
Heine-Universität Düsseldorf, Düsseldorf,
Germany). We considered an effect size of
0.87 calculated from the results of a previous
study [9], an α = 0.05, and a power of 90%.
The minimum calculated sample size was 24
participants, providing a power of 91.2%, with
six participants required for each group.
Additionally, a 20% adjustment for
participant loss was considered, resulting in a
nal minimum sample size of 31 participants.
To maintain the same number of subjects in each
study group, the sample was set at 32 participants
(n=8 per each group).
Participants of both sexes, aged between
20 and 55 years, were included in the study [17],
who required single xed partial restorations or
three-piece bridges (metal-ceramic) in the maxilla,
with vital teeth, without periodontal compromise
and without previous direct restorations that
will involve more than 50% of the tooth surface.
Participants with systemic conditions or diseases,
presence of macroscopic oral lesions, allergy
to lidocaine, history of adverse reactions to
local anesthetics, pregnant women, and people
who would participate in other clinical studies
were excluded. This information was evaluated
through a medical history and an oral clinical
examination during recruitment.
Participant recruitment
The study was conducted in accordance with
the established eligibility criteria, beginning on
July 24, 2023, and concluding on September
19, 2023. Advertisements on social networks
and information brochures were used to recruit
participants, which contained a summary of the
study and the contact details of the principal
investigator [18]. After arranging interviews,
additional information about the study was
provided, and a medical history was taken along
with an oral clinical examination. This process
was nished once the minimum required number
of participants who had signed an informed
consent form was reached before starting any
intervention.
Distribution and masking of participants
Participants were randomly assigned to four
groups in this study. The study was single-blind,
meaning only the participants were unaware of
their assigned group. The allocation of participants
was based on whether they received a desensitizing
agent or were placed in the control group. The
Research Randomizer Form 4.0 software (Social
Psychology Network, Middletown, CT, USA)
was used for randomization. The distribution
was as follows: SF Group with Shield Force Plus
(n=8), FP Group with Fluor Protector S (n=8),
MP Group with Mi Paste Plus (n=8), and Control
Group (control) with the application of glycerin
(n=8).
Sensitivity evaluation
Sensitivity was assessed using a Visual Analog
Scale (VAS), which featured a 100 mm straight
line marked from 0 to 10, with 0 signifying no
sensitivity and 10 denoting very intense sensitivity.
This methodology is widely used in clinical trials
to measure pain in various clinical situations,
including its application in dentistry [19-21].
Clinical interventions
The desensitizing agents were applied
following the manufacturer’s instructions
(Table I). All clinical experimentation began on
September 23 and ended on November 2, 2023.
All clinical experiments were closely supervised
by the principal investigator, both in person and
by phone, to ensure that participants encountered
no issues during the process. Additionally,
the experiments were conducted within the
established timeframes after obtaining informed
consent from the participants.
First session: Local anesthesia was
administered using 2% lidocaine with epinephrine
(1:80,000), delivering 1.80 ml per tooth to be
treated. With walls prepared at a convergence
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
angle of 12°. The occlusal surfaces were reduced to
1.5 mm, and the axial surfaces to 1 mm, utilizing
truncated conical diamond burs (850-010 MDT,
Afula, Israel) with a high-speed handpiece
(NSK Pana-Max, Tochigi, Japan) with abundant
irrigation. To control wear, a Zeta Labor silicone
matrix (Zhermack SpA, Badia Polesine, Italy)
was used, obtained before tooth preparation
[22-24]. The provisional restoration was made
with Primma Art (FGM Dental Group, Joinville,
Santa Catarina, Brazil) and was cemented with
CharmTemp NE (Dentkist Inc., South Korea). The
participant was scheduled for a follow-up session
two days later to conduct the first sensitivity
measurement of the prepared tooth. This timing
was chosen to account for the varying duration of
local anesthesia effects, which can differ among
patients. The decision was made to refrain from
performing the measurement during the initial
session in order to prevent any potential biases.
Second Session: During this session, the
rst sensitivity measurement of the previously
prepared tooth was conducted. The provisional
restoration was removed, and gentle bursts of
cold air were applied using a triple syringe. The
air was directed at a distance of 1 cm, with a
flow rate of 5 L/min, for 2 to 3 seconds over
the entire surface of the single abutment tooth.
To minimize measurement bias, the examiner
covered the adjacent teeth with their index and
middle ngers. Dental sensitivity was recorded
using a visual analog scale (VAS), allowing the
participant to indicate their level of discomfort.
After this, the desensitizing agent corresponding
to each experimental group was applied. A nal
impression was taken using addition silicone
(I-Sil, Spident Co. Ltd., South Korea) following
the one-step impression technique [25]. Once
the procedure was completed, the provisional
restoration was cemented, and the next
appointment was scheduled for two days later.
Third session: The provisional restoration
was removed, and gentle bursts of cold air
were used to take a second measurement of
dental sensitivity, utilizing VAS. Then, the metal
structure trial was performed, and its proper
adaptation was conrmed. Following this, the
desensitizing agent relevant to each experimental
group was applied for the second time. After
completing this procedure, the provisional
restoration was cemented back in place, and the
participant was scheduled for the next session
in two days.
Fourth session: The provisional restoration
was removed, and gentle bursts of cold air were
applied to obtain the third measurement of
dental sensitivity using VAS. After validating
Table I - Description of desensitizing agents used in the study
Desensitizing Agent Composition Mechanism of action Indications for use
Shield Force Plus (Tokuyama
Dental America Inc., San Diego,
CA, USA)
Batch:
140E22
Resin matrix 10-30% 2- (HEMA),
10-30% dis(2-hydroxypropoxy)
bisphenol A dimethacrylate,
10-30% phosphoric acid
monomer, 30-60% propan-
2-ol, 5-10% triethylene glycol
dimethacrylate, 5-10% water
Double locking mechanism:
the calcium in the tooth
substance and the adhesive
monomer react to form the first
block. The volatilization and
photoactivation of the agent
act as a second block at the
level of the dentinal tubules (50
µm), forming resin tags.
After cleaning the tooth
surface, apply Shield Force Plus
directly to the exposed dentin
with a micro-applicator. Air dry
for 5 seconds and light cure
for 10 seconds. Make sure you
cover all sensitive areas.
Fluor Protector S (Ivoclar
Vivadent, Schaan,
Liechtenstein).
Batch:
Z04C0Z
Contains 1.5% ammonium
fluoride in a varnish base
with ethanol and water as
solvents. The fluoride content
is equivalent to 0.77%, or
7700 parts per million (ppm) in
Solution, this increases after
application pH: 5.0-6.5
Control of demineralization and
remineralization is achieved by
depositing a layer of calcium
fluoride. This hinders acid
demineralization and blocks
open dentinal tubules. Thanks
to its low viscosity, the material
penetrates up to 10 µm into the
tubules, effectively blocking
their entrances.
It is applied in a thin layer to
clean and dry tooth surfaces
with a soft brush or applicator.
Let the varnish settle
independently, and avoid eating
or drinking for at least 30
minutes after application.
Mi Paste Plus (GC Corporation,
Tokyo, Japan)
Batch:
230214G
Contains RECALDENT™* with
incorporated Fluoride (CPP-
ACPF). The Fluorine level is 0.2%
by weight (900ppm)
CPP–ACP molecules bind
to biofilm, plaque, bacteria,
hydroxyapatites, and
adjacent soft tissue. Induces
remineralization. Reduces
hypersensitivity by occluding
open dentinal tubules.
Apply a small amount of Mi
Paste Plus to your teeth and
let it sit for 3 minutes. Spit out
excess without rinsing, and
avoid eating or drinking for 30
minutes.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
the bisque trial based on the aesthetic and
functional parameters, the third application of
the desensitizing agent corresponding to each
experimental group was carried out. Once
the procedure was completed, the provisional
restoration was replaced and the next session
was scheduled for two days later.
Fifth session: The provisional restoration
was removed, and gentle bursts of cold air
were applied to assess dental sensitivity. This
assessment was recorded using VAS. After this
information was collected, the nal restoration
was permanently cemented using Ketac Cem (3M,
St. Paul, Minnesota, United States).
The same methodology was applied to the
control group, using glycerin as placebo instead
of desensitizing agents.
Statistical analysis
Statistical analysis was performed with
STATA 17 (Stata Corp LP, College Station,
TX, USA) and R studio V. 3.6.1 software (R
Foundation for Statistical Computing, Vienna,
Austria). The descriptive analysis included
frequency measures and measures of central
tendency and dispersion. The Friedman test for
repeated measures, followed by the Nemenyi Post
Hoc test, was used to contrast hypotheses. The
relationship between age and dental sensitivity
was examined using Spearman’s rank correlation
coefcient. Comparison of dental sensitivity based
on sex was assessed with the Mann-Whitney U
test. To evaluate whether there are differences
between the different desensitizing agents, the
Kruskal-Wallis test was used. A signicance level
of 5% was set for all tests.
RESULTS
Initially, 38 potential participants were
evaluated, but six were excluded for not meeting
the selection criteria. A total of 32 participants
were included in the study: 20 women and
12 men, with an average age of 35.53 ± 9.91
years (ages ranging from 22 to 55). Participants
were allocated randomly to the study groups
(Figure 1). The characteristics of the participants
in each study group are presented in Table II.
The Friedman test indicated significant
differences in dental sensitivity based on the type
of desensitizing agent used during measurement
appointments (p<0.05). For Shield Force Plus,
significant differences were observed during
the third and fourth measurement compared to
the rst reading. In the case of Fluor Protector
Figure 1 - Flowchart of the participants in the clinical trial according to CONSORT.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
S, there was a signicant difference during the
fourth reading compared to the rst and second
measurement (p<0.05). At the same time, there
was no signicant difference compared to the
third measurement (p>0.05). Regarding Mi Paste
Plus, a signicant difference was found during the
fourth measurement compared to the rst and
second reading (p<0.05). In the Control Group,
no signicant difference was observed across all
measurements. These ndings are summarized
in Table III.
Furthermore, the correlation between age
and dental sensitivity as reported by participants
during the evaluation sessions was analyzed. The
results indicated that the correlations observed in
all cases were weak and not signicant (p>0.05)
(Table IV).
Table V presents a comparison of dental
sensitivity based on the sex of the participants.
The results indicated marginally significant
differences between men and women in the MP
group during the first and second evaluation
appointments (p=0.048). Similar differences
were also observed in the FP group during
the second and third evaluation appointments
(p<0.05).
Table II - Characteristics of the participants (n=32)
Variable
Desensitizing Agent
SF Group n(%) FP Group n(%) MP Group n(%) Control Group n(%)
Sex
Female 6(75.0) 6(75.0) 3(37.5) 5(62.5)
Male 2(25.0) 2(25.0) 5(62.5) 3(37.5)
Age* 35.2±9.9 34.6±11.9 35.6±9.1 36.7±10.4
Age by sex*
Female 32.5±6.7 31.2±10.8 42.5±6.7 35.0±10.3
Male 43.0±16.9 45.0±11.3 31.4±8.0 39.6±12.2
Segment
Anterior 4(50.0) 3(37.5) 3(37.5) 3(37.5)
Posterior 4(50.0) 5(62.5) 5(62.5) 5(62.5)
*Expressed as mean ± standard deviation.
Table III - Perception of sensitivity during appointments according to desensitizing agent
Desensitizing
Agent
Dental sensitivity measurements (VAS)
p-value*First Second Third Fourth
Median (IQR) Median (IQR) Median (IQR) Median (IQR)
SF Group 10(0.5)a9(1)ab 6(1)b3(1.5)c<0.001
FP Group 10(0)a10(1)a8(1.5)ab 7(2)b<0.001
MP Group 10(0.5)a10(0.5)a10(1)ab 9(1)b<0.001
Control Group 10(0) 10(0.5) 10(1) 9.5(1) 0.066
IQR: Interquartile range; VAS: Visual analog scale. *Friedman test followed by Nemenyi post hoc test. Different superscript letters in rows
indicate significant differences in dentin sensitivity between appointments.
Table IV - Correlation between age and dental sensitivity
Variable Desensitizing
Agent
Dental sensitivity measurements (VAS)
First ρ (p-value) Second ρ (p-value) Third ρ (p-value) Fourth ρ (p-value)
Age
SF Group -0.65(0.077) -0.22(0.581) -0.49(0.211) -0.01(0.975)
FP Group -0.58(0.100) -0.22(0.574) -0.24(0.559) -0.35(0.381)
MP Group -0.50(0.202) -0.50(0.202) -0.35(376) 0.05(0.890)
Control Group 0.41(0.376) 0.25(0.547) 0.03(0.947) 0.15(0.703)
ρ: Spearman’s rank correlation coefficient.
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Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
The Kruskal-Wallis test revealed signicant
differences in sensitivity reduction between the
rst and last measurements among the groups
(p<0.001). Dunn’s post hoc test showed that
sensitivity decrease observed in the Shield
Force Plus group was similar to that of the
Fluor Protector S group (p=0.309). However,
it differed signicantly from the Mi Paste Plus
group (p<0.001). The Fluor Protector S group
displayed a decrease in sensitivity comparable to
the Mi Paste Plus group (p=0.090). No signicant
differences were observed between the Mi Paste
Plus group and the control group (p=1.000).
These ndings are summarized in Table VI.
DISCUSSION
In this study, the evaluated desensitizing
agents demonstrated varying levels of effectiveness
in reducing dental sensitivity, with Shield Force
Plus proving to be the most effective. This
effectiveness can be attributed to its chemical
composition, which includes a resinous matrix,
phosphate monomer, bisphenol A-glycidyl
methacrylate, triethylene glycol dimethacrylate
and 2-hydroxyethyl methacrylate, in addition to
its double-blocking mechanism: the rst block
occurs when the adhesive monomer reacts with
dental calcium, while the volatilization and
photoactivation of the agent provide the second
blockage at the level of the dentinal tubules
(50 µm), creating resin tags [26].
Considerations for including alternative
desensitizing agents in this investigation were based
on results from previous studies demonstrating the
effectiveness of all three desensitizing agents in
various clinical settings [11,13,27,28]. However,
our study was mainly based on the ndings of
Sayed et al. [9], who evaluated the effectiveness
of three desensitizing agents in dental preparations
for xed restorations, pointing out that Shield
Force Plus showed outstanding effectiveness
against thermal (cold) and electrical stimuli. This
study was conducted over three appointments,
with 15-day intervals between visits. During these
appointments, three sensitivity measurements
were taken using a visual analog scale (VAS), and
desensitizing agents were applied three times.
Table V – Comparison of dental sensitivity according to sex between the participants
Desensitiz-
ing Agent Sex
Dental sensitivity measurements (VAS)
First Second Third Fourth
Median
(IQR) p-value* Median
(IQR) p-value* Median
(IQR) p-value* Median
(IQR) p-value*
SF Group Male 9(2) 0.275 7.5(3) 0.210 6(0) 1.000 3(2) 0.860
Female 10(0) 9(1) 6(2) 3(1)
FP Group Male 9.5(1) 0.083 9(0) 0.048* 6.5(1) 0.039* 5(0) 0.067
Female 10(0) 10(0) 8.5(1) 7(0)
MP Group Male 10(0) 0.048* 10(0) 0.048* 10(0) 0.168 90.860
Female 9(1) 9(1) 9(2) 9(1)
Control
Group
Male 10(0) 0.438 10(0) 0.236 10(1) 0.730 9(1) 0.744
Female 10(0) 10(1) 10(1) 10(1)
IQR: Interquartile range. *Mann–Whitney U test. p<0.05.
Table VI - Multiple comparisons between desensitizing agents on decreased sensitivity
Dunn´s multiple comparison test Differences in rank sum p-value
FP Group
SF Group 1.630207 0.309
MP Group 2.169118 0.090
Control Group 3.017903 0.008*
MP Group SF Group 3.799324 <0.001**
Control Group 0.848785 1.000
SF Group Control Group 4.648110 <0.001**
* p<0.01, ** p<0.001.
Note. p-value adjusted by the Bonferroni method.
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Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
A verbal telephone evaluation was conducted
fteen days after cementation. Our study utilized
a different methodology compared to previous
research. It involved ve appointments, during
which we applied the desensitizing agent three
times and assessed sensitivity to cold air four times,
using a Visual Analog Scale (VAS) at two-day
intervals. This approach more closely resembles
standard clinical practices in conventional
prosthetic treatments, where appointments are
typically not spaced so far apart. This allowed
us to evaluate the effectiveness of desensitizing
agents in a clinical setting that accurately reects
the actual timeframe required for these treatments.
Savithqa et al. [29] conducted a study on the
effects of cold air on prepared tooth surfaces for
full crowns. They evaluated the tooth sensitivity
at ve different intervals: before preparation, after
preparation, after the application of desensitizers,
just before cementation, and again after a 30-day
follow-up period, though they did not specify
the exact time between appointments. Likewise,
Gupta et al. [30], determined the effectiveness
of three desensitizing agents before and after the
cementation of complete dental crowns. Their
study assessed sensitivity levels at four intervals:
one week after applying the desensitizing agent,
immediately before cementation, and at five
minutes, one day, and one-week post-cementation.
Their study assessed sensitivity levels at four
intervals: one week after applying the desensitizing
agent, immediately before cementation, and at ve
minutes, one day, and one-week post-cementation.
Participants using Fluor Protector S showed
decreased sensitivity levels after the second
application, with more significant reductions
observed after the third and fourth applications.
Some researchers attribute this effect to its
composition, which contains 7700 ppm of uoride,
and its ability to create a thin layer on the substrate
surfaces. A study indicates that its mechanism of
action involves the formation of uorapatite, which
effectively seals the dentinal tubules and promotes
the development of secondary dentin [11].
The use of fluoride varnishes in dental
preparations for xed restorations has not been
extensively studied. Abdollahi and Jalalian [10]
evaluated the effectiveness of a uoride varnish and
another desensitizing agent after tooth preparation
for full crowns. Their study demostrated a
significant reduction in sensitivity between
appointments, which aligns with the results
obtained in our study using Fluor Protector S.
Additionally, immediate pain was reported after
applying uoride varnish followed by an air spray,
a sensation that several participants in our study
also experienced until the second application.
The effectiveness of Mi Paste Plus in reducing
sensitivity was almost nonexistent, even after
three applications. This could be because its
formulation, based on the CPP-ACP complex, is
primarily designed to remineralize tooth enamel.
This agent is most effective in remineralizing early
lesions, such as white spots, by providing calcium
and phosphate that integrate into damaged
enamel, which may help reduce sensitivity at that
level [31]. However, dentin does not respond
similarly to this remineralizing process, and there
is no documented evidence of its effectiveness in
clinical situations involving dental preparations
for xed restorations.
Therefore, Using the desensitizing agents
evaluated in this study, which have proven efcacy,
can signicantly enhance the outcomes of xed
prosthetic treatments in everyday clinical practice.
Additionally, it has been noted that repeated
applications can further increase their effectiveness.
This study assessed the effectiveness of
desensitizing agents with various mechanisms of
action, comparing them to a well-known product
recognized for its efcacy, such as Shield Force
Plus. Additionally, the ndings indicate that age
and sex do not inuence perceptions of dental
sensitivity. Despite using a randomization process
to assign participants to different groups, the
small sample size influenced the distribution
of participants by sex, so the findings should
be interpreted with caution. Although it has
been suggested that sex may be a confounding
variable in assessing pain, other studies have
concluded that sex is not a signicant factor in
dentin sensitivity [32,33]. Additionally, since age
is related to dental sensitivity, an age range was
considered to minimize its impact on the results,
as suggested by other researchers [17].
There are some limiting factors that need
to be considered in this clinical trial. Firstly,
although the Visual Analogue Scale is generally
recognized for its validity and reliability [34], the
subjective nature of self-reporting can inuence
the results. This is largely because pain intensity
is evaluated based on each participant’s personal
perception, which may be inuenced by both
physiological and emotional factors. Secondly, in
this investigation, it was not possible to follow-up
9
Braz Dent Sci 2025 Jan/Mar;28 (1): e4587
Tozo Burgos JG et al.
Evaluation of desensitizing agents for the contr ol of sensitivity in conventional fixed restorations
Tozo Burgos JG et al. Evaluation of desensitizing agents for the control of sensitivity
in conventional fixed restorations
dental sensitivity after the cementation of the
crowns. This was primarily due to the treatment
and prosthetic coverage applied, which are
factors that tend to diminish symptoms. However,
the literature indicates that sensitivity in teeth
with xed prostheses can emerge up to two years
after cementation [14].
The inclusion of placebo controls was an
important strength of this trial. It provided
a reference point for evaluating the relative
effectiveness of Shield Force compared to the
other treatments. This approach ensured the
internal validity of the study design and helped
establish the clinical margin of equivalence.
CONCLUSION
Among the desensitizing agents analyzed,
Fluor Protector S effectively reduced tooth
sensitivity, although its effectiveness was lower
than that of Shield Force Plus. In contrast, Mi
Paste Plus showed results similar to those of the
control group, indicating that it was not effective
in reducing post-preparation sensitivity.
Repeated applications of desensitizing
agents during each session proved to be more
benecial than a single application. This suggests
that the frequency of use can signicantly impact
their effectiveness.
Acknowledgements
We thank the Private University of Tacna
(UPT) for allowing us to use the Dental Teaching
Clinic of the Professional School of Dentistry
facilities to execute this research.
Author’s Contributions
JGTB: Conceptualization, Methodology,
Resources, Validation, Investigation, Writing –
Original Draft Preparation, Supervision, Project
Administration. MAST: Resources, Validation,
Formal Analysis, Investigation, Data Curation,
Writing – Review & Editing, Visualization.
NABKG: Resources, Supervision, Investigation,
Writing – Review & Editing. ADZM: Investigation,
Resources, Writing – Original Draft Preparation.
WGEO: Methodology Supervision, Project
Administration, Investigation, Writing – Review
& Editing, Visualization.
Conict of Interest
The authors have no conicts of interest to
declare.
Funding
This research received no specic grant from
funding agencies in the public, commercial, or
not-for-prot sectors.
Regulatory Statement
This study was carried out according to
all the provisions and policies of the Research
Ethics Committee of the Faculty of Health
Sciences of the Private University of Tacna,
following the recommendations of CONSORT
and the Declaration of Helsinki (revised in 2000).
The approval code for this study is FACSA-
CEI/070-07-2023.
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Date submitted: 2024 Nov 22
Accept submission: 2025 Mar 08
José Giancarlo Tozo Burgos
(Corresponding address)
Universidad Privada de Tacna, Facultad de Ciencias de la Salud, Tacna, Peru.
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