Is immediate dentin sealing a mandatory or optional clinical step for indirect restorations?

OBJECTIVE: The use of immediate dentin sealing (IDS) following tooth preparation for indirect restorations is well-supported by laboratory studies. The inclusion of IDS as a mandatory clinical step, it must be firmly supported by evidence from randomized clinical trials (RCT). The objective of this study is to assess whether IDS should be added as a mandatory procedure in all indirect restorations, taking into consideration clinically significant outcomes for the patient, such as restoration longevity and hypersensitivity. MATERIALS AND METHODS: A bibliographic search was carried out in the PubMed. In addition, a manual search was conducted in the references of literature reviews. RESULTS: Data from four RCT were included. Two studies assessed preparations for full crowns, and two assessed preparations for partial restorations. Data from full crown preparations were subjected to a meta-analysis, revealing a reduction in hypersensitivity incidence in the IDS group 1 week after restoration cementation. With respect to hypersensitivity, IDS seems to offer advantages exclusively during the provisional phase and up to 1 week following the cementation of the final restoration. One study has shown no difference on longevity. CONCLUSION: The use of IDS should be considered as an elective clinical step during the rehabilitation with indirect restorations. CLINICAL SIGNIFICANCE: IDS is an elective clinical step that should be considered in patients and preparations with a higher risk of sensitivity between appointments.