The Pulpal Response to Posterior Bite Raisers: A Prospective Study of Material and Height Effect

Volume 13 ,Issue 2 ,August 2026 ,Pages 13-22

Authors

Azheen J. Ali 1 ; Darwn S. Abdulateef 2 ; Lawand Barzinji 3

1 Orthodontics Department, College of Dentistry, University of Sulaimani, Madam Mitterrand, Sulaimani, Iraq

2 Operative Dentistry and Endodontics Department, College of Dentistry, University of Sulaimani, Sulaimani, Iraq.

3 Anderson Collegiate Vocational Institute, Whitby, Ontario, Canada.

DOI logo 10.17656/sdj.10223

Keywords

Abstract

Objective: Posterior bite raisers (PBRs) induce temporary posterior disocclusion during fixed orthodontic treatment but may affect pulp vitality under prolonged occlusal load. Objective: To compare pulpal responses to injectable nanohybrid composite PBRs and resin-modified glass ionomer cement (RMGIC) PBRs at two heights (1–2 mm; >2–4 mm) in relation to gender and age.

Methods: Eighty patients (16- 40 years old, with a mean age of 22.9 ± 5.7 years and an equal male-to-female ratio were assigned to four groups according to the material and height of PBRs, with twenty patients in each group. Cold testing and electric pulp testing (EPT) were documented at baseline, 1 week, 1 month, 2 months, and 3 months. The outcomes were divided into two groups: sensibility (positive or negative), and the differences among the four groups were compared in relation to gender and age.

Results: At 3 months, negative pulpal responses were observed only in the composite groups: >2–4 mm (15%) and 1–2 mm (5%). Material choice was the strongest independent predictor of EPT threshold change (P=0.008), with the composite associated with significantly decreased responsiveness. The interaction between material and height was highly significant (p=0.012), indicating a fivefold higher risk of negative sensibility responses with high-volume composite than with RMGIC. Younger patients showed greater susceptibility to pulpal changes (p=0.03). 

Conclusions: Composite PBRs, particularly at heights exceeding 2 mm, are associated with increased pulpal stress, whereas RMGIC demonstrates superior pulpal stability and is recommended for initial orthodontic phases to minimize adverse biological effects.  

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  • First online1 August 2026
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