How do I eliminate sensitivity from my posterior composites?

This is a question posed by a dentist regarding her patients complaining about sensitivity after having white fillings placed.

Most often sensitivity after having a filling is due to the technique use in preparing and placing the fillings. Most of my patients are not complaining of sensitivity after having a posterior composite placed. I will attempt to explain my technique.

When preparing a filling I usually use a 330 bur with out cross cuts . This bur is rounded at the end and doesn't usually create internal cross cuts or micro cracks. When using it I use gentle hand pressure and plenty of water coolant from my hand piece. Most of the time I place vitrabond over the deepest portion of the cavity preparation. I use a 15 second all etch technique and wash off the acid solution for 10 seconds or more. I dry the cavity preparation passively by waving my high speed suction tip over the preparation. My intention is to leave the preparation 'wet'. The surface should be glistening. If I have inadvertently over dried the preparation, I will re-wet the prep using a micro brush and water.

I use prime and bond and apply at least three times. I assume this is enough times to allow the acetone in the formulation to chase away the water in the prep. Then I air dry and cure as recommended by the manufacturer.

At this point I apply Flow it (flowable composite)sparingly to cover most dentin surfaces. I use an endodontic explorer to disperse it in the prep and use a micro brush to remove any of the flowable that inadvertently was applied to the cavosurface. I cure this for twenty seconds. Then I use a hybrid composite that I have previously placed on my bracket table. This composite has been prepared in to little balls of varying sizes and stored under an amber dappen dish (so that it won't set prematurely). I place small amounts into the prep and adapt each addition carefully and set it with my curing light. after the preparation is filled completely I am ready to finish always using water while removing the excess composite and smoothing the filling.

Of course there are other excellent techniques for preparing, placing and finishing composites, but I thought it might be helpful for me to share my technique.