Microsoft Powerpoint - Tooth Colored Inlays and Onlays_ i

8/18/2019 Microsoft Powerpoint - Tooth Colored Inlays and Onlays_ i

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TOOTH COLORED TOOTH COLORED

INLAYS and INLAYS andONLAYSONLAYS ““ I I ““

Dr. Nasrien AteyahDr. Nasrien Ateyah


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Introduction Introduction

The need for amalgam alternatives andthe growing demand for more esthetic

restorations has led to increasedpopularity of resin compositerestoration in posterior teeth.

Interest in esthetic dentistry lead to theintroduction of new materials andtechniques to be used for largerposterior restoration.


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Tooth Color Inlays and OnlaysTooth Color Inlays and Onlays

Have certain advantages overdirect resin composite and

bonded ceramic restorations.

• Highly esthetic

• Can be fabricated intraorallyor on a cast.


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• Highly successful in larger

restoration.

• Have many materials and techniques.

• Require special equipment and skilled

technician

COSTLY


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Composite Resin InlaysComposite Resin Inlaysand Onlaysand Onlays


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[Compared with direct compositeresin restoration]

• Contours and contacts can bedeveloped outside of the mouth.

→→→→ if contact is inadequate, it can be easily

corrected prior to cementation.

• Polymerization shrinkage should be

less because →→→→ they arepolymerized before cementation.


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• Less microleakage

• Greater strength and hardness

• Less post-operative sensitivity

[Compared with ceramic]

• Less abrasive to opposingtooth structure.

• Repairable

• Cheaper


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Advantages of Composite Advantages of CompositeResin InlaysResin Inlays

• High esthetics

• Better control of thecontact areas

• Excellent marginal adaptation

• Reduced or no laboratory fee if

done in the office• Ready repairability of material

intraorally


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Advantages of Composite Advantages of CompositeResin InlaysResin Inlays

• Cross-splinting of the compromised

tooth and easy removal if replacedbecomes necessary

• Compensation for complete polymerization shrinkage by curingthe materials outside of the mouth

• Increased composite resin strengthbecause of the heat-curing process


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DisadvantageDisadvantage• Wear faster

• Less stable

Than direct composite restoration

• Higher cost , time

• Difficult to modify extrinsic colorchairside

• More tooth reduction to create path

of insertion

than ceramic


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Indication Indication

Replacement of:• Large amalgam restoration

• Direct resin compositerestoration in premolar

and molar

Esthetic

Large caries


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ContraindicationContraindication

• Heavy occlusal forces

• Inability to maintain dryoperative field

o Deep subgingival preparation


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Direct Resin InlayDirect Resin Inlay

and Onlaysand Onlays• Fabricated directly on the

tooth (tooth as a die)• After preparation → watersoluble separating medium

and a matrix placed on thetooth.

• Preparation filled withcomposite.

• Light cured from all directions.

• Matrix removed.


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Direct Resin InlayDirect Resin Inlayand Onlaysand Onlays

• Inlay teased out ofpreparation

• Postcured

• Finally - try-in

adjusted

bonded into preparation

One Appointment


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Direct/IndirectDirect/Indirect Resin InlaysResin Inlays

• Impression is made after

preparation

• Cast is poured

• Done on one appointment

• Master cast be ready

(5 minutes)

and Onlaysand Onlays


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Direct/IndirectDirect/Indirect Resin InlaysResin Inlays

• Restoration fabricated on thedie

Master die made from

silicon material Master cast made from

die stone

• Light cure - primary

secondary

and Onlaysand Onlays


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Indirect Resin Indirect Resin Inlays and Inlays and

OnlaysOnlays• Can be constructed from:

– Hybrid resin composite

– Microfilled resin composite

• There is a newer generation of resinmaterial

– Ceromer (ceramic optimizedpolymers)

a. Artglassb. Belleglass

c. Targis

d. Skulpture fiberker


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Indirect Indirect Resin Inlays andResin Inlays and

OnlaysOnlays

They have:

– Greater durability– Fracture toughness

– Wear resistance

– Esthetic

– Repairability

Fiber-reinforced

ceromer


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Direct/IndirectDirect/Indirect Composite Inlay andComposite Inlay andOnlays SystemsOnlays Systems (Chairside Fabrication)(Chairside Fabrication)

Outline of Clinical Procedures1. Select shade

2. Isolate with rubber dam

3. Pre-wedge for proximal lesions4. Cavity preparation

• All margins in enamel when possible

• Break proximal contact

• Tapered preparation

(path of insertion)

Divergent wall 8-12 degree


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Direct/IndirectDirect/Indirect Composite Inlays and OnlaysComposite Inlays and OnlaysSystemsSystems (Chairside Fabrication)(Chairside Fabrication)

• Rounded internal line angles• Eliminate undercuts (glass ionomer

cement for block-out)

• Ends of enamel rods exposed foretching – try to avoid bevels

5. Matrix and wedge

6. Apply separating mediumfollowing manufacturers’ instructions


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Direct/Indirect Composite Inlays andDirect/Indirect Composite Inlays andOnlays SystemsOnlays Systems (Chairside Fabrication)(Chairside Fabrication)

7. Place composite resin in an incrementalfashion, curing thoroughly 60 sec.

8. Remove restoration from tooth

(scaler)


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Direct/Indirect Composite Inlays andDirect/Indirect Composite Inlays and

Onlays SystemsOnlays Systems (Chairside Fabrication)(Chairside Fabrication)

9. Clean restoration and provideadditional curing (this is systemdependent – possible modes ofpolymerization include intense orprolonged light curing, light plus vacuum,light plus heat and heat plus pressure)

7 minutes ? ? ?

10.Check fit, contour and contact andadjust/add resin as necessary


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Direct/IndirectDirect/Indirect Composite Inlays andComposite Inlays andOnlays SystemsOnlays Systems (Chairside Fabrication)(Chairside Fabrication)

11.Clean internal surface of restoration(sandblast, etching gel)

12.Apply “special bond” (Vivadent)

13.Protect adjacent teeth (celluloid strips,matrix)


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Direct/IndirectDirect/Indirect Composite Inlays andComposite Inlays and

Onlays SystemsOnlays Systems (Chairside Fabrication)(Chairside Fabrication)

14.Clean and etch enamel (conditiondentin if using dentin bondingsystem) and apply appropriatebonding resin

15.Cement inlay following manufacturers’

instructions• Always use dual-cure cement

• Apply cement to tooth and

restoration


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Composite Resin Luting AgentsComposite Resin Luting Agents ?? ? ?? ?

Several factors must be considered when theluting agent is selected, applied and cured.

Hybrid composite resin with a soft, smallparticle glass (Barium, Strontium) → more

resistant to wear

• Filler 70% by volume → to minimize amountof available resin to break

down at the margin.


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Composite Resin Luting AgentsComposite Resin Luting Agents

• Hybrid resin has → good marginal seal

and stain resistance because has thehighest potential degree of filler and good

tensile and compressive strength.

• Must be dual-cure composite resin?

activated by white light andundergoes chemical polymerization.


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Composite Resin Luting AgentsComposite Resin Luting Agents

Application

• Thin end of superfloss is placed interproximally andapical to the finish line.

• Interproximal contact separated with ultra thin strip.

• Light curing

• Time → 60 seconds per surface

• Shade of resin → darker require morecuring time

• Angle of contact → curing light at rightangle to the resin interface

• Distance → light source ↓↓↓↓ 1mm from thesurface


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Outline of Clinical Procedures:

• Seat with gentle pressureand remove as muchexcess as possible

• Seat firmly (should removeexcess of cement at all

margins) and hold in placewith instrument (amalgamcondenser, etc.)


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Outline of Clinical Procedures:

• Apply curing light from severalangles (60 seconds each angle)while maintaining pressure on

restoration

• Allow cement to continue

polymerization for 10 minuteswith no curing/light or pressure

16.Finish restoration


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IndirectIndirect Composite InlayComposite Inlay andand Onlay Onlay SystemsSystems(Laboratory Procedure(Laboratory Procedure))

Outline of Clinical Procedures

1. Isolate Select shade

2. with rubber dam3. Pre-wedge for proximal lesions

4. Cavity preparation – same as for

direct/indirect inlay systems


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Impression Impression

−Elastomeric impressionmaterial

•Polysulfides•Polyethers

•Condensation silicones•Vinyl polysiloxanes(addition silicones)


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Impression Impression

−Should have•High tensile strength

•Good surface detail

•Low deformation

•Able to disinfect it without

distortion


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Indirect Composite Inlay and Indirect Composite Inlay and Onlay Onlay SystemsSystems(Laboratory Procedure(Laboratory Procedure ) )

Outline of Clinical Procedures:5. Take impression

– Use addition silicone

– For onlays or large inlays takeimpression for opposing model

and bite registration


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Provisional RestorationProvisional Restoration

The provisional

restoration should:

1. Stabilize the existingocclusal relationship

2. Protect the preparedteeth from any anxious

stimuli


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A. Direct/Indirect Method

− Self-curing acrylic resinwith:• Vacuform shell

• Preoperative alginateimpression

B. Direct Method

− Direct composite resin withor without vacuform matrix


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C. Indirect Method

− Indirect composite resin/acrylic resinprovisional restoration

− Fabricated in a laboratory on aworking cast.

Must be cemented with a non-eugenol-

based temporary cement. ?


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Indirect Composite Inlay and Indirect Composite Inlay and Onlay Onlay SystemsSystems (Laboratory Procedure(Laboratory Procedure))

6. Temporize– Use appropriate material

– Always cement temporary with a

non-eugenol luting agent such asTemp-Bond NE (Kerr) or zone(Cadco) Fermit, Fermit In


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Indirect Composite Inlay and Indirect Composite Inlay and Onlay Onlay SystemsSystems

AT SECOND

APPOINTMENT7. Isolate with rubber

dam

8. Remove all temporarymaterial

9. Follow steps 10

through 16 listedunder direct/indirectinlays systems


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THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU

. . .. . .. . .. . .. . .. . .. . .. . .


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Advantages of Composite Advantages of Composite

Resin InlaysResin Inlays

There are several reasons for using

composite resin inlays rather thanporcelain and directly placedcomposite resin restorations.

Composite resin inlays have been inuse in clinical practice, and clinicaltrials of more than 3 years have

shown results equal to or betterthan those achieved with posterior

composite resin restorations.


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Have certain advantages over

direct resin composite andbonded ceramic restorations.

• Highly esthetic

• Can be fabricated intraorally or on a cast.

• After polymerization out of the mouth therestoration is bonded in place with a resinluting cement


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Advantage Advantage

• Less microleakage

• Greater strength and hardness• Less post-operative sensitivity

[Compared with ceramic]

• Less abrasive to opposing

tooth structure.• Repairable

• Cheaper

Documents

Microsoft Powerpoint - Tooth Colored Inlays and Onlays_ i