Ppt - Tooth Colored Inlays and Onlays - II

8/18/2019 Ppt - Tooth Colored Inlays and Onlays - II

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TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYS -------- IIIIIIIIIIIIIIII

Dr. Nasrien AteyahDr. Nasrien Ateyah


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Posterior Bonded PorcelainPosterior Bonded PorcelainRestorations Restorations

Ceramic inlays were introduced inCeramic inlays were introduced in 19131913

but did not become popularbut did not become popular →→

Difficulties in fabricationDifficulties in fabrication

High failure rateHigh failure rate

InIn 1980s1980s

Development of compatibleDevelopment of compatible refractoryrefractorymaterialsmaterials made fabrication easiermade fabrication easier

Development ofDevelopment of abrasive resin cementsabrasive resin cements greatlygreatly

improved clinical success ratesimproved clinical success rates


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Advantages Advantages

Porcelain is an excellent replacementPorcelain is an excellent replacement

material for unaesthetic tooth substancematerial for unaesthetic tooth substance

for some of the following reasons:for some of the following reasons:

ColorColor:: Most porcelain systems use wellMost porcelain systems use well--established techniques of effectivelyestablished techniques of effectively

blending in with the adjacent naturalblending in with the adjacent natural

dentition.dentition.


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Periodontal healthPeriodontal health:: A porcelain A porcelainrestoration mayrestoration may accumulate less plaqueaccumulate less plaque onon

its surface than will other systems.its surface than will other systems.

Resistance to abrasionResistance to abrasion:: The wearThe wear--andand

abrasionabrasion--resistance of these restorations isresistance of these restorations ishigh, although they have the potential tohigh, although they have the potential to

createcreate wear in the opposing arch.wear in the opposing arch.


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Radio density:Radio density: On radiographs, theOn radiographs, the

radio density of porcelainradio density of porcelain resemblesresemblesthat of normal tooth structure,that of normal tooth structure, quitequite

often allowing for radiographic accessoften allowing for radiographic access

to areas that were previously shieldedto areas that were previously shieldedby radiopaque restorations.by radiopaque restorations.


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The marginal integrity:The marginal integrity:when ceramic restorations arewhen ceramic restorations are

combined with resin bondingcombined with resin bondingand a composite resin luting agent,and a composite resin luting agent,

is excellent with the result thatis excellent with the result that

microleakagemicroleakage is decreased to anis decreased to anabsolute minimum.absolute minimum.


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Disadvantages Disadvantages

The amount of time and attention to detailThe amount of time and attention to detailrequired when these restorations are fabricatedrequired when these restorations are fabricated

and placedand placed ((techniquetechnique--sensitivitysensitivity)) makesmakes

them of necessity an expensive alternative tothem of necessity an expensive alternative toother modalities.other modalities.

Moisture contaminationMoisture contamination and placementand placementprocedures are all potentiallyprocedures are all potentially problematicproblematic..


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TheThe strengthstrength of the individualof the individualunbonded restoration is relativelyunbonded restoration is relatively

nominal, so that the trynominal, so that the try

--in proceduresin procedures

can result incan result in fracturefracture of the porcelain.of the porcelain.

TheThe laboratory feelaboratory fee for this type offor this type ofrestoration is an added factor when arestoration is an added factor when a

treatment plan is developed.treatment plan is developed.


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The potentialThe potential

wearwear

of the teeth in theof the teeth in the

opposing arch, particularly during Paraopposing arch, particularly during Para

functional habits, is a contraindication.functional habits, is a contraindication.

A new generation of A new generation of lowlow--fusing porcelainsfusing porcelains

→→→→→→→→ less wear of enamelless wear of enamele.g.:e.g.: Empress 2 pressable Empress 2 pressable ceramics ceramics → →→ → → →→ →

almost no wearalmost no wear


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In castIn cast--glass or ceramic restorationsglass or ceramic restorations

with superficical surface stain, occlusalwith superficical surface stain, occlusal

adjustment results in theadjustment results in the lossloss of theof thesurface colorantssurface colorants. This obviously. This obviously

results in aresults in a less attractiveless attractive restoration,restoration,

when esthetics may well have been thewhen esthetics may well have been thereason the patient sought treatment inreason the patient sought treatment in

the first place.the first place.


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Indication Indication

WhenWhen one cusp of posterior toothone cusp of posterior tooth is beingis beingcovered with an esthetic bonded onlaycovered with an esthetic bonded onlay

In the restoration of a molar with a shortIn the restoration of a molar with a shortocclusogingival dimensionocclusogingival dimension ((requirerequire 2mm2mmocclusal reduction.occlusal reduction. No axial reduction)No axial reduction)

All margin should be on All margin should be on enamelenamel


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Indication Indication

Should be amenable toShould be amenable to rubber damrubber dam

placementplacement

Patient should exhibitPatient should exhibit no no sign of a Parasign of a Para

functional habitsfunctional habits


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Contraindications: Contraindications:

1.1. Bruxism patientBruxism patient

2.2. Excessive tooth destruction with veryExcessive tooth destruction with very

littlelittle dentin dentin remainingremaining


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Failure Failure

Bulk fracture Bulk fracture Area of cuspal coverage Area of cuspal coverage ((↓↓↓↓↓↓↓↓ 2mm thick)2mm thick)

At the At the isthmusisthmus adjacent to marginal ridgesadjacent to marginal ridges(porcelain poorly supported by(porcelain poorly supported by

tooth structure)tooth structure)

Marginal breakdown Marginal breakdown because resin cementbecause resin cement

not be heavily fillednot be heavily filled →→→→→→→→ wearwear more quickly thanmore quickly than

the adjacent restorations or tooth structure.the adjacent restorations or tooth structure.


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Ceramic Inlay vs. ResinCeramic Inlay vs. ResinComposite Inlay Composite Inlay

Leak lessLeak less

Fit betterFit better

Adhesion of luting resin is more reliable and Adhesion of luting resin is more reliable and

durable to etched ceramic materialdurable to etched ceramic material

Porcelain inlay is quitePorcelain inlay is quite fragilefragile subject to fracturesubject to fracture

during the tryduring the try--inin

Removed proximal contact can be replaced byRemoved proximal contact can be replaced by

timetime--consumingconsuming


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Porcelain Onlays vs. ResinPorcelain Onlays vs. ResinComposite Onlay Composite Onlay

HasHas samesame disadvantages as porcelain inlay.disadvantages as porcelain inlay.

It is a cuspal coverage restorationIt is a cuspal coverage restoration causecausewear of opposing enamelwear of opposing enamel

But provide longBut provide long--term occlusalterm occlusal

stabilitystability


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Ceramic Materials that can be usedCeramic Materials that can be usedfor Posterior Inlays and Onlays for Posterior Inlays and Onlays

1.1. Conventional ceramicsConventional ceramics

2.2. Glass ceramicsGlass ceramics

a.a. Castable glass ceramic Castable glass ceramic

b.b. Injection molded glass ceramics Injection molded glass ceramics c.c. CAD CAD - - CAM and Copy milled materials CAM and Copy milled materials


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A. A. Conventional Ceramic Conventional Ceramic

The concept of a ceramic inlay dates back to theThe concept of a ceramic inlay dates back to theend of the last century, when the firstend of the last century, when the firstrestorations of this type were fabricated. Therestorations of this type were fabricated. Theproblems inherent with porcelain, such as:problems inherent with porcelain, such as:

•• Material weaknessMaterial weakness

•• Lack of Marginal integrityLack of Marginal integrity

•• Lack of an adequate cementing mediumLack of an adequate cementing medium

Initially made this an unsuccessfulInitially made this an unsuccessfulrestoration.restoration.


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Conventional Conventional CeramicCeramic

Advantage AdvantageCeramic restoration provide:Ceramic restoration provide:

••

Color stabilityColor stability

•• Stain resistanceStain resistance

•• Marginal integrityMarginal integrity (resin bonding and(resin bonding and

composite resin luting agent)composite resin luting agent)•• Microleakage to absolute minimumMicroleakage to absolute minimum


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Conventional Ceramic Conventional Ceramic

DisadvantageDisadvantage

•• ↑↑ timetime

••

Tend to fracture during porcelain tryTend to fracture during porcelain try--inin•• ExpensiveExpensive

•• Wear of opposing teethWear of opposing teeth

•• Difficult to adjustDifficult to adjust


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B.B. Glass Ceramics Glass Ceramics

1.1. Castable glass ceramics (Dicor)Castable glass ceramics (Dicor)

2.2. Injection molded glass ceramicInjection molded glass ceramic

3.3. CADCAD--CAM and copy milled materialCAM and copy milled material


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1.1. Castable Glass Ceramics Castable Glass Ceramics (Dicor) (Dicor)

Over the years castable glassOver the years castable glass--ceramicceramic

systems have proved to be a viablesystems have proved to be a viable

alternative ceramic system.alternative ceramic system.This systems have been used for aThis systems have been used for a

variety of different clinical situationsvariety of different clinical situations

as:as:

Core for ceramic crownsCore for ceramic crowns

Inlays and onlaysInlays and onlays


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1.1. Castable glass ceramics (Dicor) Castable glass ceramics (Dicor)

−− The immediate advantage of this type ofThe immediate advantage of this type of

ceramic process over the conventional is thatceramic process over the conventional is that→→

a.a. It utilizes the conventionalIt utilizes the conventional waxing on awaxing on a

die.die.b.b. Casting techniques similar to theCasting techniques similar to the

conventionalconventional lost wax technique lost wax technique used forused forcastcast--metal restorations.metal restorations.

Indication:Indication:

For single unitFor single unit


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TheThe fitfit of castof cast--glass restorations reportedlyglass restorations reportedlysupersedes that of conventional porcelain.supersedes that of conventional porcelain.This decreases the amount of resin lutingThis decreases the amount of resin lutingagent at the margins, in turnagent at the margins, in turn decreasingdecreasingthe potential forthe potential for ditching.ditching.

TheThe wearwear on the opposing occlusion ison the opposing occlusion ispredicted to be less than that ofpredicted to be less than that ofconventional porcelains.conventional porcelains.


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TheThe thermal cyclingthermal cycling properties of castproperties of cast

glass approximate those of enamel.glass approximate those of enamel.

Flexural strengthsFlexural strengths is reportedlyis reportedly

greater than it is for conventionalgreater than it is for conventional

porcelain.porcelain.


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TheThe colorantcolorant is a surface stain, hence anyis a surface stain, hence any

grinding on the restoration leaves angrinding on the restoration leaves an

unaesthetic opaque white area.unaesthetic opaque white area.

An An additional chairsideadditional chairside visit is necessary tovisit is necessary to

fit and adjust the contacts, anatomic form,fit and adjust the contacts, anatomic form,

and occlusion prior to staining. Once stained,and occlusion prior to staining. Once stained,

the surface cannot be adjusted withoutthe surface cannot be adjusted without

compromising the esthetics.compromising the esthetics.


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The whole process isThe whole process is techniquetechnique--sensitivesensitive, from the casting of the, from the casting of the

inlays through the staining of theinlays through the staining of the

cerammed restorations.cerammed restorations.


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2.2. Injection molded glass ceramicInjection molded glass ceramic

– –

pressed pressed - - ceramic systemceramic system(IPS Empress) (IPS Empress)

A newer material of the all A newer material of the all--ceramic type,ceramic type,

which is not cast but injection molded,which is not cast but injection molded,

isis IPS EmpressIPS Empress..

−−

This system usesThis system uses highhigh--temperaturetemperaturepressing of a prepressing of a pre--cerammed glass ceramiccerammed glass ceramic

withwith hydrostatic pressurehydrostatic pressure in a vacuumin a vacuum

unit.unit.


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IPS Empress II IPS Empress II

Utilizes veneering techniqueUtilizes veneering technique

The core is a glass ceramicThe core is a glass ceramic

Veneer contains fluoroapatite crystals Veneer contains fluoroapatite crystals

Higher volume of crystalsHigher volume of crystals

Stronger than the original IPS EmpressStronger than the original IPS Empress


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Advantages of Pressed Advantages of Pressed - - Ceramic Systems Ceramic Systems

The pressedThe pressed--ceramic system involvesceramic system involvesrelativelyrelatively simplesimple processing procedures thatprocessing procedures that

accuratelyaccurately reproduce the waxed patternreproduce the waxed pattern..

The cerammed restorations have a highThe cerammed restorations have a high

degree ofdegree of stability stability during subsequentduring subsequent

shading or layering techniques.shading or layering techniques.


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The precerammed porcelain has aThe precerammed porcelain has a

high degree of flexural tensilehigh degree of flexural tensile

strengthstrength (exceeding(exceeding 200 MPa).200 MPa).


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Advantages of Pressed Advantages of Pressed - - CeramicCeramic Systems Systems

The versatility of the process allows for theThe versatility of the process allows for thedevelopment of verydevelopment of very estheticesthetic restorationsrestorations

ranging fromranging from inlaysinlays andand onlaysonlays toto fullfull

crownscrowns andand llaminateaminate veneersveneers, even in, even invery thin sections of onlyvery thin sections of only 1mm1mm


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TheThe lost lost - - wax technique wax technique andand ceramicceramicinjection moldinginjection molding allow forallow for accurate fitaccurate fit..

The preshaded base ingots with twoThe preshaded base ingots with two

different characterization techniques allowdifferent characterization techniques allow

achievement ofachievement of excellent harmonyexcellent harmony andandblending with adjacent teeth.blending with adjacent teeth.


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3 3 - - CAD CAD - - CAM Systems CAM Systems

The introduction of computerThe introduction of computer--aidedaideddesign/computerdesign/computer--aidedaided

manufacturermanufacturer (CAD/CAM)(CAD/CAM)

systems to restorative dentistrysystems to restorative dentistry

represents a major technologicalrepresents a major technological

breakthrough.breakthrough.


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CAD CAD - - CAM Systems CAM Systems

New fabrication method in which the restorationNew fabrication method in which the restoration

is milled out of ais milled out of a piece of ceramic that ispiece of ceramic that isprepre--manufactured.manufactured.

Elimination of laboratory techniquesElimination of laboratory techniquesvariablesvariables

Improvement in the properties of theImprovement in the properties of the

ceramic materialceramic material Less porosityLess porosity

Extremely expensiveExtremely expensive


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Component of the System Component of the System

1.1. Three dimensional video cameraThree dimensional video camera

2.2. Electronic image processorElectronic image processor

3.3. Three accessThree access--of rotatingof rotating--millingmilling

machinemachine4.4. Computer component and screenComputer component and screen

of the cerec systemof the cerec system


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Material Material

1.1. Dicor ceramic materialDicor ceramic material

2.2. Vita porcelain (Vita Mark II Vita porcelain (Vita Mark II))


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Advantages of the Cerec System Advantages of the Cerec System

CeramicCeramic--bonded restorations offer a widebonded restorations offer a wide

range of advantages over conventionalrange of advantages over conventional

restorative materials.restorative materials.

Single appointmentSingle appointment

No impressionNo impression


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Reduced marginal gapReduced marginal gap Wear hardness similar to enamelWear hardness similar to enamel

Less fractureLess fracture of the inlay,of the inlay, becausebecause it isit ismilled from a solid, homogeneous block milled from a solid, homogeneous block

Excellent polishingExcellent polishing characteristicscharacteristics

Improved estheticsImproved esthetics Less reduction to tooth structureLess reduction to tooth structure, hence, hence

better periodontal healthbetter periodontal health


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Bonded restorations enhance toothBonded restorations enhance toothstrengthstrength

Preparation, fabrication, cementation,Preparation, fabrication, cementation,

and polishing normally accomplished inand polishing normally accomplished in1 to 11 to 1½½ hourshours


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4 4 - - Copy Milling Celay Copy Milling Celay

An innovative system, the celay technique An innovative system, the celay techniqueis a variation on the directis a variation on the direct--indirectindirect

restoration concept butrestoration concept but without thewithout the

need forneed for a laboratory techniciana laboratory technician..

This systemThis system duplicateduplicate the hard compositethe hard composite

resin patterns of the restoration fromresin patterns of the restoration fromthe improved material mentioned in thethe improved material mentioned in the

CADCAD--CAMCAM


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Advantages of the Celay System Advantages of the Celay System

A precisely A precisely fittingfitting ceramic restoration canceramic restoration canbe developedbe developed

In one patient session.In one patient session.

Without the need for a laboratoryWithout the need for a laboratory

technician.technician.

InIn factoryfactory--fired highfired high--grade porcelain.grade porcelain.


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Advantages of the Celay Advantages of the Celay

System System

The processing time required is very short.The processing time required is very short. A A small inlay small inlay can be milled incan be milled in 33 minutesminutes,,

aa mesiomesio--occlusooccluso--distal inlaydistal inlay in lessin less

thanthan 88 minutesminutes, and a complete, and a complete onlayonlay inin1212 toto 1313 minutesminutes..


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The preparation should incorporate theThe preparation should incorporate the

following features:following features:

A A 1.5 to 2.0mm1.5 to 2.0mm reduction in vertical heightreduction in vertical height

of the cusps and all occluding areasof the cusps and all occluding areas

Preparation finish lines on any supportingPreparation finish lines on any supporting

cusps that arecusps that are hollowhollow--ground chamfers,ground chamfers,

generally withgenerally with no bevelno bevel


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WellWell--rounded anglesrounded angles on the cuspalon the cuspalpreparation, to prevent propagation ofpreparation, to prevent propagation of

porcelainporcelain fracturefracture from these sharpfrom these sharpstress pointsstress points


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The specifically developed instrument with a newlyThe specifically developed instrument with a newly

designed tip results in the following:designed tip results in the following: A A flatflat pulpal floor with the calculated divergentpulpal floor with the calculated divergent

axial wallsaxial walls

A A roundedrounded line angle between the pulpal andline angle between the pulpal and

axial wallaxial wall


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Highly retentive axial wallsHighly retentive axial walls because of thebecause of the hybridhybrid

diamonddiamond on the shank, which increases the surfaceon the shank, which increases the surface

area for bonding and developsarea for bonding and develops mechanical retention.mechanical retention.

A well A well--defined cavosurface margindefined cavosurface margin at theat the

occlusal surface on which the hollowocclusal surface on which the hollow--ground chamferground chamfercan be developedcan be developed FineFine--grit round instrumentgrit round instrument


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Fabrication Fabrication

The most common method of fabrication of porcelainThe most common method of fabrication of porcelaininlays and onlaysinlays and onlays →→→→→→→→ refractory dierefractory die

After a master die is poured in die stone After a master die is poured in die stone

1.1. Refractory die is made by:Refractory die is made by:

Duplicating the master die or Duplicating the master die or

Repouring the impression in refractory material Repouring the impression in refractory material

2.2. The porcelain is backed on the refractory die,The porcelain is backed on the refractory die,

recovered, and fit to the master dierecovered, and fit to the master die


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The newer generation of pressed ceramic isThe newer generation of pressed ceramic is

fabricated much differentlyfabricated much differently

1.1. The restoration isThe restoration is waxed on a stonewaxed on a stone diediein the traditional manner and investedin the traditional manner and invested

in ain a special investmentspecial investment..

2.2. The invested wax pattern is burned outThe invested wax pattern is burned outas in the traditionalas in the traditional lostlost--wax technique.wax technique.


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3.3. An ingot of the pressed ceramic An ingot of the pressed ceramic

material ismaterial is heatedheated andand pressedpressed into theinto the

lostlost--wax pattern space.wax pattern space.4.4. After After coolingcooling, the investment is, the investment is

removed and the ceramic restoration isremoved and the ceramic restoration is

retrieved and finished in the sameretrieved and finished in the samemanner as a feldspathic porcelainmanner as a feldspathic porcelain

restoration.restoration.


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The FourThe Four--StageStageTryTry--InIn

Prior to final luting of the porcelain inlays, it isPrior to final luting of the porcelain inlays, it isimportant to follow the fourimportant to follow the four--stage trystage try--in. Thein. Therestorations need to be evaluated for therestorations need to be evaluated for the

following criteria:following criteria:

Marginal integrityMarginal integrityThe intimate adaptation ofThe intimate adaptation of

all porcelain margins to theall porcelain margins to theprepared tooth surface mustprepared tooth surface mustbe checked.be checked.


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The FourThe Four

--StageStage

TryTry--InIn

Proximal relationsProximal relations.. The collective fit andThe collective fit andrelationship of one restoration to the other orrelationship of one restoration to the other or

the adjacent tooth must be evaluated.the adjacent tooth must be evaluated.

Occlusal relations.Occlusal relations. The contact relations,The contact relations,with the opposing arch in centric occlusionwith the opposing arch in centric occlusion

and lateral excursive movements of theand lateral excursive movements of the

mandible, aremandible, are best evaluatedbest evaluatedafter inlay placement.after inlay placement.


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The FourThe Four

--StageStage

TryTry--InIn

Color:Color: Posterior restorations, theirPosterior restorations, their

basic shade should blend with thebasic shade should blend with the

surrounding teeth. The need forsurrounding teeth. The need forindividual characterization, such asindividual characterization, such as

fissure stainingfissure staining or other such coloror other such color

highhigh--lights, must also be ascertained.lights, must also be ascertained.


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Inlay/Onlay PlacementInlay/Onlay Placement

Procedure Procedure

The porcelain restoration bonds to the tooth inThe porcelain restoration bonds to the tooth in

a series of individual links:a series of individual links: At the tooth interface At the tooth interface, etched, etched

enamelenamel micromechanicallymicromechanically

bonds with dental bonding agent.bonds with dental bonding agent.

At the restoration At the restoration interfaceinterface,etched,etched

porcelain is made reactive viaporcelain is made reactive viaaa silanesilane,, whichwhich mechanically andmechanically and

chemicallychemically bonds to an unfilledbonds to an unfilled

resin layer.resin layer.

I l /O l Pl tI l /O l Pl t


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Inlay/Onlay PlacementInlay/Onlay Placement

Procedure Procedure

These two reactive interfaces are joinedThese two reactive interfaces are joinedby an optimizedby an optimized dualdual--cure hybridcure hybrid

composite resin luting agent.composite resin luting agent.


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THANKTHANK

YOU YOU


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Conventional Ceramic Conventional Ceramic

−− The recent development of reinforcingThe recent development of reinforcing

systems for porcelain, however, coupledsystems for porcelain, however, coupled

with the ability towith the ability to etchetch andand bondbond thetheporcelain to the underlying etched toothporcelain to the underlying etched tooth

structure.structure.

Ad t f P dAd t f P d


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Advantages of Pressed Advantages of Pressed - -

Ceramic Systems Ceramic Systems

The precerammed porcelain has aThe precerammed porcelain has a highhighdegree of flexural tensile strengthdegree of flexural tensile strength

(exceeding(exceeding 200 MPa).200 MPa).

This makes the material adequate forThis makes the material adequate for

most normal restorations, let alone thosemost normal restorations, let alone thosebonded to the underlying tooth structure.bonded to the underlying tooth structure.

Documents

Ppt - Tooth Colored Inlays and Onlays - II