Haris Mehmood Final year BDS 786haris@gmail.

com

LEARNING OBJECTIVES
 Identify the types of materials that can be used

when placing indirect composite resin restorations.
 Discuss the clinical considerations for placing

indirect restorations.
 Describe the preparation, adhesion, and

cementation processes for placing indirect restorations.

INDIRECT RESTORATION
It is a technique of fabricating the restoration

outside of the mouth using the impression of the prepared tooth.

Types Of Indirect Restorations
Inlays and Onlays Crowns Bridges Veneers

INLAYS
Definition: An inlay is an indirect restoration (filling) consisting of a solid substance (as gold or porcelain) fitted into a cavity in a tooth between cusps and cemented into place.

INLAYS

ONLAYS
Definition: A cast type of restoration that is retained by frictional and mechanical factors in the preparation of the tooth and restores one or more cusps and adjoining occlusal surfaces of the tooth.

ONLAYS

MATERIALS AVAILABLE
Composite
Hybrid resin composite Microfilled resin composite Ceromer or Ceramic optimized polymer

A Newer generation of resin material

Ceramics
Porcelain inlays and onlays CAD/CAM ceramic Restorations

PREPARATION FOR INDIRECT RESTORATIONS
Preparation is almost same for all types of

materials including ceramics, resin composite inlays and onlays and CAD/CAM inlays and onlays.

PREPARATION DESIGN
Divergent, relatively non retentive Rounded proximal boxes Grooves should not be used Primary resistance and retention form by

adhesion to enamel and dentin. Walls and floor of preparation smooth and even Internal line angles rounded

PREPARATION DESIGN

PREPARATION OF INDIRECT INLAYS AND ONLAYS

This kind of diamond will provide the proper degree of divergence, a butt-joint, and smooth internal line angles.

Cont…(PREPARATION) Cont…
Occlusal reduction of minimum 2mm for

strength. Bevels should be avoided because margins of both composite and porcelain usually chip off. 90 degrees butt joint is recommended. For esthetic blend in facial surfaces, Long Chamfers should be placed.

Large preparation

Bases and Liners
Initially Glass ionomer was used for dentinal

protection and to base the preparation to ideal form. Now, Glass ionomer cement is recommended only for routine block out of undercuts.

ADHESIVE CEMENTATION
Resin luting cement is the material

recommended for this type of restoration because it bonds to enamel, dentin and restorative material. Luting resin cement limits microleakage and enhances strength of the restoration.

PREPARING THE RESTORATION FOR BONDING
Adhesion is more reliable in ceramic than

resin composite. Ceramics must be first etched and then silane is applied on it to enhance wetting. Bonding to resin composite is more difficult
No air inhibited layer Relatively few unreacted methacrylate groups

ACID ETCHED DENTIN

Dentin that has been treated with phosphoric acid, washed, and blot-dried with a cotton pellet. Note that the collagen layer has not collapsed.

Cont..
With hybrid resin composite, intaligo surface

should be air abraded with 50 micro meter Aluminium oxide to achieve a rough surface for frictional retention. Bonding of microfilled resin composite is more problematic.

PREPARING THE TOOTH FOR BONDING
Rubber dam applied 4th generation light cure adhesive should not

be used because they need to be air thinned to ensure absence of pooling of adhesive, which would prevent seating of restoration. This air thinning also decreases bond strength. Most research support dual cure fourth generation dentin bonding system.

ETCHING

RINSE AND DRY

DUAL CURE LUTING RESIN APPLIED

INDIRECT RESTORATION PLACED

BULK OF LUTING RESIN REMOVED

LIGHT CURE

FINISHED SURFACE

DECIDUOUS MANDIBULAR LEFT SECOND MOLAR

AFTER CARIES EXCAVATION

THE BUCCAL EXTENSION PREPARATION

PULPAL PROTECTION

UNDERCUT ELIMINATION AND CUSP REINFORCEMENT

The undermined cusps are reinforced with Glass Ionomer Cement. All undercuts are blocked and Occlusal divergence is created during the placement of the cement to obtain the features a cavity for inlay restoration

IMPRESSION

Rubber base impression material

PREPARATION OF THE INLAY ON THE CAST

In increments, to reduce the polymerization shrinkage

FINISHED INLAY

Occlusion is checked with the Maxillary cast. Occlusal adjustment are made with rotating

diamond instruments. Polished with points, cups and DISCS Finally the inlay is removed from the cast

ROUGHENING THE UNDERSURFACE OF THE INLAY

air abrasion in order to enhance the bond strength

CEMENTATION OF THE INLAY

TOOTH AFTER RESTORATION USING INDIRECT TECHNIQUE

CAD/CAMCERAMIC RESTORATIONS
Computer Aided Design / Computer Assisted

Manufacturing Procedure:
 An optical impression of the prepared tooth is taken

using a camera.  Next, the specific software takes the digital picture and converts it into a 3D virtual model on the computer screen.  A ceramic block that matches the tooth shade is placed in the milling machine.  An all-ceramic, tooth-colored restoration is finished and ready to bond in place.

An example of the preparation for CAD/CAM restoration.

BUCCAL VIEW

LINGUAL VIEW

OCCLUSAL VIEW

With advances in software and milling materials,

the newest generation of chair side CAD/CAM technology can produce restorations with lifelike esthetics and optimal fit.

By James Klim, DDS, FAGD, FADFE, PC

CROWNS

BRIDGES

VENEERS

As mentioned earliear,

the preparations for ceramic and resin composite inlays and onlays are the same. (Fundamentals of Operative Dentistry) pg. 514

REFERENCES:
Fundamentals of Operative Dentisitry 3rd Ed.

Chapter 18 Considerations for the Successful Placement of Laboratory-Processed, Indirect Composite Restorations by Gary Alex, DMD Indirect Posterior Composite Restoration -An Extended Scope in Pediatric Dentistry by India, JSS Dental College – Mysore – Prashant S. Simplifying CAD/ CAM Dentistry by Dr. Alex Touchstone and Dr. Randy J. Phillips

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