You are on page 1of 10

Ceramic Inlays: Clinical Assessment and

Survival Rate
Massimo FuzziVGiorgio Rappellib

Purpose: This study evaluates the olinical behavior of oeramic inlays piaced during the past decade.
Materials and Methods: One hundred eighty-two inlays were examined in 66 patiehts. The interval between placement and assessment was oh average 5.9 years ±2.7, ranging from 2 to 11.7 years. Restorations still present at the time of evaluation were clinically assessed according to modified USPHS criteria.
Kaplan-Meier statistical analysis was used to assess the survival rate.
Results: According to USPHS criteria, good results were obtained for color match, marginal discoloration,
recurrent caries, contour, and marginal integrity. Six inlays failed: four for endodontic reasons, one due to
recurrent caries, and the other due to fracture. The results indicate that a success rate of 95% could be
predicted at 11.5 years.
Conclusion: The lack of recurrent canes, the ohiy slight changes ih marginal discoloration and color
match, combined with the excellent longevity prove that ceramic inlays are a valuable tool for the restoration of posterior teeth.
J Adhesive Dent 1999; 1; 71-79.

Submitted for publication: 06.10 98: accepted for publicai/on: 05.11,98.

he challenge of reproducing natural esthetics
has been present for several decades, with a
constant improvement of restorative materials and
appiicatjon techniques.
Since 1882, when Herbst introduced the first ceramic iniays,2^ great progress has been made.
Today, thanks to improvements in adhesion techniques and material characteristics, indirect ceramic restorations are one of the aiternatives to
amalgam, particularly in large cavities, enabling the
esthetic demands of patients to be met for their
posterior teeth. j ^ j g type of restoration
aiso strengthens the tooth structure and preserves
dentai tissue to a large extent.^


Porcelain remains the materiai of choice for naturai-looking, esthetic restorations, due to its excellent optical qualities, indirect fabrication process,
and favorable bioiogical response. However, investigations on the longevity and ciinical behavior of ceramic inlays are insuffioient.

in 1992, Mörmann and Krejct^^ estimated a suocess rate with the Cerec system of 75% after 5
years. That same year, Studer et ai^o reported a
survival rate of 98% based on 130 iPS Empress inlays, examined at 18±6 months. In 1994, Reiss^^
examined 1000 Cerec-type inlays and, using the Kapian-Meier survivai analysis, found a success rate
of 9 1 % after 6 years. In 1994, Moaci< and Rouieti^
examined porcelain inlays piaced by students and
found a survivai rate of 75% after 4 years. In 1995,
Rouletts assessed 123 iniays with the KapianiVleier analysis and found a success rate of 76% at
6 years. The failures were due to fractures and en^ Private practice. Bologna, Itaiy.
dodontic causes, partiy related to extended applica' Private practice, Osimo (An), itaiy
tions. Studer and coworkers^^ published data in
1996 on 130 IPS-Empress iniays, reporting a surReprint requests: Dr Massimo Fuzzi, 7 Piazza P.ta Mascareila. vivai rate of 97.5% after 2 years, in 1996, Qual40128 Boiogna. Itaiy Fax: ++39 051 240513; E-mail: SAOS-FUZZim
trough and Wilson^" obtained a success rate of

Vol 1, No 1,1999,,,


Chicago. Scotchbond MP (3M Dental Products Division. Viganelio-Lugano. and dried. Amherst. Patient age ranged from 23 to 50 years. MN. USA). MN. CA. St Paul. the varnish was applied with a pellet and removed with alcohol after luting the inlays^" (Fig 3). Cavity preparations with aii margins iocated in enamei were completed in each tooth using Cerinlay diamond burs (Intensiv. excess luting ma- The Journal of Adhesive Dentistry . A fluid msteriai (Permadyne biue. Enamel and dentin were etched and primed. USA) from 1 9 9 1 to 1996. All restorations were made by the same technician using Microbond Natural fired ceramics (Austenal Dental-Austenal Internationai Inc. Switzeriand) (Fig 1). A 10% maieic acid or 37% phosphoric acid was applied to the enamei for 30 s and to the dentin for 15 s. Germany) is applied to the tray. Fig 2 The impression with poiyether materiai reproduces aii the details of the preparation. New York. St Paul. in the period from 1986 to 1990 and Fortune fired ceramics (Williams-lvociar. St Paul. Liechtenstein) or a reiated material was used to make temporary restorations. Santa Maria. NY. The dentin side. The present study assesses the survival rate and ciinicai condition of porcelain inlays provided by one of the authors in his ciinicai practice over the period 1986 to 1996. Holland. Fuil-arch impressions including the preparations were taken using a polyether impression material (Impregum. Japan) was used to protect the external part of the cavity during luting. Germany) (Fig 2). That same year. occluso-distal (45). St Paui. when neoessary. 4 1 female and 26 male. A thioi^er material [Impregum. is reoonstruoted with a glass-ionomer photooured base. mesio-occlusal (35). USA) in the period from 1991 to 1996. From 1993 to 1996. USA) from 1986 to 1990 and indirect Porceiain System Dentist Bonding (3M Dental Products Division. Schaan. after rinsing and gently drying. ESPE. The iniays included occiusai restorations (11). mesio-occlusal-distal (63) and cus pal-cove rage restorations (28). ESPE. Roulet^* reported a 4% annual faiiure rate of Dicor porcelain inlays. Seefeid. Siianization with 3M Silane (3IVI Dental Products Division. The fitting surface of the ceramic restorations was etched with hydrofiuoric acid (HF 10%) by the technician after try-in. The luting materials used were dual-cured composites: Ultra-Bond (Den Mat Corp. Following restoration placement.Fuzzi/Rappeili Fig 1 The margins of the preparation are placed on the enamel. enamel was etched with 37% phosphoric acid for 30 s. USA) was used as the adhesive. Luting was carried out with a rubber dam in place. FSPF. Germany) is applied to the tooth. The adhesive used in the period from 1986 tc MATERIALS AND METHODS One hundred eighty-two porcelain inlays were examined in 66 patients. Fradeani et ai^ reported a 96% success rate over 125 iPS-Empress inlays examined at 4. USA) 72 1992 was Scotchbond 2 (3M Dental Products Division. a thin layer of primer was appiied to the dentin. Seefeid. MN. Fermit acrylic (Ivociar. In 1997. while the opposing arch was replicated with an algînate impression. MN. Vivadent. IL. by Kuraray Co Ltd. rinsed. 82% from 50 ceramic inlays examined at 3 years. USA) was carried out by the dentist just before luting. Cavex Protect Varnish (Cavex.5 years. A bonding agent was used to achieve adhesion. Haarlem. and a bonding agent was used to achieve adhesion. Seefeid.

both for the whole sample and separateiy for permanent molars and premolars. The oiinicai variables (color match. reinstruction of oral hygiene measures. Fig 4 The finished case. and super floss. Kaplan-Meier survivai curves were piotted. older restorations. To reconstruct the changes in the variables. and fiuoridation. This care was provided by a dental hygienist.7 years. terial was removed with sponge pellets. Ali patients were enroiied in a 3-to 6-month periodontai maintenance program consisting of remotivation. RESULTS Assessment of USPHS criteria showed 100% alpha concerning recurrent caries. The time elapsed from the date of luting until the iast check was 2 to 11. The margins were checked with a HuFriedy XP 23/OW (Hu-Friedy. The luting composite was light cured from all aspects (5 min totai). and excess luting materai were removed.96 the estimated standard error of the probabiiity of survival at the time of each failure. The statistical program SOLC 4. No 1.Fig 3 A varnish is applied to the external surface of the preparation to faciiitate the removal of the composite after polymerization. professional tooth cleaning. e] periodontal problems.0 for D0S22 was used for calculations. The frequency of "alpha" vaiues in the two groups was compared by means of the exact analogue of the chi-square test. To display the life expectancy of the inlays and onlays. The varnish. version 6.08. The subgroup recent included Vol 1. Occlusion was then checked and adjusted. USA] explorer. the median duration (5 years and 132 days) was used to create two subgroups: recent vs. Marginal discoloration in older restorations was rated 83% alpha and 17% bravo. Those inlays no longer present at the time of assessment were considered failures. 95% confidence intervals were constructed by multiplying by 1. Chicago iL. Color was assessed under Siroiux iliumination (Siemens AG. without necessarily providing an explanation ofthe cause.i^ A iarger percentage of alpha in the group of more recent restorations was interpreted as a trend towards better values over time. Bensheim. Failures were classified according to cause: a) fractures. The restorations still present at the time of assessment were evaiuated clinically by a suitably trained operator using modified USPHS criteria^i" (Table 1). Diamond finishing burs and rubber points were used for finishing margins (Fig 4). contour. marginal discoloration. b) caries: c) endodontic reasons: d) unacceptable esthetics.i^ For the whole sample. rubber dam. 1 9 9 9 . whiie recent restorations scored 94% alpha 73 . Color match analysis of older restorations yielded 57% alpha and 43% bravo: recent restorations were rated 8 1 % alpha and 19% bravo (Fig 5). brush.2-' A conditional anaiysis of the iniays and onlays still intact at the last observation was performed on those variables for which several values of "bravo" or worse had been recorded. 1 year after completion. A transparent sticky wax is applied to the occlusal part to facilitate the manipulation of the inlay. 89 and the subgroup older 87 inlays. Germany). recurrent caries. marginal integrity) were tabled using the statistical program SAS for Windows.

2% after 11. indicating that the edge of the restoration does not adapt ciosely to the tooth structure. deep discoloration adjacent to the restoration. ahd the mismatch is outside the hormal range of tooth shades and transiucency. or. The restoration does hot match the shade and transiucehcy of adjacent tooth structure. There is visuai evidence of marginai discoloration at the junction of the tooth structure and the restoration. 1 % (Fig 9). There is no visual evidence of dark. 8).Fuzzi/Rappeii Table 1 Criteria for the clinical evaluation of the inlays Category Rating Characteristic Color matoh Alpha The restoration appears to match the shade ahd transiucehcy of adjaoent tooth tissues. if the explorer doesoatoh. The restoration does hot match the shade and transiuoency of adjacent tooth tissues. The Journal of Adhesive Dentistry . but the dentin or base is not exposed. The restoration is a continuation of existing anatomic form or is siightiy fiattened. When the side of an expiorer is placed tangentiaiiy aoross a restoration. and another was caused by recurrent caries after 8 years. but the mismatch is within the normai range of tooth shades. while the survival rate of the molar restorations was 90. Five failures took piace in mo- 74 iars and one in a premolar. deep discoioration adjacent to the restoration (but not directly associated with cavosurfaoe margins). 6 failed. the explorer touches two opposing oavosurface iine angies at the same time. there is no visible crevice aiongthe periphery of the restoration. Of these failures. Bravo Charlie Oscar Marginal disoo i oration Aipha Bravo Recurrent caries Alpha Bravo Alpha Chariie Marginal integrity Alpha and 6% bravo (Fig 6¡. Of the 182 iniays examined. but the disooloration has not penetrated aiongthe restoration in a puipai direction. There is a ioss of restorative substance so that a surface concavity IS evident and the base and/or dentin is exposed. Using the Kaplan-Meier analysis. the survivai index at 11. Marginal integrity was rated alpha in all restorations except five assessed as bravo. Tlie expiorer penetrates a orevice defect that extends to the dentin-enamei junction. The expiorer does not catch when drawh across the surface of the restoration toward the tooth. the survivai rate of the premolar restorations was 99%. Contour received bravo scores in 2 cases and alpha in all others (Tab 2 and Tab 3) (Figs 7. There is visual evidence of marginai discoioration at the junction of the tooth structure and the restoration that has penetrated aiongthe restoration in a puipai direction. There is no visual evidence of marginal discoloration different from the color of the restorative matenai and from the coior of the adjacent tootli structure. it does not touch two opposing oavosurface line angles at the same time. The dentin is not exposed. ranged from 86. and the restoration is not mobiie. calculated with a 95% confidence interval (CI). The restoration cannot be examined without using a mouth mirror. One failure occurred after 3 years due to fracture. into whioli the explorer penetrates. 4 were caused by endodontic probiems and occurred during the first 6 months after cementation. The expiorer catches and there is visibie evidence of a orevice. Asurfaoeoonoavity is evident.5 years (Fig 10). and the values.5 years was 95%. When the side of the explorer is piaced tangentiaiiy aoross the restoration. Separating the results of the premoiars from those of the molars.5% to 9 8 . There is visual evidenoe of dark.

8%) 2 (1.4%) 156 ¡88. The onlays on teeth 16 and 15 have been evaiuated as bravo for color match.3%) 0 (0%) 5 (2. Fig 6 The marginal discoloration of two iniays after 4 years in a patient who smotes.Fuzzi/Rappelli Fig 5 A ciinicai example of 3 ceramic restorations after 11 years. Fig 8 Radiographie verifications of the previous case. Note the good ohromatic and marginai adaptation.2%| 174 (98. P < 0. Some points of the occlusal and proximai margins of tooth 14 are stained. while the restoration on tooth 14 has been evaluated as aipha. Notice the absence of overhangs and the good marginal adaptation. Fig 7 MOD iniays on tooth 36 anO 37.05 (ChiMest) Recent restorations Older restorations Marginal discoloration Cclor match Aipha 84 (94%) 72(83%) Alpha 72 (81%) 50(57%) Bravo 5 (6%) 15(17%) Bravo 17 (19%) 37(43%) 75 . Table 2 Results of the clinical evaluation of 3ll 176 inlays examined Recurrent canes Marginal integrity Contour Marginal discoloration Color match 176 176 176 176 176 176 (100%) 171 [97.6%) 20 (11. OD inlay on tooth 35.6%] 122(89.4%] 54(30.7%) Table 3 Marginal discoioration and coior match of recent (< 5 y) vs older {> 5 y) restorations.

3 who found 54% of assessed inlays showing The Journal of Adhesive Dentistry . No recurrent caries was observed. 90% . Better resuits on coior match were reported by Studer et al^f and Krejci et ai. this fact might be due both to the experience of the technician in choosing the coior of the porcelain and to the dentist's choice of the iuting composite.4% of the oases. examined 3 1 inlays only 6 months after luting. which is in aooordance with the findings of Stenberg and Matsson. We did not observe this difference. and Krejci et al.. Rouletts found marginai gaps in 14% of inlays. " The oontour was assessed as alpha in 98. Krejci et ai^''reports an important difference between the occiusal and interproximai margins. The same results were obtained by Cavel et al. Cerutti and ooworkers^ reported 84% alpha contours on 109 Cerec CAD/CAM inlays 6 years after luting. Marginai integrity was assessed as bravo in 5 oases and alpha in ail the others.25 and Krejci e t a l .^'' who assessed 10 iniays at 18 months.l'^ Bessing and iVIolin." who. 76 12 Fig 10 Kapian-Meier survival rates of restorations in premolars and molars (P < 0.Fuzzi/Rap pe 11 Kstill intact sjrviMlrBtt T- ss% 9S% . 0 2 4 6 a 10 DISCUSSION All the inlays assessed were found to be clinicaiiy satisfactory. Studer et aP*^ examined 130 inlays at 18 months (6 months) and assessed the contour of 87% of the restorations as alpha. aithough our assessment was limited to a clinical examination with the expiorer.^! Âberg et al. Exampies are shown in Figures 11al l d . and no replicas were made for a scanning eieotron microscopic examination. .28 Tidehagand and Gunne. The quality of the color matoh decreased significantly as a function of time (Tabie 3). Since we do not expect ceramics to change color over time. S4iii>lars %slillinlacl -38 premolars 190% -| r 98% — 9B% 94% 92% .05). . however. 1 ' 1 2 : 3 92% 90% 8fl% 86% 0 2 4 S 8 10 12 Years Fig 9 Kaplan-Meier survival curve evaiuated for the totai number of inlays (2) and 95% confidence interval (1 and 3).

After a 3-year observation period.^ the influence of the luting material on the longevity of ceramic inlays was investigated. an "acceptable" color match. Van Dijken et aP^ evaluated 118 fired felspathic ceramic inlays luted with glassionomer cement and composite cement after 5 years.5 y survivai rate was 95%. however. this is assumed to remove the most superficial layer of colored ceramics. and postoperative pain (1).29-30 Molin and Karisson^^ examined 205 Optec inlays after 1 to 32 months. conducted on a simiiar number of restorations. The values for marginal discoloration were also significantiy different. Four restorations were lost and 3 had fractured. attributes this result to occiusal adjustment conducted after cementing. in Dicor-type inlays. the inlays luted with composite resin showed significantly fewer failures (2 failures out of 59 restorations) than those cemented with glass-ionomer cement (9 failures out of 59). As with Âberg et al. mi. The gold inlays had interproximai overhangs. Van Dijken et al found better results forthe inlays cemented with composite (93% success rate) than the inlays luted with glass-ionomer cement (76%). 1999 77 . the inlays' 11. Fig l i e An ooclusai view after 5 years Fig l i d An occiusai view after 13 years. have aiso reported favorable findings. endodontic problems (4). It is not known. Premolars Using Kaplan-Meier analysis. therefore preventing correot orai hygiene.Fig l i a Initiai case of the right upper quadrant. depending on whether the restorations were oider or more recent (Tabie 3). In Vol 1. if this discrepancy is due to a technical improvement or to a deterioration of the cementing oomposite which supposedly occurs with time. Other studies. No differences were found between the luting materials (three different luting composites). exposing the bulk ceramic. Fig l i b The view of the oeramic iniays 1 month after placement. failures being due to fracture (7). Rouiet^s found 9.7% failures among 123 Dicor inlays over a period of 4 to 82 months. a study by Âberg et a\.

Reiss B. All failures reported by Fradeani et al^ were due to fracture. Cambridge. Mehta C. Keisey WP. Fuizi M. Douglas WH. 9. The color match of the ceramic inlays was found to be better in the recent restorations subgroup than in the older restorations subgroup. Porcelain bonded restoration. Kiinische Langzeiterfahrungen mit Cerec-lnlays. Patel N. Cvar JF and Ryge G. J Dent 1996:24:317-323. and that these restorations were carried out 11. In: Dondi daii'Oroiogio G. 1991 (Survivai Anaiysis Module). 5. the difference was not statistically significant. Molin M. Noack MJ. Longitudinal study of pressed glass-ceramic inlays for four and half years. Prati C (eds). Garber DA. 7. Smith DC {eds). Acta Odontoi Scand 1996: 54:145-149. 10. however. Vehturi G. Olofsson AL. USPHS Publication no. Statisticai Software for Exact Nonparametric inference. Van Dijken JWV. Dietschi D. 4. 13. Holz J. Hihtze JL. Fradeani M. Quaitrough and Wiison. J Dent Res 1994. Bologna. This finding emphasizes the sensitivity of the ceramic iniay technique and the dependence on personal operator skill and clinical experience.S. Quaitrough AJE. Krejci D. Criteria for the Ciihical Evaluation of Dentai Restorative Materials. Cytei Software Corporation. 1985: 433^42. Brondum K. 790-244.73:196. Bessihg C. Quintessence int 1992:23:181-186. et al. A pilot study of the clinicai evaiuation of castabie ceramic inlays and a duaicure resin cement. Oper Dent 1990:15:61-70. ireland. 19. adhesively luted oeramic inlays showed no recurrent caries.5 years ago. After 11. Acta Odontol Scand 1994.78:346-353. Molm M. Survivai rates and mode of failure of Dicor iniays after 4 years |abstract759]. A 3-year ciinicsi evaluation of a porceiaih iniay system. Operator ability and care in applying the technique can be the main factors infiuencing the success rate. 1994. Lutz F. Aquilano A. when iess oiinicai information was avaiiabie about the adhesive technique and microleakage controi. J Prosthet Dent 1995:74:140-144. CONCLUSIONS Taking into account that this single-center study was conducted without using a control group.5 years. A ciinjcal evaiuation of porceiain iniays. 21. Krejci i. 5. 1995: 87-97. User's Manuai. 6. In many studies. J Prosthet Dent 1990. 18. 22. Conservative posterior ceramic restorations: a literature review.5 years). Acta Odontol Scand 1992:50:227-233. San Francisco: U. 2. An in vivo study of glass ceramic ¡Dicor*] iniays. the main reason for failure seems to be the fracture of inlays. 12. DFZ 1994:38:30-33. 4.Fuzzi/Rappeiii tended to show a better success rate. Molin and Karisson^'' reported a 90% success rate after 3 years: this was obtained by calculating the survival rates of iniays performed by 10 dentists who presented very different results. 15. Methods tc improve fracture resistance of teeth. 14. Statxact Turbo. Goldstein RE. the following conclusions may be drawn: 1. Six-years clinical evaiuation of 109 Cad/Cam inlays. Cavei WT. Chicago: Quintessence. 10 of which were fractures. Acta Odontol Scand 1990:48:351-357. 78 REFERENCES 1. Quaitrough AJE. SOLO Statistical system BMDP Statistical Software. A clinical evaluation of the Optec iniay system. 16. Isidor F. The slight occurrence of marginal discoloration over time (17% bravo for inlays older than 5 years) is still clinically acceptable. Three years comparison of fired ceramic inlays cemented with composite resin cr glass ionomer cement.52:140149. 20. Smith GA. found 18% failures due to fracture. The Journal of Adhesive Dentistry \ .5 years. Barkmeier WW. 17. Banks RG. 1997. The Netherlands: Peter Szulc Pubi Co. The porcelain inlay: An historical view. Rouiet JF. Madrid: lADR/OED [abstract 295|. Krejci i. Cork. Wilson NHF. 3. Wilson NHF. Government Printing Office 1971. in: Vanherie G. A 3 year clinical follow-up study of a ceramic (Optec) inlay system.20 examining 50 ceramic iniays after 3 years. particulariy if bruxism patients are invoived. Gerutti A. Karisson S. Restauration des dents postérieures. Mörmann W. Isidor and Brondum^s obtained even less favorabie results after 57 months with 12 failures out of 25 inlays. Bassein L. Ciinicai evaiuation of a new pressed giassed ceramic iniay material over 1. Quintessence Int 1988:19:257-252. Proc 3M Symposium. Quintessence Int 1992:23:109-115. Prati C.619-626. Porcelain and composite inlays and onlays. Adhesion in Restorative DentistryProceedings ofthe International Symposium. Rev Suisse Odontostom 1990:100:1325-1332. It shouid also be noted that 4 of the 6 failures reported in the present study occurred in the same patient for endodontic reasons (puipitis). Karisson S. 2. Molin M. Fuïii M. Within the observation time (up to 11. Posterior Composite Resm Dentai Restorative Materiais. a survival rate of 95% of all the ceramic inlays must be considered as excellent. The survival rate of premolar inlays (99%) was superior to that of molar inlays (90%). Computer-designed inlays after 5 years in situ: clinical performance and scanning eiectron microscopic evaluation. Âberg CH. MA. must also be taken into account when evaluating the mechanicai properties of ceramics.B3. J Prosthet Dent 1997. Putignano A. The selection of cases. 11. 3. 1992. 8.

31. 32. 80 iHus ¡some in coior!: ISBN 0-87417-575-9 C3047. 1999_ . Scharer P.qijintpub. Schárer P. A 2-year ciinicai foilow-up study of iPS Empress ceramic inlays. Rouiet JF. Herder S. US S40 To ORDER CallToll Free 1-800-621-0387 or Fax 1-630-682-3288 book/ Visit our web site http://www. Aota Odontoi Scand 1993:51:91-97. HARD TISSUES HYBRIDIZATION OF DENTAL HARD TISSUES Nobuo Nakabayashi and David H.Fuzzi/Rappelli 23. Degrange M. 24. 29. Chicago: Quintessence. A thorough review of the current literature rounds out the text. Longevity of giass ceramic iniays and amaigam-results up to 6 years. Aberg HC. Gary. Studer S. Pashley The hybridization of dentin—a process that creates a molecular-level mixture of adhesive polymers and dental hard tissues—gives clinicians a versatile new material. Van Dijken JWV. J Dent Res 1992:71:658. Roulet JF. this book covers the development. 28. useful in a wide array of advanced dental treatments. J Caiif Dent Assoc 1996:24:48-62. Tidehag P. NC. The longevity of giass ceramic iniays [abstract 36]. Studer S. Roulet JF. CONTENTS ! Evolution of Dendn-Resin Bonding 2 Properties of Dentin 3 Acid Conditioning and Hybridization of Substrates 4 Characterization of the Hybrid Layer 5 The Quality of the Hybndized Dentin 6 Clinical Applications of Hybrid Layer Formation ¡29 pp. J Dent Res 1996:75:1302. As the first in-depth exploration of the suhject. New Frontiers in Adhesive Dentistry 26. J Prosthodont 1996:5:277-287. Short term results of IPS-Empress ihlays and oniays. 1991. Matsson L Ciinical evaiuation of giass oeramic inlays (Dicor). and clinicians seeking a greater understanding of resin hybridization of tooth structure. Lehner C. Gunne J. Valuable for students. NO 1. Second pnnting. Inc Voi 1. present understanding. Glass-ceramic iniays and onlays made by IPS empress: first clinicai resuits. Rouiet JF. Stenberg R. researchers. Bonded ceramio inlays. Five year evaluation of oeramic inlays [abstract 72]. 27. and future research areas of this multifunctional dental material. 25. SAS institute Inc. Ihlay restorations. Brodbecii U. Lehner C. Third Edition. SAS Procedures Guide.. Clin Orai Invest 1997:1:40^6. et al. 30. J Dent Res 1995:74:405. 1992. Version 6. IntJ Prosthcdont Quintessence Publishing Co. HYBRIDIZATION O F DENTAT.