Professional Documents
Culture Documents
Evidence Based Concepts For Bonded Inlays and Onlays. PartII. Preparation Cavity-Rocca2015
Evidence Based Concepts For Bonded Inlays and Onlays. PartII. Preparation Cavity-Rocca2015
net/publication/280125441
Evidence-based concepts and procedures for bonded inlays and onlays. Part II.
Guidelines for cavity preparation and restoration fabrication
CITATIONS READS
19 13,232
4 authors, including:
Ivo Krejci
University of Geneva
361 PUBLICATIONS 7,252 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
The influence of end-core length on Marginal analysis and Fatigue resistance of premolar endocrowns View project
All content following this page was uploaded by Giovanni Tommaso Rocca on 25 August 2015.
E-mail:giovanni.rocca@unige.ch
2
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
3
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
4
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
rication methods, the tooth preparation ment of the in vivo performance of new
for all kinds of modern bonded restor- monolithic ceramic restorations in a criti-
ations relies on similar specific princi- cal biomechanical environment.
ples, which differ from those for tradition-
al cast-gold inlays and onlays, and even Preparation extent and restoration
the first generation of fired porcelain res- thickness
torations, whose limited mechanical re-
sistance imposes more demanding and All tooth-colored materials (composite
invasive preparations. resin or ceramic) used for the fabrica-
The occlusal environment has to be tion of posterior indirect restorations are
evaluated, as it plays an important role submitted to high occlusal functional
in restoration longevity and can also stresses; consequently, their inherent
influence material choice. Extensive vulnerability needs to be compensated
restorations with generally large and for by restoration thickness and proper
deep cavities (mainly non-vital teeth) adhesive cementation. Although the res-
in high load-bearing areas (especially torations should therefore be as thick as
the second molars) associated with an possible, this approach is tempered by
unfavorable occlusal context (such as the fundamental principles of minimal
patients with bruxism) have to be con- invasiveness.29 Moreover, an unconsid-
sidered biomechanically vulnerable and ered sacrifice of enamel and dentin could
more susceptible to failure. In the latter also directly weaken the tooth. For exam-
unfavorable situation, only the strong- ple, Fennis and co-workers have dem-
est materials should be chosen, based onstrated that thick overlay restorations
mainly on their superior mechanical show higher static fracture strength com-
properties. Today, new CAD/CAM com- pared to conservative ones,30 although
posite resin blocks (ie, Lava Ultimate, they present more drastic and irrevers-
3M; Enamic, Vita) or lithium disilicate- ible failures; ie, thicker restorations may
based restorations (ie, IPS e.max Press be stronger but simultaneously imply
or CAD, Ivoclar Vivadent) are preferred, thinner and weaker dental tissues under-
the former option having some interest- neath them. At the same time, extremely
ing stress-absorbing properties,17 while thin material is not systematically and un-
requiring simpler procedures when a conditionally recommended. If one takes
surface modification or repair is need- into consideration that a few tenths of a
ed.18 Recent in vitro studies on the frac- millimeter can considerably strengthen a
ture and fatigue resistance of direct and restoration, the best compromise would
indirect restorations of a severely eroded be between material resistance and the
tooth model demonstrated the favorable clinical situation.31 We should therefore
behavior of CAD/CAM composite ma- move away from the blind application of
terials.17,19-24 Apart from the non-vital “minimally invasive dentistry” to a more
tooth configuration, the aforementioned realistic concept of “minimally hazard-
findings are well supported by clinical ous dentistry”, which is particularly per-
trials.25-28 However, less information is tinent to large and deep cavities and to
available to date regarding the assess- non-vital teeth.
5
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
6
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
7
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
Fig 2 The “smile space” of two different patients. The visibility of the treated tooth during smile has to be
verified before cavity preparation. The patient’s lips can act as a curtain behind which the tooth–restoration
transition can be hidden.
8
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
Fig 3 Guidelines for buccal cusp coverage. (a) Ultraconservative buccal cusp coverage. (b) Conven-
tional buccal cusp coverage. (c) Full buccal cusp coverage. In (a) and (c), the restoration has to mimic
practically only one tissue, with only one set of optical properties – enamel (blue) in the incisal third, and
dentin (yellow) in the cervical third. Thus, esthetic outcomes are more predictable.
There are various techniques used boratory via a simple schematic drawing
to make a shade selection, depending (Fig 4) or an intraoral photograph of the
on the material (composite or ceramic), tooth. In the specific case of the buccal
which usually make use of brand-specif- cusp, enamel shades should be pre-
ic shading systems and shade guides. ferred for a minimally invasive o
cclusal
For ceramic restorations, particularly in coverage (see Fig 3a), while dentin
posterior areas, the classical VITA shade shades should be used for crown-like
guide (Vita) is the most widely used sys- preparations (see Fig 3c) in the cervical
tem for monolithic ceramic or mono- part of the restoration.
laminar composite restorations (those
following the VITA shading concept). For
layered composite restorations, more ef-
fective alternatives exist, with either a bi-
laminar shade guide, including specific
dentin and enamel color selection (ie,
Inspiro, EdelweissDR; Miris 2, Coltene
Whaledent),46,47 or, for other brands,
customized shade tabs produced free-
hand or with a mold (My Shade Guide,
Smile Line).
In addition to the basic information
about dentin and enamel shade, any
other details or characteristics to be re-
produced on the buccal and occlusal
surfaces (white spots, stains on fissures, Fig 4 Example of a schematic drawing for com-
etc) should be communicated to the la- munication with the dental laboratory.
9
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
Table 1 Clinical step-by-step protocol for the cavity preparation of bonded indirect posterior restorations
• Remove old restoration, excavate caries, and prepare but do not finish the margins of the cavity
• Isolate the cavity with rubber dam and, in case of subgingival margins, place metal matrix
• Dual Bonding (DB)/Immediate Dentin Sealing (IDS). Seal whole dentin with an adhesive system
following manufacturer’s instructions. This procedure also involves thin subgingival enamel margins,
if present
• Cavity Design Optimization (CDO) and Cervical Margins Relocation (CMR). Apply a thin layer of
composite resin to cover whole dentin, fill the retentions, and relocate margins supragingivally, if
necessary
• Isolate cavity with a layer-forming glycerine gel and light-cure the resin again for 10 s
• Finish enamel margins with fine diamond instruments without exposing dentin. Do this with
composite margins too, if present
• Take impression
• Insert the temporary resin material into the cavity, check the occlusion before the material sets,
remove excesses, and light-cure in occlusion for 30 s
10
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
a b
Figs 5a and b Rubber dam isolation is facilitated by placing a metallic matrix and interproximal wedges.
11
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
a a
b b
c c
Fig 7 Dual Bonding (DB) or Immediate Dentin Fig 8 DB or IDS with a self-etch adhesive system.
Sealing (IDS) with an etch-and-rinse adhesive sys- This procedure also involves the thin subgingival
tem. This procedure also involves the thin subgingi- enamel margins, if present. (a) The cavity before
val enamel margins, if present. (a) Orthophosphoric the adhesive treatment. (b) Application of the self-
acid etching of dentin and thin interproximal enamel etching primer on dentin and thin enamel. (c) Ap-
for 5 to 10 s. (b) Primer application on dentin. (c) plication of the bonding resin. The resin is then po-
Bonding resin application on dentin and thin enam- lymerized for 20 s.
el. The resin is then polymerized for 20 s.
12
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
13
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
Table 2 Comparison between the conventional and updated clinical protocol for bonded inlays and onlays
14
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
15
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
16
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
a b
c d
17
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
a b
c d
18
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
Provisional restoration
Following the impression, cavities will be
temporarily restored with, preferably, a
non-cemented “semi-rigid” light-curing
resin (eg, Teliotemp, Ivoclar Vivadent)
(Figs 12a to 12c). Practically, the cavity
first needs to be isolated with Vaseline
at the periphery and over the axial walls,
leaving a small central area at the cavity
a
floor without isolation (the size of which
depends on the cavity design and re-
tentiveness) to provide “semi-adhesion”
between the composite liner and provi-
sional material, granting temporary re-
tention. Then, an adequate amount of the
light-curing material is inserted into the
cavity before occlusion by the patient,
who then proceeds with anterior and lat-
eral movements in order for the tempor-
ary restoration to be shaped functionally.
b
Thereafter, interproximal, buccal, and
lingual/palatal excesses are removed
and the resin is light cured in occlusion.
Limited interproximal excesses contrib-
ute to temporary stabilization. The place-
ment of such temporaries is both simple
and fast, assuming adequate protection
of the preparation, teeth stabilization,
and the patient’s functional comfort. Due
to the very short time that it remains in
the mouth, the presence of triclosan as
an antimicrobial agent in the temporary c
material (ie, Teliotemp) and the related
Fig 12 Temporization of the cavity. (a) The soft
issues that have been raised about this resin is inserted into the cavity with a “finger” tech-
disinfectant’s potential side effects, is nique. As the provisional resin is not cemented, it
needs to be hardened inside the mesial and dis-
limited or insignificant.62,63
tal interproximal spaces. The use of interproximal
A classical provisional restoration wedges limits gingiva bleeding and material over-
made out of acrylic resin is not recom- filling against the papilla. (b) The resin is photopo-
mended any longer due to its time-con- lymerized while the patient is in occlusion. (c) The
provisional resin after the polymerization (note the
suming procedure (compared to “semi-
interproximal rinsing “tunnels”).
rigid” light-curing resin), as well as the
19
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
a b
Figs 13a and b The in-lab composite resin onlays. Only A3–A2 shades and occlusal stains were used
for the in-lab stratification (Tetric EvoCeram A2–A3, Ivoclar Vivadent; Kolor + Plus, Kerr, Rozcan Labora-
tory, Geneve).
20
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
a b
21
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
CLINICAL RESEARCH
22
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015
ROCCA ET AL
ceramic partial coverage alization. Quintessence Int 59. Zaruba M, Göhring TN,
premolar restorations. Cavity 2007;38:371–379. Wegehaupt FJ, Attin T. Influ-
preparation design, reliabil- 51. Tjäderhane L, Nascimento ence of a proximal margin
ity and fracture resistance FD, Breschi L, et al. Strat- elevation technique on mar-
after fatigue. Am J Dent egies to prevent hydrolytic ginal adaptation of ceramic
2005;18:275–280. degradation of the hybrid inlays. Acta Odontol Scand
43. Soares CJ, Martins LR, layer – A review. Dent Mater 2013;71:317–324.
Fonseca RB, Correr-Sobrinho 2013;29:999–1011. 60. De Munck J, Van Lan-
L, Fernandes Neto AJ. 52. Peumans M, Kanumilli P, De duyt KL, Coutinho E, et al.
Influence of cavity prep- Munck J, Van Landuyt K, Fatigue resistance of dentin/
aration design on fracture Lambrechts P, Van Meerbeek composite interfaces with
resistance of posterior B. Clinical effectiveness of an additional intermediate
Leucite-reinforced ceramic contemporary adhesives: a elastic layer. Eur J Oral Sci
restorations. J Prosthet Dent systematic review of current 2005;113:77–82.
2006;95:421–429. clinical trials. Dent Mater 61. Magne P, Nielsen B. Interac-
44. Stappert CF, Abe P, Kurths 2005;21:864–881. tions between impression
V, Gerds T, Strub JR. Mas- 53. De Munck J, Van Landuyt K, materials and immediate
ticatory fatigue, fracture Peumans M, et al. A criti- dentin sealing. J Prosthet
resistance, and marginal cal review of the durability Dent 2009;102:298–305.
discrepancy of ceramic of adhesion to tooth tissue: 62. Garza ADG, Haraszthy
partial crowns with and methods and results. J Dent VI, Brewer JD, Monaco E,
without coverage of compro- Res 2005;84:118–132. Kuracina J, Zambon JJ. An
mised cusps. J Adhes Dent 54. Satoh M. How to use “Liner in vitro study of antimicrobial
2008;10:41–48. Bond System” as a dentin agents incorporated into
45. Rocca GT, Krejci I. Crown and pulp protector in indirect interim restorative materials.
and post-free adhesive res- restorations. Jap J Adhes Open J Somatology 2013.
torations for endodontically Dent 1994;12:41–48. doi:10.4236/ojst.2013.31017.
treated posterior teeth: from 55. Jayasooriya PR, Pereira PN, 63. Yazdankhah SP, Scheie AA,
direct composite to endo- Nikaido T, Burrow MF, Tagami Høiby EA, et al. Triclosan
crowns. Eur J Esthet Dent J. The effect of a “resin coat- and antimicrobial resist-
2013;8:156–179. ing” on the interfacial adap- ance in bacteria: an over-
46. Dietschi D, Ardu S, Krejci tation of composite inlays. view. Microb Drug Resist
I. A new shading concept Oper Dent 2003;28:28–35. 2006;12:83–90.
based on natural tooth color 56. Feilzer AJ, De Gee AJ, 64. Ribeiro JC, Coelho PG, Janal
applied to direct composite Davidson CL. Increased MN, Silva NR, Monteiro AJ,
restorations. Quintessence wall-to-wall curing contrac- Fernandes CA. The influence
Int 2006;37:91–102. tion in thin bonded resin lay- of temporary cements on
47. Magne P, Bruzi G, Carvalho ers. J Dent Res 1989;68:48– dental adhesive systems for
AO, Giannini M, Maia HP. 50. luting cementation. J Dent
Evaluation of an anatomic 57. Rocca GT, Gregor L, Sand- 2011;39:255–262.
dual-laminate composite oval MJ, Krejci I, Dietschi D. 65. Koch T, Peutzfeldt A,
resin shade guide. J Dent In vitro evaluation of mar- Malinovskii V, Flury S, Häner
2013;41(suppl 3):e80–86. ginal and internal adaptation R, Lussi A. Temporary zinc
48. Zhao K, Pan Y, Guess PC, after occlusal stressing of oxide-eugenol cement:
Zhang XP, Swain MV. Influ- indirect class II composite eugenol quantity in dentin
ence of veneer applica- restorations with different and bond strength of resin
tion on fracture behavior resinous bases and interface composite. Eur J Oral Sci
of lithium-disilicate-based treatments. “Post-fatigue 2013;121:363–369.
ceramic crowns. Dent Mater adaptation of indirect com-
2012;28:653-660. posite restorations”. Clin
49. Bertschinger C, Paul SJ, Oral Investig 2012;16:1385–
Lüthy H, Schärer P. Dual 1393.
application of dentin bond- 58. Medina AD, de Paula AB,
ing agents: effect on de Fucio SB, Puppin-Ron-
bond strength. Am J Dent tani RM, Correr-Sobrinho
1996;9:115–119. L, Sinhoreti MA. Marginal
50. Rocca GT, Krejci I. Bonded adaptation of indirect restor-
indirect restorations for ations using different resin
posterior teeth: from cavity coating protocols. Braz Dent
preparation to provision- J 2012;23:672–678.
23
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 10 • NUMBER 3 • AUTUMN 2015