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Invited Review

Indirect resin composites
Suresh Nandini
Department of Conservative Dentistry, Meenakshi Ammal Dental College, Chennai - 600 095, India

Aesthetic dentistry continues to evolve through innovations in bonding agents, restorative materials, and conservative preparation techniques. The use of direct composite restoration in posterior teeth is limited to relatively small cavities due to polymerization stresses. Indirect composites offer an esthetic alternative to ceramics for posterior teeth. This review article focuses on the material aspect of the newer generation of composites. This review was based on a PubMed database search which we limited to peer-reviewed articles in English that were published between 1990 and 2010 in dental journals. The key words used were ‘indirect resin composites,’ composite inlays,’ and ‘fiber-reinforced composites.’ Keywords: Composite inlays; fiber-reinforced composites; indirect resin composites.

Dental composite formulations have been continuously evolving ever since Bis-GMA was introduced to dentistry by Bowen in 1962. Recent developments in material science technology have considerably improved the physical properties of resin-based composites and expanded their clinical applications. Dental restorative composite materials can be divided into direct and indirect resin composites (IRC). IRCs are also referred to as prosthetic composites or laboratory composites. These materials offer an esthetic alternative for large posterior restorations. There are a plethora of materials available nowadays.

margins.[3,4] This leads to improper sealing, which results in microleakage, postoperative sensitivity, and recurrent caries. The achievement of a proper interproximal contact and the complete cure of composite resins in the deepest regions of a cavity are other challenges related to direct composite restorations. Various approaches have been developed to improve some of the deficiencies of direct-placement composites.[5,6] However, no method has completely eliminated the problem of marginal microleakage associated with direct composite.[4,7] IRCs were introduced to reduce polymerization shrinkage and improve the properties of material. Though the mechanical properties of the IRCs are much inferior to that of ceramics, in some clinical situations, IRCs can supplement and complement (rather than replace) ceramic restorations: for example, in coronal restoration of dental implants. As ceramics exhibit a high modulus of elasticity and absorb little of the masticatory energy, considerable amount of the masticatory force is transmitted to the implant and the periosseous structure, reducing the longevity of the restoration. Polymers become the materials of choice in this situation because they absorb relatively more of the occlusal stress. For patients with poor periodontal structures who require occlusal coverage, stress-absorbing materials like IRCs are indicated[8] This review article focuses on the material aspect of this newer generation of composites. This review was based on a PubMed database search that we limited to peer-reviewed English-language articles published between 1990 and 2010 in dental journals. For the literature search the key words used were ‘indirect resin composites,’ ‘composite inlays,’ and ‘fiber-reinforced composites.’

Dental resin composites were introduced initially for use as anterior restorative materials. Later, with technological improvements, the prospect of restoring posterior teeth with composite was introduced. Though there are numerous causes for failure of clinical restorations made of direct composites, the major cause with the earlier posterior composites was poor wear resistance.[1,2] While the newest direct composite resins offer excellent optical and mechanical properties, their use in larger posterior restorations is still a challenge since polymerization shrinkage remains a concern in cavities with high C-factor. Though there have been numerous advances in adhesive systems, it is observed that the adhesive interface is unable to resist the polymerization stresses in enamel-free cavity Address for correspondence:
Dr. Suresh Nandini, Department of Conservative Dentistry, Meenakshi Ammal Dental College, Chennai - 600 095, India. E-mail: Date of submission: 23.09.2010 Review completed: 25.09.2010 Date of acceptance: 28.09.2010 DOI: 10.4103/0972-0707.73377

Touati and Mörmann introduced the first generation of IRCs for posterior inlays and onlays in the 1980s.[9] Direct


Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4

[13–16] The effect of additional cure may vary among the different studies because certain materials respond better to additional cure and because different methodologies may have been employed for determining these parameters.which uses light and heat for the indirect technique. DISADVANTAGES OF FIRST GENERATION COMPOSITES First-generation composites showed poor In vitro and clinical performance. This separating medium helps in easy removal of the inlay after the initial intraoral curing. This technique eliminates the need for an impression of the cavity and the procedure can be completed in a single sitting.[18. It is observed that 25%–50% of the methacrylate group remains unpolymerized. polymerization technique. With the first-generation composites either a direct–indirect / semi-indirect method or an indirect method was used to fabricate the restoration.[10] For inlay composites. whereas Visio-Gem® (ESPE- SECOND-GENERATION IRC The clinical failures endured with first-generation composites and the limitations faced with ceramic restorations led to the development of improved secondgeneration composites. Kuraray). which was marketed as Concept® in the US.[12] It is possible to use any posterior composite for indirect techniques with additional curing.Nandini: Indirect composites resin composites were composed mostly of organic resin matrix. Deficient bonding between organic matrix and inorganic fillers was the main problem leading to unsatisfactory wear resistance.[12] Premiere) uses heat and vaccum for additional curing. marginal gap. which improves the degree of conversion and also reduces the side effects of polymerization shrinkage. PROPERTIES OF FIRST -GENERATION COMPOSITES Various studies have demonstrated the properties of the first-generation composites. Wendt[17] demonstrated that a 5-min post-light-heat treatment at 123°C (253°F) increased the hardness and wear resistance by as much as 60%–70%.04–1 µ. The improvements occurred mainly in three areas: structure and composition. the wear rates for the heat-treated and non-heat-treated resin restorations were exactly the same: around 60 µ in 3 years. an additional or secondary cure is given extraorally. The restoration is then subjected to extraoral light or heat tempering in an oven. and modification of the polymerization system. The only shrinkage that is unavoidable is that of the luting cement. and adhesive failure in the first attempts to restore posterior teeth. camphoroquinone decomposes to form free radicals and initiates polymerization. and coupling agent. It was observed that the degree of conversion increased by 6%–44%. But. The firstgeneration IRCs had a composition identical to that of the direct resin composite marketed by the same manufacturer and the materials also bore names similar to that of the direct materials. Conquest® (Jeneric/ Pentron). EOS® (Vivadent). Flexural strength ranges from 10–60 MPa and elasticity modulus ranges from 2000–5000 MPa. Upon light initiation. One of the first materials introduced by Ivoclar was SR-Isosit®. DI-500® Oven (Coltene Whaledent) or a Cerinate® Oven (Den-Mat Corp) can be used at 110°C for 7 min. This system uses a hydropneumatic heat cure in the Ivomat® apparatus.[11] It was observed that the firstgeneration IRCs showed improved properties only in lab studies but had failures in clinical studies. Measures to solve these problems included increasing of inorganic filler content. Indirect The inlay is fabricated in a die. and fiber reinforcement. Post-cure temperature had a much higher influence on the degree of conversion than post-cure duration.[13] Direct–indirect/semi-indirect method The composite material is condensed into the cavity after the separating medium is applied to the cavity. reduction of filler size. which is in contrast Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 185 . microleakage.[13] Another example of indirect material is Clearfil CR Inlay® (Kuraray). The polymerization takes place in water at 120°C and a pressure of 6 bar for 10 min.[12] Brilliant DI® (Coltene Whaledent) and True Vitality® (Den-Mat Corp) are examples of material that uses both light and heat for this technique.19] It was observed that supplementing conventional photocure with additional cure increased the monomer conversion but did not necessarily improve the physical properties. resulting in the formation of a highly crosslinked polymer. Clinical studies of other compositions given the same heat treatment generated similar results. The inlay is then removed and heat cured in an oven at 100°C for 15 min (CRC-100 Curing Oven®. clinically. high incidence of bulk fracture. composite material is condensed in increments into the cavity and light cured for 40 sec for each surface. inorganic filler. heat treatment did not influence the wear resistance of the clinical restorations. Regardless of time. After the separating medium is applied to the die. and Dentacolor® (Kulzer) use only heat for additional curing. The advantage of this technique is that the proximal contours can be achieved appropriately.[9] Structure and composition The second-generation composites have a ‘microhybrid’ filler with a diameter of 0.

The resin matrix acts to protect the fiber and fix their geometrical orientation. Faster rates of polymerization tend to prematurely rigidify the newly formed polymerized branches. vacuum. Basically.[23] This allows a significant increase in polymer chain mobility.[29] Due to economic reasons it is impossible to irradiate single crowns or FPDs. cast furnaces. Alternatively. or special ovens. Behr and Rosentritt demonstrated that irradiated raw materials of composites can be mixed with new material to improve properties.[27] This methodology is used with polymers like polyethylene. E.[8] BelleGlass® and Sculpture Plus® employ this method of curing in a nitrogen bell. When breakage of chains occurs at the region of entanglement.21] influences the degree of conversion. thus improving the mechanical properties and increasing success rates. tends to inhibit polymerization and also plays an important role in the apparent translucency or opacity of the cured resin restoration. The possible disadvantage of this method is polymer degradation and discoloration of the resin. The radiation dosage usually given is 200 KGy. it will result in strength reinforcement.[22] The various techniques used for additional cure are desribed below. or polysulfone. Even additional light curing extraorally did not efficiently improve the degree of conversion. Others.[28] The two main reactions that occur when a polymer is subjected to electron beam irradiation are chain breakage and chain linkage. wear. and glass fibers[31–33] were tested. disallowing further propagation of the molecule. specific conditions like heat. This Fiber-reinforced composites were introduced by Smith in the 1960s.[20.Nandini: Indirect composites to that of the first-generation composites that were microfilled. and oxygen-free environment are utilized for polymerization of second-generation IRCs.39] The fibers can be arranged in one direction (unidirectional).[25] Post-cure heating of resin composite materials decreases the levels of unreacted monomer after the initial lightcuring stage. resulting either in a weave. the temperature applied in this treatment must be above the composite’s glass transition temperature (Tg). Entrapped oxygen increases the wear rate by weakening the wall around it. favoring additional cross-linking and stress relief.[24] Nevertheless. the mechanical properties and wear resistance is improved. Second. Kevlar®. have intermediate filler loading. Fiber reinforcement Nitrogen atmosphere Air. Nitrogen pressure eliminates internal oxygen before the material begins to cure. Electron beam irradiation The temperature usually used for IRC ranges from 120– 140°C.[36. and abrasion. such as Solidex® (Shofu Inc. the fibers can be arranged in different directions to one another. esthetics. Such a condition will increase their stiffness. By increasing the filler load.[26] Heat polymerization Electron beam irradiation is another method described for improving the composite’s properties. which enables better esthetics and are preferred for anterior tooth. 186 Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 . unreacted monomers would be volatilized during the heating process.[34.[30] carbon/graphite fibers.[9] The new composite resins like Artglass® and belleGlass HP® contain high amounts of filler content.[38. Ideally.37] The details of the FRC are shown in Table 1a and 1b. two mechanisms can be involved in this phenomenon.[34] When the directional orientation of the fiber long axis is perpendicular to the applied forces. polycarbonate. Glass and polyethylene are the commonly used fibers in dentistry. with the fibers running from one end to other in a parallel fashion. which make them adequate for restoring posterior teeth.[40] Forces that are parallel to the fiber orientation will produce matrix-dominated failures and consequently yield little reinforcement. but lower dosage like 1 KGy also has been shown to improve the properties. Removing all of the encased air causes the restoration to become considerably more translucent. because it contains oxygen.or mesh-type architecture. Polyethylene fibers. pressure. Multidirectional reinforcement is accompanied by a decrease in strength in any one direction when compared with unidirectional fiber. Oxygen entrapment in the restoration tends to break up or diffract natural light as it reflects from the surface of the restoration. Thus. This concept was first used by Heraeus-Kulzer in the development of Charisma®. a glassforming agent is present at 6–9 wt% in E-fibers and <1 wt% in S-fibers. and by reducing the organic resin matrix. the residual monomer would be covalently bonded to the polymer network as a result of the heat treatment. It was observed that the wear resistance increased by 35% on curing with both light and heat when compared to curing with light only. Fibers act as crack stoppers and enhance the proprety of composite.35] Boron oxide.[16] The combination of heat and light increases the thermal energy sufficiently to allow better double-bond conversion. The heat can be applied in autoclaves. Such a concept is incorporated in the curing process for both belleGlass® and Cristobal®. the polymerization shrinkage is reduced. there is induction of dense packing. This influences the bond between the filler and matrix. First. leading to increase in the conversion itself. Soft start or sow curing Polymerization techniques The concept of slow curing described by Mehl[26] is based upon the concept that a slower rate of curing will allow a greater level of polymerization.and S-fibers are the ones most commonly used in dentistry.). The filler content was also twice that of the organic matrix in the latter composites. it is noteworthy that overheating may cause degradation of the composite.

[64] observed a positive relation between the volume fraction of filler and diametral tensile strength and hardness.(Mesh) VectrisPontic – unidirectional R glass-fibres (Unidirectional) FibreKor 2K strips contain 2. Table 1b: Details of directly processed fiber composites Name Ribbond (Ribbond) Connect (Kerr) Splint It (jeneric/pentron) Everstick (Stick Tech Ltd) Fiberflex Biocomp Glaspan (glaspan) DVA fibers (dental/Ventures) Fiber-splint (polydentiainc) Composition Polyethylene Gas plasma treated woven polyethylene fibers. and position influences both flexural strength and modulus of resin composite. Fiber volume. and Pontic. Single.57–63] are presented in Table 3.60Wt% for pontic and around 45-50% for the other materials. Vectris MatrixLaunched in 1996 BisGMA and TEGDMA(24. FiberKor S-glass fibers(60%) in 100% bis-GMA matrix (Jeneric/Pentron) EverStick net (Stick tech Ltd) E-glass fibers impregnated with PMMA. (Unidirectional) Mesh type glass fibers Processing method Initial polymerization -1 min with light curing unit final polymerization -light and heat curing unit (Targis power) for 25 minutes. Chung et al. Neves et al.41] Applying unidirectional glass fibers which are not preimpregnated or aged at the tensile side instead of polyethylene fibers improves flexural strength.[43] The various second-generation composites are shown in Table 2.29. Mechanical properties The additional cure and the increased volume of inorganicfillers has improved flexural strength to 120 -160 MPa and elastic modulus to 8.3&0. Adding polyethylene fibers on the side of compression adds strength to the material.[38. Other studies also investigated the association between the mechanical properties of composites and the filler volume. Glass Glass polyethylene Glass Kevlar Glass Polyethylene Glass Fiber arcitecture Lenoweave (cross link stitch weave) Braid Unidirectional Weave Weave Unidirectional Unidirectional Braid Unidirectional Weave Processing method Chair side impregnation required Preimpregnated Preimpregnated Preimpregnated Chair side impregnation required Chair side impregnation required Chair side impregnation required Chair side impregnation required In high stress–bearing areas. high elastic modulus.[35] The other factors that affect the modulus of FRC are the physical and chemical properties of the composite[42] and the interfacial adhesion and matching of the modulus between the fiber and the overlying veneering composite.51. as assessed in various studies.000 fibres and FibreKor 16K strips contain 16. and high impact and fatigue resistance is required.5–12 GPa.0. filler content.[65] also concluded that the filler content directly affects the hardness values. Filler content could be an important factor in deciding the physical and mechanical properties of different composite materials.000 individual fibers. aging.[43] It has been suggested by some that the interfacial bonding between the polyethylene fibers and matrix is weak. because there are other factors involved.1wt%. low deformation. The Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 187 .[44] It has been proved that the use of resin pre-impregnated silanized glass fibers results in the best mechanical properties. An improvement in the degree of conversion itself does not necessarily result in better mechanical properties. Lab studies have shown that effective reinforcement is achieved only when the fibers are placed in the side where tensile stresses act. and particle size and distribution. a material with high flexural strength. architecture.[9. such as resin composition. FibreKor4K strips contain 4. Single and Frame are glass-fibre woven E fibers. preimpregnated E &R glass . But no correlation was observed between the degree of conversion and the mechanical properties evaluated.000 fibres.39 Wt %) by Ivoclar decandioldimethacrylate UDMA .Nandini: Indirect composites Table 1a: Details of lab processed indirect fiber composites Name Composition Types / architecture Frame. Initial polymerization -light cuirng unit (alpha lightI)for 1minute followed by light-heat curing for 15 minute in(alpha lightII) 45 The wetting of fibers is done with stick resin and polymerization as for fiberKor.[45–56] PROPERTIES OF SECONDGENERATION IRCS The mechanical properties of secon-generation IRCs.

Heraeus/ Kulzer). Bonding to the metal substrate This type of light exposure increases polymerization is achieved by applying an potential. and cooling for 5 min. microfiller particles can insert Polymerization of this material with two different themselves into the gaps between light sources improves the property[50]. Polymerization Key points Photo-cured in a special unit using a xenon Can be used to fabricate inlay. The polymerization is carried by heating in an oven at 140oC at 80 psi for 20 minutes.015-0. fibre reinforced bridges and for the The polymerization mode for alpha source is 15 seconds customization of prefabricated teeth. Claire in 1996 Filler-Silanatedmicrohybrid fillers of 0. The material can be without framework material. Additional to conventional bifunctional molecules.7% wt and 65% volume) Surface material has borosilicate fillers which provide enhanced optical characteristics are used (74%wt and 63% volume). able to absorb the stresses. with a conventional light cuirng unit which stabilizes the restoration during build up and reserves unreactive surfaces for bonding. Uses two different curing units. Targis Launched in 1996 by Ivoclar Vivadent [ceromer] filler. In addition. Base and surface composites are available which are used on dentin and enamel respectively. which reacts with the metal or the metal oxide. The high intensity is emitted for only 20 metals). which will allow for further reduction in polymerization shrinkage9. Visio beta). This gives the advantage of incremental buildup and resembles the natural tooth with the hard. SR Link comprises a monomer that contains a highly hydrophobic aliphatic hydrocarbon chain and a phosphoric ester with a methacrylate function. longer period of nonexposure allows the already a flexible copolymer. Belleglass HP introduced by Belle de St. made available for reaction[45]. It is a form of amorphous silicon dioxide with a primary particle diameter of < 0. to the metal cured resin molecules to partially relax. Five different shades of enamel composites are available. for inlays / equipped with a halogen lamp whereas the Visio beta is equipped with four fluorescent tubes. to fabricate adhesive inlays/onlays/ veneers and anterior crowns. After the metal oxide reaction has been completed. a liner.ultra-fine glass or glass-ceramic powders Pyrogenic silica is also used as a microfiller. Targis system has continuously been revised and the. A copolymer is produced by grinding a microfilled composite into particles of approximately 10-30 µm and later incorporated into inorganic microfillers. Upon polymerization. Matrix-polyfunctional methacrylate monomers. The phosphates form a passivating layer on the metal surface. incisal material and Opaquer.6 µ. forming a phosphate. enamel covering the more opaque and softer dentin. SR Adoro (Ivoclar Vivadent) The dentin and enamel materials constitute the main components. The surface composite is heat cured. They unit equipped with two metal halide lamps. individual crowns. Spheroid silica filler -0.conventional monomers. The onlays. The with an intensity of 150W for 60 seconds[49]. The base composite is light cured. and more surface before placing and curing of the nonreactive double-bond carbon groups are the restorative material[13]. The base composite has barium glass fillers (78. components of this system include SR Link (to bond to metal frame work).a combination of a hydrocarbon saturated methacrylate diurethane of TEGDMA & aliphatic dimethacrylate. the macrofillers. Matrix. for enamel .77wt% . whereas. Matrix. The short excitation time followed by a acrylonitrile copolymer (Kevloc). translucent. The reduction in size of the filler improves the polishability and smoothness of the material. Artglass contains four to six functional groups which provides the opportunity for more double-bond conversions[45]. produced in an oxy-hydrogen gas flame. followed by 80 milliseconds of darkness. Targis is coated with glycerin gel (Targis Gel) to prevent formation of oxygen-inhibited surface layer and placed in the curing unit Targis Power (IvoclarVivadent) for the following cycle: light emission in the first 10 min along with increase of temperature to 95oC for 25mins.70wt% filler of bariumsilicate glass of 0. glass polymerization wavelength ranges from 400-550nm. the layer becomes very inert. metal substrate (ranges from while the emission range is between 320 and 500 nickel-chromium to gold-based nanometers. The are used to control the rheological wavelength is in the range of 250-600nm and properties of the composite. application could now be defined for SR Adoro The phosphoric acid group of the molecule is a strong acid. Sinfony Introduced by 3M ESPE Used for full veneering of fixed The proprietary system consists of two polymerising and removable prostheses on units (Visio alpha.05 µm. The onlays and crowns with/without system emits 4.the Visio alpha is metal frameworks. Fillers . Targis is suitable for veneering metal frameworks. whereas that of beta source is 40oC for 15minutes[47.25 µ and colloidal silica – 0. milliseconds.Nandini: Indirect composites Table 2: Details of second generation IRC Brand name Artglass Launched in 1995 By HeraeuslKulzer Composition Filler.05 µ. Newer composite like “Foundation” has been modified to have a filler diameter of 30 µ in the base composite.30wt% organic resin. Resin matrix of dentin -bis-GMA.5 watts as usable luminous power. dentin material. forming a copolymer and thereby providing a bond to the veneering resin. 188 Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 . The methacrylate group of the phosphoric acid reacts with the monomer components of SR Link. the copolymers become completely integrated into the composite and a homogeneous composite with a high loading of inorganic microfillers is obtained.7µ. The atmosphere is maintained oxygen free and under nitrogen gas pressure[46]. stains. The liner has 49% by weight barium glass filler particles. Targis is a veneering composite material.48] Pyrogenic silica has large surface The other non proprietary unit used is Hyper area (up to 350 m2/g) and have LII which is a high – intensity polymerization therefore a thickening effect. Matrix-of dentin and incisal material consists of UDMA instead of Bis GMA and TEGDMA and the copolymer filler load is about 63% by weight. stroboscopic light (UniXS. trimodal and has barium glass of particle size of 1µ.

Pearlcure heat. prepolymerised filler (75wt%)[56] authors reported that materials with higher filler volumes showed better mechanical properties. Filler –alumina ultrafine filler. Pearlcure light –high pressure mercury lamp 150W*1. Fillers-silanated fillers such as barium boro-silicate glass. which provide support to the working die while reflecting and diffusing light around the chamber and onto the composite surface. and TEGDMA[52].67] Borba et al. The additional light polymerization is done with Introduced Filler -53 vol% of 1µ silicon dioxide and Solidilite system which is equipped with 4 halogen by Shofu aluminium oxide inorganic fillers[51] and ceramic lamps for fast curing for a curing time of 1~5 microfilaments. (GC Corp) Filler – silica powder. The average particle size for this composite is approximately 50 nanometers (0. TEGDMA ZetaLC Fillers. build-up without removing the restoration from the body. accelerator. Incisal Material Matrix utilizes a low Bis. opaceous Body and neck Paste.6 micrometer. UDMA. Matrix -difunctionalmethacrylates of PCBisGMA.05µm). Sublitecuring system is resins and 22% conventional resins/ light-initiators. –multiphase feldspar frits and silicon (Vita dioxide (44. It also contains a small amount of Al2O3.heat cup with the restoration submerged in water.acts as a “crack arrester.GMA concentration. BisGMA. Paradigm MZ100 blocks are made in two cylindrical sizes. Polymerization is done in a light cup and heat cup underwater.heat oven 15 min under atmospheric pressure.08µ) Dental Corp) Estenia C&B (Kuraray) Matrix– UDMA. These materials have the advantages of both composite resins and porcelains without being confined by the inherent limitations of either. incisal. Secondary ppolymerization . Matrices for the dentin. Each increment is light cured for 2 minutes. cervical. photoinitiator. This system maintains a higher density of inorganic ceramic microfillers compared to the earlier-generation direct and indirect systems[54]. body and incisal material -Bis. nano-sized fi llers that ensure high translucency due to natural refraction. The body and the incisal material consist of a reinforced microfill (70% by weight). The presence of these 1-1µm reinforcement particles . silicate glass powder. which is 0. UDMA. and an average particle size of 0. The polymer matrix consists of bisGMA and TEGDMA and a ternary initiator system. designed for initial or short polymerization during It is available as metal primers. observed that the hardness and flexural strength of direct resin composites were better than that of the IRCs. 350-550nm for 120S. minutes at a wavelength of 420-480 nm and Matrix-25 wt % co-polymers of multi-functional temperature of 55 ºC. compared to the main filler. . It pressurizes with nitrogen gas and automatically runs an 8min cure cycle that includes 5min of pressure. Sculpture plus (Pentron) Nano-hybrid IRC available as body. zirconium silicate. Secondary Light cure – Alpha II for 5 min Secondary heat cure – KL 100at 110oC for 15 minutes[55]. Filler-The dentin material is a highly filled hybrid (85% by weight. Made from Z100 restorative material under optimized process conditions that assure thorough cure and a high degree of crosslinking. The light cup contains white reflection beads.GMA.” while the increased particle concentration of the microfill particles provides improved clinical performance.3 wt%) Zahnfabrik) Additional light curing can be done with Dentacolor Used for the full and partial XS curing unit at circa 40oC at wavelength of 350. This was attributed to the high filler content of 78–84 wt% of D250® and D350® than Sinfony® and Vita®.04µ). nano-particulated silica. The particles have a spherical shape.04µm in size. The artificial dentin is initially pressurized (60 pounds per square inch [psi]) in a light cup before the light-curing cycle is initiated to eliminate the incorporation of internal voids and bubbles during the incremental build-up process. incisal. Added to the nanoparticles is a “reinforcement” particle that averages 1-µm in size. whereas the dentin and body materials have a higher concentration Sculpture curing light is an automatic curing light under pressure both prior to and during light cure.veneering of crowns. TESCERA ATL (BISCO INC) Paradigm 85 wt% ultrafine zirconia-silica ceramic particles MZ100 that reinforce a highly crosslinked polymeric (3M ESPE) matrix. Secondary Light cure – Alpha II for 5 min Pearleste Bis-MPEPP TEGDMA. ethoxylatedbis “a” dimethacrylate. Thus. Alternative to porcelain blocks for CEREC restorations. E2 Filler-SilicaZirconia(0. The ultrafine zirconia-silica filler particles are synthesized by a patented sol-gel process that results in a unique structure of nanocrystalline zirconia dispersed in amorphous silica. stabilizer and pigments.[66. 10 and 14. The filler particles are silanated for suitable adhesion to the organic matrix. followed by 3 minutes of high intensity light.Nandini: Indirect composites Brand name Composition Polymerization Key points Solidex Light cured indirect ceramic polymer system. Residual free oxygen in the water is removed by adding an oxygen-scavenger agent. Silica –titania (Tokuyama (0. UDMA and HDDMA. IRCs Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 189 . 73% by volume). model. EBPADMA.UDMA. The two curing cycles are a build-up cycle and a final cycle when the restoration build-up is complete. glass filler (92wt%) Gradia Matrix. and as 500nm long-term temporary metal-free restorations. UDMA. Vita Matrix -Bis GMA. opaque and translucent shades. The final restorations are cured using an initial full cycle of pressure (60 psi) with light and heat (peak heat of 130°C and decreasing to approximately 90°C before releasing pressure) for 10 to 13 minutes[53]. these correspond to the CEREC sizes. This contrasts sharply with milled glass fillers in conventional hybrid composites.

observed that Sinfony®. IRCs polymerized under light activation only may have intermediate mean microhardness values (e.3* 6 16 7000MPA* 55v 72 34.[45] A change in concentration of Bis-GMA can also improve the wear resistance. with 50 wt% and 45–48 wt%.5 2. even though it is polymerized with light and vacuum. respectively) and lower values for the mechanical properties evaluated than expected for second-generation systems could be classified as intermediate laboratory composite resins[68]. Vita Zeta®. Sinfony® presents inferior mechanical properties. which may be attributable to the volume of filler.[74] Kim et al.7 3. This suggests that the composition of the material influences the degree of conversion during polymerization resulting into lower resistance to indentation. This was because of the number of remaining double bonds.[61] Freund and Munksgaard have found that there is a hydrolytic action of the esterase enzyme on resin restorations in the oral environment.g.[73] Krecji and colleagues demonstrated that Artglass® was considerably more wear-resistant than conventional light-cured composite resins.1 - Belleglass Artglass 22. shape. 13100(d). 442(e) 142 (D) 148 (E) 33(DTS) 110 37(DTS) 95-130 110 -135 100 145 140* 120* 120* 77 130* 0. Nakazawa et al. This is because degradation of the material may have occurred due to the heat generated by the high level of light energy. The mode of curing and the remaining double bonds may influence the color stability of the material. Consequently. Artglass® and Solidex®). while the Artglass® formulation exhibits only 50%–60% this amount. observed that the wear resistance and hardness of Artglass® detroriates on immersion in water. did not discolor when immersed in water but showed color deterioration when immersed in tea. when cured with the manufacturer-prescribed curing unit. Tanoue et al. when Sinfony® was cured with the Hyper LII® unit. whereas that of Solidex® does not. exhibits an average annual wear rate of only 8 µ..46 µ/rev 6 µ/yr 0. Sinfony®. This may be because there is a correlation between the method of polymerization and the microhardness.. a conventional composite resin.8-1 Elastic modulus GPa Hardness Solubility g/mm3 -2.[70] reported that heat might facilitate monomer conversion by breaking the double bonds on the polymer network into single bonds.g.[71] Wear of composite resin materials has been evaluated in terms of two main clinical components: occlusal contact/ attrition wear and contact free/abrasive wear. On the other hand.7mm3 41mm(after water immersion) 0. which resists wear.7 11 20 3 8 13. observed that there was an increase in lightness and a green-yellow or green-blue shift in color in IRCs on curing as well as after aging in various 190 Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 .5 28 52 490 Targis 163kgf Sinfony* 272 Paradigm Z100* 500 Sculpture 281 Gradia Vita zetallc Solidex 206 SR Adoro * denotes manufacturer details with lower percentage of inorganic content (e. On the other hand. This could be due to the use of microfillers and the small particle size and the interparticle spacing. The substantial increase in wear resistance of the indirect material can be attributed in part to the incorporation of multifunctional monomers.[69] pointed out that the best mechanical and physical properties are achieved by using a combination of composite material and curing unit from the same manufacturer. and bonding to matrix affects wear.Loss mm3 or Rate µ -) strength (MPa) (MPa) (MPa) 163 223kgf 413(d). The chemical treatment of filler to increase bonding to matrix decreases wear. which permits better control over the positions along the carbon chain where the cross-linking does occur. the mechanical properties increased but it showed yellowish discoloration even on immersion in water. Belleglass® showed less wear than Artglass® and Targis®.46 µ/rev 26mm3 1µ 9µ/yr 0. also observed that there is a net color change of belleGlass® during curing that should be taken into consideration when shade matching. volume. Optical properties One of the problems associated with composite materials is the unpredictable color stability.6mm3 0.[72] Bayne et al.35 µ/rev 22 mm3(after water immersion) 0.Nandini: Indirect composites Table 3: Comparison of properties of Second generation IRC Name Compressive Tensile strength Flexural strength Wear (Vol.[75] Papadopoulos et al. Miranda et al.1 -2. Charisma®.2mm3 0. observed that Targis® had the highest microhardness among the IRCs even though its filler content was less than in the others. Faria et al. Yamaga et al. thus optimizing the polymerization of the residual monomers. studied the wear rates and proved that the wear of Concept® was less than that of belleGlass®. Filler size. 9700(e) 90. The curing of uncured material on the tooth with a hand-held curing unit has to be done for enhanced shade matching of IRCs. this can aid in improving the wear resistance and the other physical and mechanical properties of the resin matrix.

2010) wear patterns of the veneering material Alpha 1 score for overall success -71% .5% in 5 yrs can be used as long term temporary crown increased plaque accumulation restricts the indication TetricEvo Ceram. Other parameters direct resin performed better. Concept F. Clinical study type Four – six year follow up of resin inlay /onlay[85] (Leirskar et al. fracture of tooth. single and multi 89. and In 1 yr – 19µ for anterior and premolar. CM. AF. CM.surface roughness. A 4-6 yr retrospective study on Direct composite restoration Acceptable &survival rate-93 % cracked tooth bonded with indirect followed by indirect onlay 7% failure rate resin[91] (Signore et al.color match. MI.8% of Artglass and 84. F. F. MI-marginal integrity. Estilux. MI.75% Alpha ratings for all parameters for concept.5mm shoulder / 0. arch. loss of marginal integrity. 2. Maxxim. MF. Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 191 . 68 posterior. Cerec Cos 2. Charisma Class I.W More failure of inlays than conventional composites conventional resin restorations[94] (USPHS criteria) Direct inlay technique gave no clinical advantage over (Wassell et al. (USPHS criteria) Failure more in molar than premolar failure were fracture of restoration.100% Alpha ratings for all parameters for both direct and indirect composites. Seven year follow up resin inlay / Cast gold.1% of Charisma inlays – inlays[96] surface Class II inlays. acceptable (Manhart et 2007California Dental Association Quality Evaluation System SR. Z 100 Parameters compared Form. 2010) modified USPHS criteria This is a short term study. 2003) Materials compared Tetric. SC. Targis MD. MD.marginal fit. 2009) Tetricevoceram (Nano filled SR. F.5mm chamfer was prepared 13 crowns – replaced. 2010) (USPHS criteria) No significant differences between premolar and molars Small inlays survived better Failure was mainly due to bulk fracture. CS. SR Class II restoration in molar 70% of direct fillings and 88% of inlays were in An 11-year evaluation[95] isosit and premolars acceptable ratings (Pallesen et al. periodontal composite and ceramic[89] parameters. MD. Rt direct composites) (Ryge criteria) Tescera ATL. SR.both materials Both materials have acceptable success after 36 months Survival rate andsuccess rate was 88 and 56% forcomposite Survival rate andsuccess rate was 97 and 81% for ceramics Increased wear and decreased esthetics of composite makes ceramics superior for CAD CAM restorations One year results for direct and indirect composite inlays[90] (Mendonca et al. W. loss of proximal contact. AF.MD. SC – secondary caries. CM. CM. Concept yields clinically acceptable restorations particularly in premolars 85. and (Vanoorbeek et al. 2010) (Modified USPHS criteria) Three yr follow up of CAD CAM marginal fit. volume loss.acceptable and required minimal corrections.GA. Adhesively luted metal free crowns Artglass for5 years[98] (Lehmann et al. 44µ for premolar and 84µ wear for molars. SR. forCM. Filtek supreme XT. No difference between location or preparation design on complications.form. SC. modified retrospective study 3 estilux inlays were replaced indirect and ceramic inlay[93] Brilliant DI. CM. 28% . Two year wear assessment[97] Artglass Influence of gender. 1999) premolars One year follow up[87] AELITE.marginal discoloration. 2003). incremental placement Composite resin fillings and inlays. 2009) Location and preparation design on survival rates. survival rate -96% in 3 yrs 88. estenia Three year follow up[88] Admira (ormocer). SR.surface restoration performed better than 3 surfaced and onlays 50. secondary caries. (Signore et.MD (Ducik w et al. Brillinat DI. and loss of restoration no significant difference between fillings and inlays or between types of restoration Three year follow up of resin Artglass. MD. onlay[86] (Ryge criteria) in molars and (Donly et al. 2002) conventional.PS.W-wear. 5 crowns – repaired.SR.complete loss of restoration.Nandini: Indirect composites Table 4: Summary of clinical studies on IRC. and indirect composite for severely restorations in premolar and material was evaluated Direct and indirect resin composites for restoring worn worn teeth[92] (Bartlett 2007) molar of severely worn teeth. MF.SC Comments 22% of restorations . Grandio SR.SC 5 yr follow up of direct inlays and MD. SR similar to both materials. Class I and Class II (Cetin AR et al. Vita Dur. PS – no changes PS. 2007) A 3 yr RCT in evaluating direct 32 direct and indirect Wear fracture and loss of 22% fractured. posterior teeth is contraindicated. 2008) crown location on the occlusal In 2 yr – 36 µ for anterior. Estilux on cracked tooth bonded with 6 vitadur inlays were repaired (Thordruo 2006) indirect resin Both materials were in acceptable range after 10 yrs. 46 anterior crowns with 0. SR. 10 year follow up on direct. MF. 21µ for molars (Stober et al.

The use of hydrofluoric acid for surface treatment causes microstructural alteration of the composite because of the dissolution of the inorganic particles.[77. Polymerization shrinkage and polymerization shrinkage stress in polymer-based restoratives. Further clinical research is needed to evaluate the success rates with these newer IRCs. Carvalho RM. 8.21:17-24. Schmalz G.[82] Although ceramic inlays perform poorly in lab analysis. Since.4:137-44. Dias AL. is more than that of ceramics. the only polymerization that occurs is that associated with a thin liner of luting agent. Composite materials have shown a greater capacity to absorb compressive loading forces and reduce the impact forces by 57% more than porcelain.35:29-34. Leinfelder KF. Jackson RD. Campanile G.[79. Compend Contin Clinical advantages of IRCs A properly fabricated indirect restoration is wear resistant. observed that marginal adaptation and bond strength of an indirect resin system after thermocycling was better than that after direct restoration.e. a few other studies found no significant differences in microleakage after thermocycling of direct and indirect resin restorations. Feilzer AJ.[20] This causes a nonselective degradation of the resin and promotes better adhesion. Loguercio AD. application of silane after sand-blasting resulted in higher bond strength. composite inlays tend to degrade in the oral environment.[84] The various clinical studies comparing the materials are tabulated in Table 4. The surface roughness ranges from 6–8 µ.[99] Tsitrou found that resin composites have a lower tendency for marginal chipping than ceramics. thus increasing the marginal gap. Quintessence Int 1995. Thonemann B.[81] IRCs shows better marginal adaptation than ceramics because of lower polymerization contraction. a polymer of the above-mentioned materials is considered when restoring the coronal aspect of a dental implant. observed that heat-treated inlays showed less microleakage than direct restorations. 6. In the absence of multiple long-term studies. Singer JM. Mazzocco KC. Oper Dent 1999. ideal proximal contacts. Davidson CL.[2. Indirect posterior composite resins. These materials perform well in In vitro and short-term In vivo studies. 7. Loguercio AD. Quintessence Int 2004. Reis A. Microleakage in Class 2 composite resin restorations: Total bonding and open sandwich technique. esthetic. Another possible factor for bacterial adherence is the presence of remaining uncured monomers. Similar observations were found in other studies. Pereira JC. the marginal adaptation of composites is better than that of ceramics Surface properties One of the main failures of IRC restoration is the formation of secondary caries due to plaque accumulation.25:435-40. Busato AL. 2.[21] When compared to porcelain and porcelain-fused-to-metal restorations. J Dent 1997. J Am Dent Assoc 2000. the potential for tensile stresses on the odontoblastic processes is considerably less. excellent anatomic morphology.24:261-71.80] Aggarwal et al. less biofilm adhesion.[85–98] REFERENCES 1.[56] CONCLUSION Our literature review shows that there are numerous IRCs available nowadays. J Adhesive Dent 2002. According to Soares. and relatively less prone to postoperative sensitivity.22] Additional clinical benefits include precise marginal integrity. which is aggravated by the surface roughness of the material. such as better mechanical performance and a significant reduction in polymerization shrinkage (i.131:375-83. It is also apparent that IRCs can effectively supplement the use of ceramics in certain clinical conditions. The new posterior resins and a simplified placement technique.Nandini: Indirect composites environments. 4. et al. Scampa U. either alone or with fiber reinforcement. Surface treatment of IRCs The treatment of the intaglio surface of indirect restorations determines the bonding of the restoration to the tooth. 5. which can result in similar clinical behavior of both the materials sensitivity. Dietschi D. Polishing with diamond pastes also renders a smooth surface. Pashley DH. Glunder W. OperDent 1996.. Smaller filler size with more weight% produces a smooth surface and. Bauer JR.78] However. Thus. 3.26:127-38. Federlin M. needs to be assessed with long-term clinical trials. Since the compositions of the IRCs are similar. Marginal adaptation and seal of direct and indirect Class II composite resin restorations: An In vitro evaluation. the survival rate of IRC restorations cannot be assessed. Reis A. The refractory die is fractured to remove the ceramic inlays and this may result in marginal microfracture. It has been shown that the edge strength of belleGlass®. consequently. and optimal esthetics. Holz J.[76] Marginal adaptation and microleakage Leinfelder et al. the surface treatment for all materials can be the same. which translates into less potential for postoperative 192 Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 . limited to the dual-cured luting cement). The biofilm accumulation is based on the filler size and matrix monomer. Total bonding vs selective bonding: Marginal adaptation of Class 2 composite restorations. The improvement in properties due to the additional polymerization. Microleakage of packable composite in Class 2 restorations. IRC restorations offer some benefits as compared to direct restorations. the transfer of masticatory forces is considerably less.[100] Due to the similar composition of the luting cement and composites. which was observed in these studies.[83] The best alternative method to raise the surface energy is by sand-blasting with aluminium oxide particles for 10 sec. A review of polymerization contraction: The influence of stress development versus stress relief. Indirect laboratory-processed composite resin systems provide an esthetic alternative for intracoronal posterior restorations and may also reinforce tooth structure. Grande RH. but the changes were found to be within the clinically acceptable range. This reflects the ability of the material to maintain the marginal integrity to occlusal loading. Yoshiyama M. Morgan M.

Bronkhorst EM. Dent Mater 2004.26:589-99. 50.16:349-54. Mesquita RV. Watts DC. 16. Vaishnavi C. Am J Dent 2009. Surface treatment protocols in the cementation process of ceramic and laboratory processed composite restorations. Pract Proced Aesthet Dent 2001. 30. Dent Mater 2007. Influence of temperature on the viscoelastic properties of direct and indirect dental composite resins. Hopkin JK. Nemoto M. RodriguesFilho LE.8:290-5. Roating fatigue and flexural strength of direct and indirect resin-composite restorative materials.18:60-4. J Prosthodont 1998. Soares CJ. Burnett Jr LH. 17. Chai J. Effect of water storage. Dent Update 2003.19:93-8. Rueggeberg FA. Dent Mater 1992. Wear. A metal halide light source for laboratory curing of prosthetic composite materials. Dent Mater 2008. J Dent 1997. 56. Mechanical properties of new composite restorative materials. color stability. Lesaffre E. Chow TW. Mechanical properties of direct and post-cured composites. Manhart J. 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Fernandes de couto C. 20. 45. Kobayashi M. Lassila LV.23:5-10. The effect of secondary curing of resin composites on the adherence of resin cement. Kavitha S. Ladizesky NH. 59. 25. Koizumi H. Clinical considerations for aesthetic laboratory fabricated inlays/ onlay restoration a review. J Esthet Dent 1997. J Oral Rehabil 2004. Atsuta M.68:934-9 Meiers JC. A literature review. Indian J Dent Res 2010.26:467-75. Tezvergil-Mutluay A. Faria AC. J Dent Res 1990. Fonesca RB. J Prosthet Dent 2005. Discacciati JA. Nikaido T.76:688-93.Gerstorfer. Touati B. Fiber reinforced dental composites in beam testing. Fushiki R. Watts DC. Stomatologija 2007. Properties of an IRC material polymerized with two different laboratory polymerizing systems. Law D.22:219-22. 23. Dyer SR. Yamagata S. Erkstand K. 67.23:166-74. J Dent Res 1997. Dent Mater 1997. Ogino T. J Cons Dent 2010. et al. Imai T. Wendt SL. Effect of surface characteristics on adherence of S.16:244-7. Bagis B.21:761-72.13:381-2. Dent Mater 201. 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If file size is large. . Wear and surface roughness of current prosthetic composites after tooth brush/ dentifrice abrasion. high resolution image. Navajaz-Rodriguez de Mondelo JM. Isidor F.20:609-16. 74. Do not zip the files. Sato Y. 91. One-year clinical evaluation of direct nanofilled and indirect composite restorations in posterior teeth. Dukic W. your names in page headers etc. Soares CJ. Neto RG. Limit the file size to 1 MB. Do not incorporate images in the file. Silikas N. Cetin AR. 86.50:295-301.33:587-92. For online submission. Ferracane JL.28:620-6.19:613-7.22:857-63. Heymann HO. Van Noort R. Delija B. Effect of surface treatments of laboratory fabricated composites on the microtensile bondstrength to a luting resin cement. Eickemeyer G. Color stability of IRC materials polymerized with different polymerization systems.84:93-7. J Dent 2008. Hörsted-Bindslev P A prospective clinical study .30:163-8. A clinical comparison of resin .28:375-82. Condon JD. The size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1200 pixels) or by reducing the quality of image. metal-free composite crowns after five years. Jain V. Akagawa Y. Colour Stability of Veneering Composites after Accelerated Aging. JPEG is the most suitable file format.36:337-42. Donly KJ. 85. Edge strength of indirect restorative materials. Dreyhaupt J. J Appl Oral Sci 2003. 72. 2. 75. McCabe JF. 76. Yamaki M. Thordrup M. J Oral Rehab 1996. Acta Odontol Scand 2003. Do not include any information (such as acknowledgement. Brittleness index of machinable dental materials and its relation to the marginal chipping factor. Gonzalez-Lopez S. Images should be submitted separately. 100. 84. 89. Miranda CP Pigani C.11:493-8.51:267-73. J Dent 2007. Oper Dent 2003. composite inlay and posterior restorations and cast gold restorations at 7 years. Benedicenti S. 78.37:139-44. Article File: The main text of the article. Direct composite inlays versus conventional composite restorations: 5-year follow-up. Int J Prosthodont 2007. 79. Shah N. Use text/rtf/doc/pdf files. Effect of cyclic loading on marginal adaptation and bond strength in direct Vs indirect class II MO composite restorations. Quint Int 1995. 96. Giannini M. Unlu N. Giannini M. Ambrosano GM.21:161-5. Tanoue N. Int J Prosthodont 2006.) in this file. Author Help: Online submission of the manuscripts Articles can be submitted online from http://www. Navarro MF. Lehmann JF. Sarafianoub A. Thoresen NR. Lee Yk.23:223-30.29:42-8. metal-free ceramic-filled polymer crowns after 2 years in service. Northeast SE. Santiago SL. J Oral Rehabil 1995. A comparison . Bartlett D. Qvist V. Changes in color and color coordinated of an indirect resin composite during curing cycle. Faus LlacerVJ. Rammelsberg P Adhesively luted. Oliveira MT. Hasanreisoglu U. Lehnung U.126:127-38. DukicOL. An invitro comparison with direct . Composite resin inlays. Signore A.35:156-64. Quintessence Int 1999. 99. Llena Puy MC. Forner Navarro L. Nordbo H. 90. Watts DC. Lucena-Martin C. Direct resin composite restorations versus indirect composite inlays: One-year results. Use text/rtf/doc/pdf files. Pimenta LA. Do not zip the files. A four to six year follow up of indirect resin composite inlay/ onlays. and 3 years. marginal adaptation of IRCs and ceramic inlays system.12:45-50. always retain a good quality.Nandini: Indirect composites 69. Dent Mater 2009. Oper Dent 2010. Quintessence Int 2010. Hatzikyriakos A. Triolo P Chan D. Chen HY. Mehl A.Computer-aided designed/ computer-assisted manufactured composite resin versus ceramic singletooth restorations: A 3-year clinical study. Stober T. 1) 2) First Page File: Prepare the title page. graphs can be submitted separately as images. Protection hypothesis for composite wear. Each image should be less than 4 MB in size. Oper Dent 2008. Uctasali S. Thermal and mechanical load cycling on microleakage and shear bond strength to dentin. Martins LR.11:157-61. Wassell RW. Hardness and fracture toughness of four commercial visible light-cured composite resin veneering materials. Spiegl K. Bayne SC.journalonweb. Soares CJ. Covani U.4:137-42. 95. Bedran de Castro AK. Vandamme K. Paulillo LA. 81.61:247-51.37:799-806. Yamaga T. Images: Submit good quality color images. This high resolution image should be sent to the editorial office at the time of sending a revised article. 71. 88. 92. Ereifej N. Aggarwal V. Composite resin fillings and inlays. Nakazawa M.86:481-8. The effect of various surface treatments and bonding agents on the repaired strength of heat treated composites. Naert I.23:66-71. All information related to your identity should be included here. Mendonça JS. The image quality should be good enough to judge the scientific value of the image.11:25-32. Benetti AR. Atsuta M. J Prosthet Dent 2000. Taylor DF. Rammelsberg P Occlusal wear of . Cardoso PE. Sundaram G. Henaug T. 93. Hickel R. Tsitrou EA. and filler treatment. 98. Lijnen I.35:897-902. Wilson HJ. Clinical evaluation of indirect composite restorations at baseline and 36 months after placement. Logani A. Acta Odantal Scand 1992. J Dent 2009. 3) 4) 194 Journal of Conservative Dentistry | Oct-Dec 2010 | Vol 13 | Issue 4 . Martins LR.76:1095-411. 80.8:305-9. This will reduce the size of the file. An up to 3-year randomized clinical study comparing indirect and direct resin composites used to restore worn posterior Quintessence Int 2006. J Appl Oal Sci 2004. Matsumura H. A 4. Dent Mater 1992. J Dent 2000. Jensen ME. Microleakage of direct and indirect inlay /onlay systems. Int J Prosthodont 2010. Papadopoulosa T. Vanoorbeek S. Mileding P Microleakage of IRC inlays. Clinical study of indirect composite resin inlays in posterior stress-bearing preparations placed by dental students: Results after 6 months and 1. Wakasa K. Legends: Legends for the figures/images should be included at the end of the article file. using a word processor program. 87. J Adhes Dent 2009.41:399-410. 77. A study of marginal adaptation. J Prosthet Dent 2001. composite technique. Int J Prosthodont 2008. Eur J Dent 2010. Pallesen 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. covering letter. Fernandes AJ. Von der Fehr FR. Invirto wear of composite with varied filler level.7:71-9. Lim Sh. Taira M. the articles should be prepared in two files (first page file and article file).28:689-94. Source of Support: Nil. without their being incorporated in the article file. acknowledgement etc. Ferrandez A. Manhart J. De Carvalho RM. Milardovic S. 70. J Oral Sci 2009. 82. of indirect and direct composite and ceramic inlays: Ten-year results. An 11-year evaluation. 94. Lauris JR. 97. Leirskar J. J Contemp Dent Pract 2010. Ravera G. beginning with the Abstract to References (including tables) should be in this file. Sonmez H. 83. For the purpose of printing. of microhardness of IRC Restorative materials. Conflict of Interest: None declared. Bottino MC. J Dent Res 1997. Oper Dent 2004. Clin Oral Investig 2003. Walls AW. 73.

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