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WELCOME

TO
WEEKLY
SCIENTIFIC SEMINER

CHAIRPERSON

DR. MD. MAHABUBUR RAHMAN


BDS,DDS,PhD
ASSOCIATE PROFESSOR & CHAIRMAN
DEPARTMENT OF PROSTHODONTICS

BSMMU,DHAKA

CO-ORDINATOR

DR. MD. MASUDUR RAHMAN


BDS,MS,FCPS
ASSOCIATE PROFESSOR
DEPARTMENT OF PROSTHODONTICS
BSMMU,DHAKA

PRESENTER

Dr. A. K. M. Rashedul Alam


FCPS Part-2 trainee
Department of Prosthodontics
Faculty of Dentistry, BSMMU

Metal free Inlay retained


fixed partial denture

Metal free Inlay retained


fixed partial denture
Its a newer technique in the field
of
Prosthodontics.
It is highly technical & material
selective procedure.

Why should we choose


metal-free inlay retained
FPD ?
Due tothe advantage of preservation of tooth structure
excellent esthetics
entirely fabricated by tooth color materials
a high degree of light transmission
outstanding corrosion resistance
less plaque accumulation- so less caries & less periodontitis

Generally

Metal-reinforced system are the material


of choice for fabricating posterior FPDs
because of their

Reliability
Durablity

But this prosthesis characterized by


certain basic disadvantages May

have a negative effect on adjacent


soft tissue
May induce caries in adjacent teeth
The unattractive opaque & darkish
appearance mainly in the abutment teeth
portion.

So, we can overcome the limitations of


Metal
Reinforced system by metal free inlay
retained fixed partial denture.

Indications
short span FPDs
residual dentition exhibits low caries

activities
parallel alignment of abutment
teeth
immobility of abutment teeth
minimum height of abutment teeth
> 5mm
good oral hygiene

Possible indication for a metal-free


inlay retained FPD.

Contraindications:
Severe parafunctions
Short clinical crown
Poor oral hygiene with unhealthy

periodontium

ContinueExisting therapy resistant

periodontopathologic complaints
Any allergy to the components of
dentine adhesive or luting composite

So, the factors should be carried out before


planning inlay retained all ceramic FPDs -

Thorough intraoral examination


Radiographs of the designated

abutment teeth(proximal caries,


periodontium )
Model analysis of both jaw

Continueposition of the antagonistic contact


Existing hyper balances
The length of clinical crown
Pontic span
Alignment of abutment teeth

ContinueGeneralized wear facets


In addition, canine guidance must be

ensured to protect the inlay retained


all ceramic FPDs from torsional
stress.

Materials used for metal free inlay


retained FPDs-

1.High strength
pressed ceramic

Continue-

2.Fibre-reinforced
composite(FRC)

Preparation of the abutment teeth


for inlay retained all ceramic FPDs-

2-mm occlusal

preparation depth
(floor of the isthmus
to central groove)
1.5 mm preparation
depth of proximal
box

ContinueIsthmus width of 1.5-

2mm in premolars and


2.5-3 mm in molars
Proximal angle of the
internal cavity surface
to the enamel surface
100 to 120 degrees
Minimum dimensions

of connectors: 4mm x
5mm

Continue Abutment teeth with a wide buccooral defect as well as devitalized


abutment teeth; inclusion of cusps in
the preparation
Divergence angle of the cavity of
approximately 6 degrees

Impression and provisional


restoration
A one step technique using

elastic materials is
recommended for
impression taking(egpermadyne, ESPE)
The provisional restoration
is fabricated using
transparent, reusable
polyethylene-based
vacuum-formed templates
and a bis-GMA resin(egprotemp 2, ESPE

Insertion
The restoration must be

inserted according to the


adhesive technique
exclusively in conjunction
with absolute isolation
using a rubber dam
Provisional cement
residues are removed
using pumice paste ; the
use of H2O2 is
contraindicated-as nascent
oxygen may inhibit the
polymerization of the

ContinueThen, in case of

high strength
pressed ceramic,
the contact surface
of inlays are etched
with a buffered
hydrofluoric acid for
20 seconds.

ContinueBut, in case of FRC

materials the
surfaces of
restoration must be
conditioned
according to
modified procedure

ContinueFollowing the

drying, a bonding
agent (silane) is
applied to the
conditioned contact
surfaces of the
restoration

ContinueThe prepared tooth is

thoroughly cleaned
and dried
The enamel margin of

the cavity are


selectively etched
with 37%
orthophosphoric cid
for approximately 30
seconds.

Continue

The dentine surface are wetted with


bonding agent (dual bonding agent)

The bonding agent is also to be applied to


the conditioned inlay contact surface

During the following treatment, neither

the inlay-retained FPD nor the prepared


tooth should be directly exposed to the
operatory lights to prevent premature
polymerization

The bonding agent is

blown to a thin layer


with a gentle stream
of air after the
reaction time(20 sec)

Following enamel and dentine

conditioning, the cavities are


filled with a highly viscous,
purely light curing composite
materials.

Luting composite are available

in a variety of shades
The inlay-retained FPD is placed

on the abutment teeth and


seated in the cavities using an
ultrasonic tip.

Once the restoration is

correctly place, excess


composite is removed with
resin pellets and dental
tape.

Subsequently, a glycerin

gel is applied to the


tooth-restoration
interface to prevent the
formation of an oxygeninhibited layer.

Initial curing period- 10-

20 sec which turns the


composite into a jelly like
state. At this stage,
excess can be removed
near the sulcus with the
help of a scalar.

The final curing must be

conducted very carefully.


The abutment teeth are
exposed to a high
performance curing light
from all sides, each side
is exposed for 120
seconds.

Because of the limited curing depth

associated with inlay-retained FPDs


featuring framework of more than 3mm in
thickness- dual cure (eg, Variolink2,Vivadent) or self-curing(eg, Panavia 21
TC,Kuraray) luting composites are
recommended.

Preparation of an FRC
FPD which has been
prepared for a partial
crown retainer

Completed FRC FPD


prior to the adhesive
placement with low
viscous dual cure luting
composite

Glycerin gel applied to


the tooth-restoration
interface after
removal of excess
resin

Permanently placed
FRC FPD after
finishing and
polishing.

THANK YOU