INDIRECT_COMPOSITE_INLAY fixed appliences .pdf

indirect composite restoration, fixed prosthesis

1. INDIRECT TOOTH COLOURED
RESTORATIONS-COMPOSITE
DR. HINA AHMED M.D.S.
Dept. of Conservative Dental Sciences

2. LECTURE LEARNING
OUTCOMES
By the end of this lecture, students
should be able to:
•List the advantages, disadvantages, clinical
indications and contraindications for
tooth-coloured restorations
•Explain the clinical and laboratory steps for
the fabrication of indirect composite inlays
and onlays.

3. INDIRECT TOOTH-COLOREDRESTORATIONS
Restorations are fabricated
outside of the patient’s
mouth and cemented later.
Made on a replica of the
prepared tooth either
chairside or in the dental
laboratory.

4. INLAY

5. INDICATIONS OF INLAY
•It is an alternative to amalgam and composite when higher strength
and superior control of contours & contacts is desired.
•Used instead of amalgam in patients with low caries rate who require
small class II with ample supporting dentin.
▪Large cavities that offer difficulty of access in cavity and material
application. (Also, when proximal surface caries is extensive)
▪To restore badly broken-down teeth.
▪Endodontically treated teethTo restore and cap the endodontically
treated molars andbicuspids.
•For the restoration of teeth with wide interproximal spacing and
those presenting problems in occlusion and arch alignment.

6. CONTRAINDICATIONS OF INLAY
•High caries rate.
•Young patients.
•Esthetic concerns.
•Small restorations.
•They rely on intracoronal wedging, therefore
unless sufficient bulk of tooth is there to
provide retention and resistance, it is
contraindicated.

7. ADVANTAGES OF INLAY
Strength
Biocompatibility
Low wear
Control of contours & contacts

8. DISADVANTAGES OF INLAY
Higher chair side time & increased appointments
Temporary required between preparation & delivery
appointments
Cost factor
Technique sensitive
Splitting forces

9. INDICATIONS
OF TOOTH
COLORED
RESTORATION
Esthetics: Indicated for Class I and II restorations
(inlays and onlays) located in areas of esthetic
importance for the patient.
Large defects or previous restorations: Restorations of large
Class I and II defects or replacement of large compromised
existing restorations, especially those that are wide
faciolinguallyor require cusp coverage. Large intracoronal
preparations are best restored with adhesive restorations
that strengthen the remaining tooth structure.
Retention: In preparations where is it is difficult to provide
retentive features for the restorative material to stay in
place.

10. CONTRAINDICATIONS OF TOOTH COLORED
RESTORATION
Heavy occlusal forces: Ceramic restorations can fracture when they lack
sufficient thickness or are subject to excessive occlusal stress, as in patients
who have bruxing or clenching habits. Heavy wear facets or a lack of occlusal
enamel are good indicators of bruxing and clenching habits.
Inability to maintain a dry field: Adhesive techniques require near-perfect
moisture control to ensure successful long-term clinical results.
Deep subgingival preparations:Preparations with deep subgingival margins
should be avoided.

11. A. Clenching and bruxing
habits can cause extensive
wear of occlusal surfaces. This
patient is not a good
candidate for ceramic inlays.
B. Example of a fractured inlay in a patient
with heavy occlusion.

12. A. Defective mesio-
occluso-distal amalgam
restorations on
mandibular premolars
were replaced with
tooth-coloredinlays.
B. Ceramic inlays after 12
years of clinical service.

13. ADVANTAGES OF INDIRECT TOOTH COLOURED
RESTORATIONS
Improved physical properties
Variety of materials and techniques
Wear resistance
Reduced polymerization shrinkage
Support of remaining tooth structure
More precise control of contours and contacts
Biocompatibility and good tissue response
Increased auxiliary support

14. DISADVANTAGES OF INDIRECT TOOTH COLOURED
RESTORATIONS
Increased cost and time
Technique sensitivity
Difficult try-in and delivery
Brittleness of ceramics
Wear of opposing dentition and restorations
Short clinical track record
Low potential for repair

15. CAVITYPREPARATION
Preparation of the cavity have the same principles of cavity
preparation except for some modification which will be followed
to meet the physical nature and requirements of these restoration.
Cavity walls and margins must be prepared to allow indirect
composite restoration/wax pattern/ceramic restoration be
inserted and removed only in one direction without distortion.

16. KEY FEATURES OF CAVITY
PREPARATION FOR TOOTH-
COLOURED RESTORATIONS
Cavity width should be 1/3
rd
of the intercuspal
distance. Isthmus should be at least 2 mm wide to
prevent inlay fracture.
The axiopulpalline angle should be rounded to
avoid seating errors and to lower stress
concentrations
The pulpal floor should be prepared to a depth of 2
mm. The proximal margins should be extended to
allow at least 0.5 mm clearance of contact with the
neighbouring tooth. Gingival margins in enamel are
greatly preferred.
Widened isthmus
Rounded axiopulpal line angle
2 mm depth
Rounded line angle

17. Cutting instrument is oriented to a single path of draw, usually the long axis
of the tooth crown.
The occlusal portion of the preparation should be 2 mm deep.

18. Typical diamond rotary
instruments used for tooth
colored inlay or onlay tooth
preparations.

19. Reduction of
centric cusps
Reduction of
centric cusps
Uniform
reduction
Enamel margins

20. The facial and lingual walls should be extended to sound tooth structure
and should go around the cusps in smooth curves.
Ideally, there should be no undercuts that would prevent the insertion or
removal of the restoration. Small undercuts, if present, can be blocked
out using a resin-modified glass ionomer (RMGI) liner. The pulpal floor
should be smooth and relatively flat.

21. For all walls, a 90-degree cavosurfacemargin is ideal because ceramic
materials are fragile in thin sections.

23. INDIRECT COMPOSITE RESTORATIONS
The physical properties of composite restorations are improved when the
composite is free of voids, and the resin matrix is maximally polymerized.
Generating dense, well-cured restorations is best accomplished in the dental
laboratory using devices that polymerize the composite under pressure, vacuum,
inert gas, intense light, heat, or a combination of these conditions.

24. ADVANTAGES OF INDIRECT COMPOSITE RESTORATIONS
Laboratory-processed composite
inlays/onlaysare more resistant to
occlusal wear than direct composites,
however, they are less wear resistant
than ceramic restorations.
Offer less resistance to debonding at
interfaces than ceramic restorations.
They offer easy adjustments.
Low wear of the opposing dentition.
Good esthetics.
Potential for repair.

25. INDICATIONS
OF INDIRECT
COMPOSITE
RESTORATIONS
When a ceramic restoration is not
indicated because of concerns about wear
of the opposing dentition.
Areas where achievement of proper
contours and contacts would be difficult
otherwise.
When maximum wear resistance is
desired from a composite restoration.

26. INDIRECT COMPOSITE RESTORATION
Laboratory Processed Method
Chair-Side Method

27. TYPES OF LABORATORY-PROCESSED
COMPOSITES
Heat-cured and pressure-cured microfill
composites (Concept; IvoclarVivadent,
Amherst, NY)
Polymer glasses
Filled polymers
Ceramicoptimizedresins (“ceromers”)

28. FABRICATION STEPS
OF LABORATORY
PROCESSED
COMPOSIRES 1. The indirect composite restoration is
initially formed on a replica of the prepared
tooth.

29. 2. The composite is
built up in layers,
polymerizing each
layer with a brief
exposure to a visible
light-curing unit

30. 3. After it is built to full contour, the restoration
is coated with a special gel to block out air and
prevent formation of an oxygen-inhibited surface
layer.

31. 4. Final curing is accomplished by
inserting the inlay into an oven-like
device that exposes the composite
to additional light and heat and, in
some cases, pressure

32. 5. The cured composite inlay is
trimmed, finished, and polished in
the laboratory.

33. CHAIR-SIDE INDIRECT COMPOSITE RESTORATION

35. LECTURE LEARNING
OUTCOMES
By the end of this lecture, students
should be able to:
•List the advantages, disadvantages, clinical
indications and contraindications for
tooth-coloured restorations
•Explain the clinical and laboratory steps for
the fabrication of indirect composite inlays
and onlays.

36. ESSENTIAL READING
Sturdevant’sArt and Science of Operative Dentistry 5
th
Edition
Sturdevant’sArt and Science of Operative Dentistry 6th
th
Edition
https://www.youtube.com/watch?v=vbHkHovVp-Y&t=4s
https://www.youtube.com/watch?v=mmaaT2PtcOI&t=1s
https://www.youtube.com/watch?v=mgU_nE3XJwA&t=76s

37. THANK YOU