INDIRECT RESTORATIONS.pptx

IT GIVES INSIGHTS OF VARIOUS TOOTH COLOURED RESTORATIONS

1. GOOD MORNING

2. TOOTH COLOURED -INDIRECT RESTORATIONS R PRANEETH

3. What is indirect restoration???? Indirect restoration – restorations are fabricated outside of the mouth. Tooth colored indirect system include laboratory processed composites and ceramics. In addition chairside Computer-aided design/ Computer-assisted manufacturing (CAD/CAM) systems are currently available for fabrication of ceramic restoration. Sturdevant’s ED 5

4. INDICATIONS The indications for Class I and II indirect tooth-colored restorations are 1]Esthetics-Indicated for Class I and II restorations located in areas of esthetic importance for the patient. 2] Large defects or previous restorations—They are considered for restoration of large Class I and II defects or replacement of large compromised existing restorations, especially those that are wide facio -lingually and require cusp coverage. Sturdevant’s ED 5

5. INDICATIONS Indirect tooth-colored restorative materials are more durable than direct composites when placed in large occlusal posterior restorations, especially in regard to maintaining occlusal surfaces and occlusal contacts.[ Söderholm etal ] The wear resistance provided by indirect materials is especially important in large posterior restorations that involve most or all of the occlusal contacts [ Sturdevant etal ] Economic factors—Some patients desire the most esthetic dental treatment available, regardless of cost Sturdevant’s ED 5

6. Contraindications 1] Heavy occlusal forces—Ceramic restorations can fracture when they lack sufficient bulk or are subject to excessive occlusal stress, as in patients who have bruxing or clenching habits 2] Inability to maintain a dry field. 3] Deep subgingival preparation. These margins are difficult to record with an impression and are difficult to finish. Sturdevant’s ED 5

7. TAKE HOME MESSAGE Indirect tooth- colored restorations should be considered for restoration of large Class II defects or replacement of large compromised existing restorations. Indirect tooth- colored restorations contraindicated where tooth is subject to excessive occlusal stress. Indirect tooth- colored restorations avoided in patients with high plaque and caries index Indirect tooth- colored restorations contraindicated in deep gingival preperations .

8. PROS Improved physical properties: I ndirect restorations have better physical properties than direct composite restorations because they are fabricated under relatively ideal laboratory conditions Variety of materials and techniques Wear resistance—Ceramic restorations are more wear resistant than direct composite restorations, an especially critical factor when restoring large occlusal areas of posterior teeth Reduced polymerization shrinkage Ability to strengthen remaining tooth structure—Tooth structure weakened by caries, trauma, or preparation can be strengthened by adhesively bonding indirect tooth-colored restorations Sturdevant’s ED 5

9. PROS More precise control of contours and contacts Biocompatibility and good tissue response Sturdevant’s ED 5

10. CONS Increased cost and time —Most indirect techniques, excluding chairside CAD/CAM methods, require two patient appointments, plus fabrication of a temporary restoration Technique sensitivity —Restorations made using indirect techniques require a high level of operator skill Sturdevant’s ED 5

11. CONS Brittleness of ceramics —A ceramic restoration can fracture if the preparation does not provide adequate thickness to resist occlusal forces. Wear of opposing dentition and restorations —Ceramic materials can cause excessive wear of opposing enamel or restorations Sturdevant’s ED 5

12. CONS Resin-to-resin bonding difficulties —Laboratory-processed resins are highly cross-linked, so few double bonds remain available for chemical adhesion of the composite cement Low potential for repair —Indirect restorations, particularly ceramic inlays/ onlays , are difficult to repair in the event of a partial fracture. Sturdevant’s ED 5

13. TAKE HOME MESSAGE Indirect restorations have better physical properties than direct composite restorations. Tooth structure weakened by caries, trauma, or preparation can be strengthened by adhesively bonding indirect tooth- colored restorations. A ceramic restoration can fracture if the preparation does not provide adequate thickness to resist occlusal forces. Ceramic materials can cause excessive wear of opposing enamel or restorations.

14. A schematic representation of the types of restorative materials, based on the materials used and based on the manufacturing technique

15. Laboratory-Processed Composite Inlays and Onlays Processed composite restorations are indicated when 1] Maximum wear resistance is desired from a composite restoration, 2]Achievement of proper contours and contacts would be difficult otherwise, 3] The indirect composite likely would cause less wear of the opposing dentition than a similar ceramic restoration Sturdevant’s ED 5

16. Laboratory making of Inlays and onlays 1. The indirect composite restoration is initially formed on a replica of the prepared tooth 2. The composite is built up in layers, polymerizing each layer with a brief exposure to a visible lightcuring unit 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. Sturdevant’s ED 5

17. Processing cont ……. 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 5. The cured composite inlay is trimmed, finished, and polished in the laboratory Sturdevant’s ED 5

18. Ceramic Inlays and Onlays Among the ceramic materials used are feldspathic porcelain, hot pressed ceramics, and machinable ceramics designed for use with CAD/ CAM systems The physical and mechanical properties of ceramics come closer to matching those of enamel than do composites. They have excellent wear resistance and a coefficient of thermal expansion close to that of tooth structure. Sturdevant’s ED 5

19. Feldspathic Porcelain Feldspathic Porcelain Inlays and Onlays . Dental porcelains are partially crystalline minerals (feldspar, silica, alumina) dispersed in a glass matrix. Currently, some ceramic inlays and onlays are fabricated in the dental laboratory by firing dental porcelains on refractory dies, but more are fabricated by pressing or milling methods . Sturdevant’s ED 5

20. The fabrication steps for fired ceramic inlays and onlays are summarized as follows After tooth preparation, an impression is made, and a die- stone master working cast is poured. The die is duplicated and poured with a refractory investment capable of withstanding porcelain firing temperatures. Porcelain is added into the preparation area of the refractory die and fired in an oven. Multiple increments and firings are necessary to compensate for sintering shrinkage The ceramic restoration is recovered from the refractory die, cleaned of all investment, and seated on the master die and working cast for final adjustments and finishing Sturdevant’s ED 5

21. DISADVANTAGES The major disadvantage is its technique sensitivity, both for the technician and the dentist. Inlays and onlays fabricated with this technique must be handled gently during try-in and bonding to avoid fracture. Feldspathic porcelains are weak, so even after bonding, the incidence of fracture can be relatively high. Sturdevant’s ED 5

22. Pressed Glass-Ceramics Dicor (DENTSPLY International, York, PA) a popular ceramic for dental restorations. A major disadvantage of Dicor was its translucency, which necessitated external application of all shading. Newer leucite-reinforced glass-ceramic systems (e.g., IPS Empress, Ivoclar Vivadent , Amherst, NY) also use the lost-wax method, but the material is heated to a high temperature and pneumatically pressed, rather than centrifuged, into a mold . Sturdevant’s ED 5

23. The fabrication of leucite-reinforced pressed ceramic restoration is summarized as follows After tooth preparation, an impression is made, and a working cast is poured in die-stone. A wax pattern of the restoration is made using conventional techniques. After spruing , investing, and wax pattern burnout, a shaded ceramic ingot and aluminum oxide plunger are placed into a special furnace . At approximately 2012°F (1100°C), the ceramic ingot becomes plastic and is slowly pressed into the mold by an automated mechanism Sturdevant’s ED 5

24. FABRICATION CONT…. After being separated from the mold , the restoration is seated on the master die and working cast for final adjustments and finishing. To reproduce the tooth shade accurately, a heavily pigmented surface stain is typically applied. The ceramic ingots are relatively translucent and available in a variety of shades, so staining for hot pressed ceramic inlay and onlay restorations is typically minimal. Sturdevant’s ED 5

25. ADVANTAGES The advantages of leucite-reinforced pressed ceramics are their (1) similarity to traditional “wax-up” processes, (2) excellent marginal fit, (3) moderately high strength, and (4) surface hardness similar to that of enamel. Sturdevant’s ED 5

26. TAKE HOME MESSAGE The major disadvantage in Feldspathic porcelains is technique sensitivity. Feldspathic porcelains are weak, so even after bonding, the incidence of fracture can be relatively high. IPS Empress inlays and onlays have performed well in clinical trials ranging up to 12 years in duration. Lithium disilicate is a moderately high-strength glass ceramic that also can be used for full crowns or ultra-thin veneers.

27. CAD/CAM CAD/CAM systems are expensive laboratory-based units requiring the submission of an elastomeric or digital impression of the prepared tooth. The CEREC system was the first commercially available CAD/CAM system developed for the rapid chairside design and fabrication of ceramic restorations. Sturdevant’s ED 5

28. CAD/CAM CAD/CAM restoration begins after the dentist prepares the tooth and uses a scanning device to collect information about the shape of the preparation and its relationship with the surrounding structures . This step is termed optical impression Sturdevant’s ED 5

29. CAD/CAM The system projects an image of the preparation and surrounding structures on a monitor, allowing the dentist or the auxiliary personnel to use the CAD portion of the system to design the restoration The operator must input or confirm some of the restoration design such as the position of the gingival margins. Sturdevant’s ED 5

30. CAD/CAM After the restoration has been designed, the computer directs a milling device (CAM portion of the system) that mills the restoration out of a block of high-quality ceramic or composite in minutes. The restoration is removed from the milling device and is ready for try-in, any needed adjustment, bonding, and polishing. Sturdevant’s ED 5

31. CAD/CAM Different types of ceramics are available for chairside CAD/CAM restoration fabrication. These include the feldspathic glass ceramics Vitablocs Mark II ( Vident , Brea, CA) and CEREC Blocs (Sirona, manufactured by Vita Zahnfabrik , Bad Säckingen , Germany). The ceramic blocks are available in various shades and opacities, and some are even layered to mimic the relative opacity or translucency in different areas of a tooth. Sturdevant’s ED 5

32. CAD/CAM The major disadvantages of chairside CAD/CAM systems are the high initial cost and the need for special training. CAD/CAM technology is changing rapidly, however, with each new generation of devices having more capability, accuracy, and ease of use Clinical studies have reported good results on the longevity of CAD/CAM ceramic restorations. Sturdevant’s ED 5

33. TAKE HOME MESSAGE Ceramic blocks are available in various shades and opacities, and some are even layered to mimic the relative opacity or translucency in different areas of a tooth. The major disadvantages of chairside CAD/CAM systems are the high initial cost and the need for special training. Clinical studies have reported good results on the longevity of CAD/CAM ceramic restorations. Sturdevant’s ED 5

34. Tooth Preparation of inlays and onlays First clinical step, the patient is anesthetized and the area is isolated, preferably using a rubber dam. The compromised restoration is completely removed and all caries is excavated. All margins should have a 90-degree butt-joint cavosurface angle to ensure marginal strength of the restoration. All line and point angles, internal and external, should be rounded to avoid stress concentrations in the restoration and tooth, reducing the potential for fractures. Sturdevant’s ED 5

35. Tooth Preparation of inlays and onlays The carbide bur or diamond used for tooth preparation should be a tapered instrument creates occlusally divergent facial and lingual walls, which allows for passive insertion and removal of the restoration. It should be greater than the 2 to 5 degrees taper per wall recommended for cast gold inlays and onlays . Resistance and retention form are required to help preserve the adhesive interface, so excessive divergence must be avoided. Sturdevant’s ED 5

36. Tooth Preparation if inlays and onlays The occlusal portion of the preparation should be 2 mm deep. Most ceramic systems require that any isthmus be at least 2 mm wide to decrease the possibility of fracture of the restoration. The facial and lingual walls should be extended to sound tooth structure and should go around the cusps in smooth curves. Sturdevant’s ED 5

37. Tooth Preparation 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. Sturdevant’s ED 5

38. Tooth Preparation After removal of extensive caries or previous restorative material from any internal wall, the floor is restored to more nearly ideal form with a material that has a reasonably high compressive strength such as an RMGI liner or base. The facial, lingual, and gingival margins of the proximal boxes should be extended to clear the adjacent tooth by at least 0.5 mm. Sturdevant’s ED 5

39. Tooth Preparation The gingival margin should be extended as minimally as possible because margins in enamel are greatly preferred for bonding. Deep gingival margins are difficult to impress and to isolate properly during bonding. Facial or lingual surface is affected by caries or other defect, it might be necessary to extend the preparation (with a gingival shoulder) around the transitional line angle to include the defect. Axial wall of the shouldered extension should be prepared to allow for adequate restoration thickness (i.e., 1–1.5 mm). Sturdevant’s ED 5

40. Tooth Preparation When extending through or along the cuspal inclines to reach sound tooth structure, a cusp usually should be capped if the extension is two-thirds or greater than the distance from any primary groove to the cusp tip. Sturdevant’s ED 5

41. Tooth Preparation If the cusps must be capped, they should be reduced by 2 mm and should have a 90-degree cavosurface angle. When capping cusps, especially centric holding cusps, shoulder is prepared to move the facial or lingual cavosurface margin away from contact with the opposing tooth, either in maximum intercuspal position or during functional movements. Sturdevant’s ED 5

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43. Impression Gingival retraction cord can be used to reflect the gingival tissues away from the tooth structure thus providing access to the impression material to reach the subgingival margins. Tooth- colored inlay or onlay systems require an elastomeric or optical impression of the prepared tooth and the adjacent teeth and interocclusal records, which allow the restoration to be fabricated on a working cast in the laboratory. With chairside CAD/CAM systems, no working cast is necessary. Sturdevant’s ED 5

44. TAKE HOME MESSAGE 90-degree butt-joint cavosurface angle to ensure marginal strength of the restoration. The occlusal portion of the preparation should be 2 mm deep and isthmus 2 mm wide. More than 2 to 5 degrees taper per wall recommended for cast gold inlays and onlays . Gingival margin should be extended as minimally as possible because margins in enamel are greatly preferred for bonding. Gingival retraction cord can be used to reflect the gingival tissues away from the tooth structure thus providing access to the impression material to reach the subgingival margins.

45. Provisional Restoration Provisional restoration protects the pulp–dentin complex in vital teeth, maintains the position of the prepared tooth in the arch. The provisional can be made using conventional techniques and bis-acryl composite materials. Temporary restorations for PFM and cast gold restorations typically are cemented with eugenol-based temporary cements Sturdevant’s ED 5

46. Provisional Restoration Eugenol reacts with free radicals, thereby inhibiting the polymerization of methacrylate monomers, however, and potentially could reduce the adhesion of the permanent composite cement to tooth structure. Because of the nonretentive design of the onlay preparation, the more retentive polycarboxylate cement is the temporary luting cement of choice. Sturdevant’s ED 5

47. CAD/CAM Techniques Tooth preparations for CAD/CAM inlays must reflect the capabilities of the CAD software and hardware and the CAM milling devices that fabricate the restorations. CEREC system automatically “blocks out” any undercuts during the optical impression, large undercuts should be avoided. This system eliminates the need for a conventional impression, provisional restoration, and multiple patient appointments Sturdevant’s ED 5

48. Try-in and Bonding Try-in and bonding of tooth- colored inlays or onlays are more demanding than those for cast gold restorations because of the relatively fragile nature of some ceramic materials, the requirement of near-perfect moisture control, and the use of resin cements. Occlusal evaluation and adjustment generally are delayed until after the restoration is bonded, to avoid fracture of the ceramic material. Sturdevant’s ED 5

49. Preliminary Steps The use of a rubber dam is strongly recommended to prevent moisture contamination of the conditioned tooth or restoration surfaces during cementation and to improve access and visibility during delivery of the restoration. After removing the provisional restoration, all of the temporary cement is cleaned from the preparation walls. Sturdevant’s ED 5

50. Restoration Try-in and Proximal Contact Adjustment Inlay or onlay is placed into the preparation using light pressure to evaluate its fit. If the restoration does not seat completely, the most likely cause is an over-contoured proximal surface Using the mouth mirror the embrasures should be viewed from the facial, lingual, and occlusal aspects to determine where the proximal contour needs adjustment to allow final seating of the restoration. Abrasive disks or points are used to adjust the proximal contour and contact relationship. Sturdevant’s ED 5

51. Restoration Try-in and Proximal Contact Adjustment ………… If the proximal contours are not over-contoured and the restoration still does not fit completely, the preparation should be checked again for residual temporary materials or debris. If the preparation is clean, internal or marginal interferences also might prevent the restoration from seating completely. When these interferences have been identified through careful visual inspection of the margins or using “fit-checker” materials, they can be adjusted on the restoration, in the preparation. Sturdevant’s ED 5

52. Restoration Try-in and Proximal Contact Adjustment……………………………….. Marginal fit is verified after the restoration is completely seated. Ceramic inlays and onlays typically have slightly larger marginal gaps than gold restorations. Slight excesses of contour can be removed, if access allows, using fine-grit diamond instruments or 30-fluted carbide finishing burs. These adjustments are done preferably after the restoration is bonded so that marginal fractures are avoided. Sturdevant’s ED 5

53. Bonding For proper adhesive bonding, the internal surface of the inlay or onlay must be treated appropriately. HF acid or a similar acid usually is used to etch the internal surfaces of the restoration for 60 sec Sturdevant’s ED 5

54. BONDING…………….. Chairside ceramic etching can be done with a brief application of 5% to 10% HF acid on the internal surfaces of the inlay or onlay . Application time depends on the type of ceramic material being used. After etching, the ceramic is treated with a silane coupling agent to facilitate chemical bonding of the resin cement. Sturdevant’s ED 5

55. BONDING………… The inlay or onlay is tried-in again and checked for fit. The preparation surfaces are etched with phosphoric acid and treated with the components of an appropriate adhesive system. A dual-cure resin cement is mixed and inserted into the preparation with a paddle-shaped instrument or a syringe Sturdevant’s ED 5

56. BONDING The internal surfaces of the restoration also are coated with the resin cement and using light pressure, the restoration is immediately inserted into the prepared tooth. A ball burnisher or similar instrument applied with a slight vibrating motion is usually sufficient to seat the restoration. Sturdevant’s ED 5

57. BONDING Excess resin cement is removed with thin-bladed composite instruments, brushes, micro- brush, or an explorer. Light-activated with multiple exposures from occlusal, facial, and lingual directions, according to the manufacturer’s recommendations for the specific cement and light-curing device. Sturdevant’s ED 5

58. TAKE HOME MESSAGE CAD/CAM eliminates the need for a conventional impression, provisional restoration, and multiple patient appointments. Proximal contours are not over-contoured and the restoration still does not fit completely, the preparation should be checked again for residual temporary materials or debris. HF acid usually is used to etch the internal surfaces of the restoration for 60sec. Chairside ceramic etching can be done with a brief application of 5% to 10% HF acid on the internal surfaces of the inlay or onlay .

59. Finishing and Polishing Procedures After light-curing the cement, all marginal areas are checked with an explorer tine. Medium-grit or fine-grit diamond rotary instruments are used initially to remove any excess resin cement at the margins. Slender flame shapes are used interproximally , whereas larger oval or cylindrical shapes are used on the occlusal surface. Sturdevant’s ED 5

60. Finishing and Polishing Procedures Interproximally , a No. 12 scalpel blade can be used to remove excess resin cement when access permits. Abrasive strips of successively finer grits also can be used to remove slight interproximal excesses. Sturdevant’s ED 5

61. Finishing and Polishing Procedures With care and appropriate instrumentation, ceramic restorations can be polished to a surface as smooth as glazed porcelain using the abrasive sequence Sturdevant’s ED 5

62. Finishing and Polishing Procedures The rubber dam is removed after all of the excess resin cement has been removed, marginal integrity has been verified. The occlusion is now checked and adjusted, if necessary. Premature occlusal contacts can be adjusted using fine-grit diamond instruments, followed by 30-fluted carbide finishing burs and appropriate polishing steps. In selected cases, the occlusion can be adjusted on the opposing dentition. Sturdevant’s ED 5

63. Common Problems and Solutions The most common cause of failure of tooth- colored inlays or onlays is fracture . Fractures can result from placing the restoration in a tooth where it was not indicated, from lack of appropriate restoration thickness resulting from insufficient tooth preparation or from restoration contours that introduce excursive interferences in occlusal function. If fracture occurs, replacement of the restoration is almost always indicated. Sturdevant’s ED 5

64. Repair of Ceramic Inlays and Onlays Minor defects in ceramic restorations can be repaired, but before initiating any repair procedure, the operator should determine whether replacement, rather than repair, is the appropriate treatment. A small fracture resulting from occlusal trauma might indicate that some adjustment of the opposing occlusion is required. Sturdevant’s ED 5

65. Repair of Ceramic Inlays and Onlays The repair procedure is initiated by mechanical roughening of the involved surface. A better result is obtained with the use of airborne particle abrasion using aluminum oxide particles and a special intraoral device. Initial mechanical roughening is followed by brief (typically 2 minutes) application of 5% to 10% HF acid gel. Sturdevant’s ED 5

66. Repair of Ceramic Inlays and Onlays The next step in the repair procedure is application of a silane coupling agent. Silanes mediate chemical bonding between ceramics and resins and may improve the predictability of resin–resin repairs Sturdevant’s ED 5

67. Cast gold CERAMIC composite Cast gold usually made of 10 to 22 carats gold , copper, silver , palladium, platinum, nickel, zinc. INDICATIONS Extensive tooth loss, Correction of occlusion Restoration of endodontically treated teeth  Preexisting cast metal restorations CONTRAINDICATIONS Occlusal disharmony Dissimilar metals Ceramic restorations, also known as porcelain restorations, are made of dental-grade ceramic materials. 1. ESTHETICS 2.PRESERVATION OF TOOTH STRUCTURE 1]Heavy occlusal forces 2] Inability to maintain a dry field. 3] Deep subgingival preparation. Resin composite restorations are made of a mixture of plastic (composite resin) and fine glass particles 1. . ESTHETICS 2.WORN OUT TOOTH 3]BRUXISM 4]ALLERGY

68. Cast gold CERAMIC composite ADVANTAGES 1.Greater tensile strength 2. Precise reproduction of the form and minute details 3. Metal alloys used are tarnish and corrosion resistant 4. Finishing and polishing can be done outside the oral cavity, thus preventing damage to the pulp DISADVANTAGES Leakage around and under the restorations through the cement- restoration - tooth junction 2.It involves extensive tooth preparation 3. Technique sensitive 4. Galvanic deterioration 1]Wear resistance—Ceramic restorations are more wear resistant than direct composite restorations. Ability to strengthen remaining tooth structure 3]More precise control of contours and contacts 4]Biocompatibility and good tissue response 1]Brittleness of ceramics . 2]Wear of opposing dentition and restorations 3]Resin-to-resin bonding difficulties 4]Low potential for repair 1]Bonding and reinforcement 2]Reduced sensitivity 3]Repairability 4]Conservative tooth preparation 5]Biocompatibility 1]Durability 2]Staining and discolouration 3]less lifespan 4]technique sensitive 5]limited strength in large restorations

69. Cast gold usually made of copper, silver, platinum, nickel, zinc Gold offers high strength and durability. They are more suitable for posterior teeth where esthetics are not a primary concern Ceramic restorations, also known as porcelain restorations, are made of dental-grade ceramic materials. They are generally not as strong as metal restorations. They are highly esthetic and are commonly used in the front teeth. Resin composite restorations are made of a mixture of plastic (composite resin) and fine glass particles They are generally not as strong as ceramics or metals. They offer excellent esthetics and are commonly used in both front and back teeth. Cast gold CERAMIC composite LUTING CEMENT : Zinc phosphate cement provides good retention and is particularly useful for cast gold restorations due to its ability to bond to both metal and tooth structure[ Donovan and Cho, 1999] TOOTH PREPERATION: Bevel is needed Cast gold inlays, a slight divergence or taper of 2 to 5 degrees is required Occlusal Reduction:1.5-2 mm Resin cements are widely used for luting ceramic restorations due to their excellent adhesive properties and esthetics Bevel is usually not recommended The divergence angle of more than[ 2 to 5 ]. helps ensure a secure fit and stability of the restoration within the tooth preparation 1.5 to 2mm. Resin cements used for composite inlays are typically dual-cured or light-cured [ el-Mowafy et al. ] Bevel not needed. The divergence angle of [ more than 2 to 5 degrees] same as ceramic 1.5 to 2mm

70. Cast gold CERAMIC composite Isthmus width is to be 1 to 1.5 mm C eramic systems require that any isthmus be at least 2 mm wide to decrease the possibility of fracture of the restoration. Composite also require 2mm isthmus width

71. Cast gold CERAMIC composite Biocompatibility is good ADAPTABILITY Gold restorations are more adaptable LONGEVITY Gold restorations known for their durability [ Leempoel et al. ] TYPE OF TOOTH PREP Gold restorations usually require less tooth removal Dental ceramics are generally biocompatible Ceramics are difficult to adapt Ceramic restorations are known for their excellent long-term durability[ Wendt SL etal ] Ceramic restorations may require more tooth structure removal They are also biocompatible Composites are also difficult to adapt They tend to have a shorter lifespan compared to ceramic restorations. [Taylor DF, et al] Resin composite restorations require less tooth structure removal

72. "Every tooth in a man's head is more valuable than a diamond." - Miguel de Cervantes

73. Aparnna Sreeprakash

74. Judith

75. M.ASMA

76. Sanjna

77. Direct resin composite restorations versus indirect composite inlays: one-year results Juliano Sartori Mendonça  et al. J Contemp Dent Pract . 2010 Methods and materials:  Seventy-six Class I and II restorations (44 direct and 32 indirect) were inserted in premolars and molars with carious lesions or deficient restorations in 30 healthy patients according to the manufacturer's instructions. Each restoration was evaluated at baseline and after 12 months according to the modified USPHS criteria for color match (CM), marginal discoloration (MD), secondary caries (SC), anatomic form (AF), surface texture (ST), marginal integrity (MI), and pulp sensitivity (PS). Data were analyzed by Fisher and McNemar Chi-square tests. Results:  No secondary caries and no pulpal sensitivity were observed after 12 months. However, significant changes in marginal discoloration (MD) criteria could be detected between baseline and one-year results for both materials (p<0.05). For marginal integrity (MI) criteria, the differences between baseline and one-year recall were statistically significant (p<0.05). For marginal integrity (MI) criteria, Tetric Ceram (TC) showed results statistically superior to Targis (TG) in both observation periods (p<0.05). No statistically significant changes in color match (CM), anatomic form (AF), or surface texture (ST) appeared during the observation periods (p>0.05). Conclusions:  BDirect resin composite restorations performed better than indirect composite inlays for marginal integrity, but all restorations were judged to be clinically acceptable. Shaik Imran 3 rd Yr Pg

78. ABHIRAJ G

79. Kirtana II MDS

80. Loyola

81. S.MURALIDARAN CONCLUSION: Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin prior to impression making is recommended. The IDS technique helps achieve improved bond strength, fewer gap formations, decreased bacterial leakage and reduced dentin sensitivity. This concept should stimulate both the researchers and clinicians in the study and development of new protocols for the rationalization and standardization of adhesive techniques and materials leading to maximum tooth structure preservation, improved patient comfort, and long term survival of indirect bonded restorations

82. Sai Saranya 2nd PG

83. Aishwarya.B 1 st PG

84. ASHOK

85. Pooja Gomase

86. Comparison between metal and ceramic indirect restorations Metal Metal Restorations: These restorations are typically made of various metal alloys, such as gold, silver, or base metal alloys like cobalt-chromium or nickel-chromium. These metals offer high strength and durability. They are more suitable for posterior teeth where esthetics are not a primary concern CERAMIC Ceramic restorations, also known as porcelain restorations, are made of dental-grade ceramic materials. They are generally not as strong as metal restorations. They are highly esthetic and are commonly used in the front teeth.

87. Comparison between metal and ceramic indirect resrorations METAL Biocompatibility varies depending on the specific metal used. Metal restorations are more adaptable CERAMIC Dental ceramics are generally biocompatible Ceramics are difficult to adapt

88. Comparison between resin composite and ceramic composite Resin composite restorations are made of a mixture of plastic (composite resin) and fine glass particles They offer excellent esthetics and are commonly used in both front and back teeth. While resin composites have improved in terms of strength, they are generally not as strong as ceramics or metals. ceramic Ceramic restorations, also known as porcelain restorations, are made of dental-grade ceramic materials they provide a lifelike appearance and are commonly used for front teeth where esthetics are a primary concern. Ceramic restorations are known for their excellent strength and durability. They can withstand heavy biting forces and are less prone to fracture or wear

89. Comparison between resin composite and ceramic composite Resin composite restorations require less tooth structure removal They tend to have a shorter lifespan compared to ceramic restorations. ceramic Ceramic restorations may require more tooth structure removal Ceramic restorations are known for their excellent long-term durability.