Inlay.pptx

Inlay

1. Presentation by – Dr. Manjiri Honap Department of Conservative Dentistry and Endodontics INLAY

2. Introduction Definitions Indications Contra indications Advantages Disadvantages Flowchart

3. Principles of cavity preparation for class II cast metal inlay Armamentarium

4. Variations in proximal marginal design

5. Introduction Baum L, Phillips RW, Lund MR. Textbook of operative dentistry. WB Saunders Company; 1985.

6. Introduction Donovan TE, Chee WW. Conservative indirect restorations for posterior teeth. Cast versus bonded ceramic. Dental clinics of North America. 1993 Jul;37(3):433-43.

7. Definition

8. Why cast metal restorations ? Tucker, R.V., 2008. Why gold castings are excellent restorations.

9. Why cast metal restorations ? Advantages Tucker, R.V., 2008. Why gold castings are excellent restorations.

10. Why cast metal restorations ? Advantages Tucker, R.V., 2008. Why gold castings are excellent restorations.

11. Disadvantages Tucker, R.V., 2008. Why gold castings are excellent restorations . Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

12. Indications Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

13. Contraindications Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

14. Tooth preparation for class II cast metal inlays

15. Armamentarium Shillingburg , H., Sather, D., Wilson, E., Cain, J., Mitchell, D. and Blanco, L., 2012. Fundamentals offixed prosthodontics .

16. Armamentarium Shillingburg , H., Sather, D., Wilson, E., Cain, J., Mitchell, D. and Blanco, L., 2012. Fundamentals offixed prosthodontics .

17. Dimensions configuration of No. 271, No. 169L, and No. 8862 instruments. Conventional 4-degree divergence from line of draw (line  x-y ). Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

18. Steps : Initial preparation Occlusal step Proximal box Final preparation Removal of infected carious dentin ,pulp protection Preparation of bevels & flares Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

19. Initial Preparation Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

20. Inlay taper Apico-occlusal taper. Cavity walls must diverge from floor outwards. To permit unobstructed removal & placement of wax pattern & casting. Axial walls obtuse angle with pulpal floor. Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

21. According to Sturdevant : → 2 ° – 5 ° from line of draw. →Short vertical walls : 2 ° → Long vertical walls : > 2 ° According to Marzouk : → 2 ° – 5 ° from path of prep n. According to Charbeneau : → 10 ° – 16 ° of convergent angle. → 5 ° – 8 ° on each wall. Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

22. Occlusal Step No. 271 carbide bur held parallel to the long axis of the tooth , depth of 1.5 mm A general rule -bur parallel to the long axis of the tooth crown at all times Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

23. Occlusal Step Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12. Punch cut 1.5 mm to establish depth of pulpal wall keeping the faciolingual width minimum keeping the mesial marginal ridge strong by not removing the dentin support of the ridge Occasionally, a fissure extends onto the mesial marginal ridge.

24. The occlusal step is extended distally into distal marginal ridge sufficiently to expose junction of proximal enamel & dentin. As the prep n is extended distally, the faciolingual width is progressively widened – till proximal surfaces clear adjacent teeth by 0.2 – 0.5 mm. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

25. Proximal box Continuing with 271 bur the distal enamel is isolated by cutting a proximal ditch. Mesiodistal width of ditch : 0.8mm (Tip diameter of bur) prepared approximately 2/3 (0.5 mm) at the expense of dentin and 1/3 (0.3 mm) at the expense of enamel. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

26. Make 2 cuts at facial & lingual limit of proximal ditch Until the bur is nearly through the marginal ridge enamel Gingival extension- 0.5 mm clearance of unbevelled gingival margins Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

27. If the wall of enamel is still present, it is broken away using a spoon excavator Proximal & gingival walls – planed- hand instruments to remove all remaining enamel. Modified palm & thumb grasp used in chisel like motion in occluso – gingival direction. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

28. No. 15 Straight chisel / Binangle chisel/ Enamel hatchet may be used. Gingival wall is planed using a hoe in facio -lingual scraping direction ; Axial wall may be planed with edge of blade. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

29. Shallow (0.3mm) retention grooves may be cut on the facioaxial & linguoaxial line angles with No.169L bur. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

30. Removal of infected carious dentin & pulp protection. Preparation of bevels & flares. Final preparation Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

31. Small round bur (No. 2 or 4) / spoon excavator used Light intermittent cutting Pulp protection- Dycal /GIC Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

32. weakest link : Tooth/ cement/ cast joint complex Peripheral marginal anatomy: Circumferential tie Marginal peripheries: designed for the most favorable relationship between the restoring casting and the luting cement THE CIRCUMFERENTIAL TIE Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

33. Bevel A plane of a cavity wall or floor directed away from the cavity preparation “ Flexible extensions” of a cavity preparation, allowing the inclusion of surface defects, supplementary grooves, or other areas on the tooth surface. Six types according to the shape and tissue involvement A. Partial bevel B. Short bevel C. Long bevel D. Full bevel E. Counterbevel F. Hollow ground / Concave bevel Preparation features of the circumferential tie: Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

34. BEVELS- Functions Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

35. BEVELS- Functions Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

36. FLARES Flat or concave peripheral portions of the facial and lingual walls It is the conventional and basic part of circumferential tie facially and lingually for intracoronal preparation Functions : same as bevels Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

37. FLARES : Functions & Indications of secondary flare Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo

38. Preparation of Bevels & Flares

39. The cavosurface design helps seal & protect margins & results in strong enamel margin with an angle of 140° . Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

40. Gingival bevel Should result in 30 ° marginal metal. Instrument is tilted slightly mesially . 0.5 – 1 mm wide. Should blend with lingual secondary flare. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

41. The bevel should result in 30 ° marginal metal on inlay . 0.5 – 1 mm wide Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

42. Lap, sliding fit of prescribed bevel decreases the 50-µm error of seating to 20 µm.  Weak enamel is removed burnishable 30 metal Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

43. Slender flame shaped fine grit diamond is used to bevel Gingival marginal trimmers can be used Gingival retraction cord widens sulcus to 0.5mm results - open sulcus improves visibility & prevents injury to gingival tissue. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

44. Preparation of Flares

45. No. 169L or paper disc Slender flame shaped fine grit diamond can be used to prepare secondary flare

46. Secondary flare are directed to result in 40 ° marginal metal & 140° marginal enamel Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

47. 40 ° marginal metal should result Completed facial secondary flare Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's art & science of operative dentistry. Elsevier Health Sciences; 2014 Mar 12.

48. Variations in Proximal Marginal Design The design of the proximal margins will vary depending upon the following factors. The extent of tooth tissue loss. The location of that loss. Tooth form i.e. curvatures and embrasures . The positional relationship with adjacent teeth. The need for retention form

49. A. BOX PREPARATION Principally used with the proximo-occlusal preparation for the direct method of wax pattern formation Charbeneau GT. Principles and practice of operative dentistry. Lea & Febiger ; 1988.

50. Involves conservative disking of the proximal surface to establish the buccal and lingual extent of the finish lines and provide a lap joint for finishing. B. SLICE PREPARATION Charbeneau GT. Principles and practice of operative dentistry. Lea & Febiger ; 1988.

51. C. AUXILLARY SLICE Provides external support of weakened tooth as it wraps partially around the proximal line angles, thus providing additional tooth support. Minimal bulk of tooth tissue is lost- enhancinhg the resistance form, retention form. Charbeneau GT. Principles and practice of operative dentistry. Lea & Febiger ; 1988.

52. D. MODIFIED FLARE PREPARATION: (Hybrid of box and slice preparation) Buccal and lingual proximal walls are initially formed within minimal extension, and then disked in a plane that only slightly reduces the proximal wall dimension. Charbeneau GT. Principles and practice of operative dentistry. Lea & Febiger ; 1988.

53. Compound & complex tooth involvement AUXILLARY MEANS OF RETENTION Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

54. Reciprocal means of retention : Standardized tapered fissure bur: No. 169L Accentuated: Wedelstaedt/ Hatchet Contraindicated: - impinge on the pulp chamber - undermine/ involve axial angle of the tooth GROOVES Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

55. Expense of the gingival floor- internal dentinal plane inclining gingivally - axially Locks the restoration & prevents proximal displacement Gingival marginal trimmers REVERSE BEVEL Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

56. One of the most efficient way- immobilizing restoration In dentin 4 vertical surrounding walls joining the floor at definite line and point angles Next to a intact marginal ridge Anywhere in the preparation floor with sufficient dentin bulk Prevents micromovements of inlay INTERNAL BOX Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

57. Box shaped preparations opening to the axial tooth surface Accommodate grooves in their surrounding walls Peripheral portions: beveled or flared Contraindicated for cast ceramics EXTERNAL BOX Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

58. Internal cavity- floor of a preparation Less locking, but more readily reproduced in casting Indication: same as internal box SLOT Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

59. PINS: Cemented & threaded/ Parallel & non- parallel/ Vertical & horizontal/ Cast & wrought Used for Pinlay design of cast restoration COLLAR : Surface extension completely surrounding a cusp or a surface of a tooth SKIRT : A Specific extension involving a part of the axial angle of a tooth Part of surface extension preparation designs PINS, COLLAR, SKIRTS Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

60. Finishable cleansable finish line created Intact marginal ridge, sound adjacent proximal surface & pronounced occlusal embrasure Collars, skirts, caps: all classes of materials with modifications CAPPING MARGINAL RIDGE Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

61. Internal/ tooth surface of Class IV cast material : electrolytic etching Margins & external surface : covered with sticky wax Electrolytic cell: 0.5 N HNO 3 ,Anodic electrode of the casting, Cathode of another non- noble alloy Low voltage current passed – selective etching of the casting, dissolution of grain boundaries Microscopic irregularities similar to acid etching of enamel 10- 15 minutes Electrolytic etching of tooth surface of the casting Marzouk MA, Simounton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-Tokyo, Ishiyahu EuroAmerica Inc. 1985.

62. Summary

63. Sturdevant’s art & science of operative dentistry 5th edition. Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's Art & Science of Operative Dentistry-E-Book. Elsevier Health Sciences; 2014 Mar 12. Operative dentistry, modern theory & practice 1st edition – by M.A. Marzouk . Atlas of operative dentistry preclincial & clinical procedures – by Joseph R Evans Fundamentals of operative dentistry. Summitt , robbins 3rd edition References

64. Charbeneau GT. Principles and practice of operative dentistry. Lea & Febiger ; 1988. Gilmore HW, Lund MR. Operative dentistry. CV Mosby; 1973. Donovan TE, Chee WW. Conservative indirect restorations for posterior teeth. Cast versus bonded ceramic. Dental clinics of North America. 1993 Jul;37(3):433-43. Tucker RV. Why gold castings are excellent restorations. Anusavice KJ, Shen C, Rawls HR. Phillips' science of dental materials. Elsevier Health Sciences; 2013. References

65. Thank You