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23542 Views - Jul 2017

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The choice of the restorative procedures is quite often a cause of doubt, perplexity, and indecision for the dentist. There's a lot of confusion among the colleagues about what to do and when. We, as Style Italiano, strongly believe that, whenever possible, a direct approach must be taken, when talking about restorative procedures in posteriors; but in all those clinical situations in which there's the need of a cusp coverage and when there are a lot of cavities to restore, such as a quadrant or more, an indirect approach can avoid spending a lot of chairside time for modeling and creating good shapes, as all the contact areas can be perfectly managed on a plaster model too, thus helping the clinician with one of the big challenges in restoring multiple cavities. 

This clinical case shows how to treat a quadrant with composite inlays and onlays, in a modern and easy way. 



Img. 1 - Preoperative picture of the old restorations that have to be removed due to the occurrence of secondary caries

Img. 2 - Isolation of the field with the rubber dam

Img. 3 - Cleaning of decays and preliminary preparations

Img. 4 - After cleaning and disinfection of the dentin the etching of the enamel for 20 secs is performed

Img. 5 - Adhesion is performed with a Universal (8th generation) adhesive system thanks to its brilliant performance and its semplification of the operative procedures. It's used in a self etching mode

Img. 6 - The adhesive's brushed on the cavities for 20 seconds for each tooth

Img. 7 - It's then lightcured for 40 seconds for each tooth

Img. 8 - The build-ups are done with a bulk flowable composite

Img. 9 - The final preps are done with finishing burs

Img. 10 - Impression is taken with a polyvinylsiloxane (Imprint 4)

Img. 11 - The restorations are first tried without the dam, then we put back in place the rubber dam and sandblast the build-ups with aluminum oxide particles.

Img. 12 - We then try the restorations again with the rubber dam in place

Img. 13 - Details of the sandblasting of the inner surface of restorations which needs to be done too

Img. 14 - The selective etching procedure's done for 20 seconds over the enamel only

Img. 15 - The Universal adhesive is applied both on the build up and on the enamel

Img. 16 - Application of the adhesive on the inner surface of the restorations

Img. 17 - The indirects are bonded with a dual curing cement, two by two

Img. 18 - Details of the bonding procedures on the other two teeth

Img. 19 - The application of the spiral system for polishing, after the finishing procedures

Img. 20 - Details of the anatomies at the end of the work

Img. 21 - Details after finishing and polishing

Img. 22 - After removal of the rubber dam

Img. 23 - Occlusal check (cross bite)

Img. 24 - Two years follow-up

Conclusions

The usage of modern materials can be applied also in old techniques, such as partial indirect estethic posterior restorations. Nowadays we can afford these workflows as faster and precise at the same time, keeping in mind the health of our patients as supreme and most important goal. Thanks to Mr. Sebastiano Nardo for the lab. work.
 

Bibliography

  1. Marginal fit of indirect composite inlays using a new system for manual fabrication. Pott P, Rzasa A, Stiesch M, Eisenburger M. Eur J Paediatr Dent. 2016 Sep;17(3):223-226.
  2. Direct versus indirect inlay/onlay composite restorations in posterior teeth.A systematic review and meta-analysis. Angeletaki F, Gkogkos A, Papazoglou E, Kloukos D. J Dent. 2016 Oct;53:12-21.
  3. The application of indirect composite onlays in the restoration of severely broken down posterior teeth.McCarthy R. J Ir Dent Assoc. 2015 Dec;61(6):309-12.
  4. Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements. Marcondes M, Souza N, Manfroi FB, Burnett LH Jr, Spohr AM. J Adhes Dent. 2016;18(1):59-67.
  5. Marginal adaptation, fracture load and macroscopic failure mode of adhesively luted PMMA-based CAD/CAM inlays. Ender A, Bienz S, Mörmann W, Mehl A, Attin T, Stawarczyk B.Dent Mater. 2016 Feb;32(2):e22-9.
  6. Adhesive Cementation of Indirect Composite Inlays and Onlays: A Literature Review.D'Arcangelo C, Vanini L, Casinelli M, Frascaria M, De Angelis F, Vadini M, D'Amario M.Compend Contin Educ Dent. 2015 Sep;36(8):570-7; quiz 578. Review.

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