Non-invasive indirect restorations

18 Dec 2012 - 27532
Fig. 1

My patient Marco, 8 years old, was on vacation with their family in a location very near to my office, playing with his twin brother on the beach.

Fig. 2

He comes with non-complicated fractures (enamel-dentin, non pulp exposure) in #11 and #21.

Fig. 3

Lateral view showing dentin and no pulp exposure.

Fig. 4

Previous to the rubber dam insertion a full color chart is filled up (in collaboration with the dental technician). When mixed dentition is present is often difficult to obtain a full isolation field, reason why many times we come up with the solution of isolating only the dental elements where the rubber dam invagination is possible.

Fig. 5

The fracture margins were regularized with a minimal chamfer preparation with a 40 micron diamond bur and a flat finishing line on the palatal and proximal walls.

Fig. 6

All of the prepared margins were polished with a medium-low abrasion rubber point.

Fig. 7

To avoid sensibility during the following days the tooth was disinfected, etched and the dentin was hybridized with an adhesive agent.

Fig. 8

The adhesive placed carefully over the dentin and polymerized during one minute. Is important to remove the oxygen inhibited layer in order to avoid interaction problems with the silicon material.

Fig. 9

Impression phase with a polyether material, after the impression the patient can go home.

Fig. 10

The stone model already prepared for work.

Fig. 11

The dentinal core is constructed leaving 0,5 space for the enamel and effects.

Fig. 12

White and opal effects inserted.

Fig. 13

Enamel final layer of 21.

Fig. 14

A lateral view of the almost-finished restoration.

Fig. 15

Palatal view of the margins

Fig. 16

Lateral view of the finished restorations already polished and ready to be taken off the model.

Fig. 17

Frontal view of the finished restorations already polished and ready to be taken off the model.

Fig. 18

On the second appointment, normally two days after the impression, the little inlays come very well protected and marked in a box. This inlays are often confused by the parents as the “recovered fragments”… and that is exactly how they must look. Restorations are already sandblasted.

Fig. 19

In the same laboratory order, we must ask for a hard silicone stent, which will act as a guide during cementation and inlay handling.

Fig. 20

A mild sandblasting to the dental substrate is performed in order to remove the adhesive protective layer that was placed for dentin protection.

Fig. 21

Acid etching is performed for 15 seconds on the enamel.

Fig. 22

Primer and bonding is placed over the enamel and dentin according to the manufacturer’s instructions.

Fig. 23

Without removing the inlays from the silicone stent, the restorations can be silanized. When the restorations are accurately sandblasted, this is an optimal step which is not mandatory but can help in the adhesion. Placing primer is reported to beneficial as well.

Fig. 24

In the same silicone stent, and after drying the primer/silane the bonding agent is placed.

Fig. 25

The hybrid composite is pre-heated in an especial oven at 50ºC and is placed directly on the teeth.

Fig. 26

Inlays are placed over the preparations very accurately hold and pushed by the silicone stent.

Fig. 27

Composite excess is removed in the vestibular and proximal areas with a probe, while working under low light conditions this step is carried out with no rush.

Fig. 28

Polymerization of the vestibular cement during at least 30 seconds per element.

Fig. 29

Once the silicone key is taken off, all palatal excess is removed.

Fig. 30

A final polymerization is done at least for 60 seconds per tooth, a double lamp reduces time.

Fig. 36

Marco smiling again with his brother after the treatment