Composite inlays and onlays

The choice of composite inlays and onlays as restorative procedures is quite often a cause of doubt, perplexity, and indecision for the dentist. There’s a lot of confusion among 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 chair-side 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

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

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Fig.2
Isolation of the field with the rubber dam

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Fig.3
Cleaning of decay and preliminary preparations

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Fig.4
After cleaning and disinfection of the dentin, etching of the enamel for 20 seconds is performed

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Fig.5
Adhesion is performed with a universal (8th generation) adhesive system thanks to its brilliant performance and its simplification of the operative procedures. It’s used in a self etching mode.

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Fig.6
The adhesive agent is brushed on the cavities for 20 seconds for each tooth

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Fig.7
It’s then light cured for 40 seconds for each tooth

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Fig.8
The build-up of cavities is done with a bulk flowable composite

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Fig.9
The final preparations are done with finishing burs

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Fig.10
Impression is taken with a polyvinylsiloxane material (Imprint 4)

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

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

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

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Fig.14
The selective etching procedure is done for 20 seconds over the enamel only

style italiano styleitaliano dentistry

Fig.15
The universal adhesive is applied both on the build up and on the enamel

style italiano styleitaliano dentistry

Fig.16
Application of the adhesive on the inner surface of the restorations

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Fig.17
The indirect restorations are bonded with a dual curing cement, two by two.

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Fig.18
Details of the bonding procedures on the other two teeth. Excess material is accurately removed.

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Fig.19
After cementation, spiral system is used for polishing, after the finishing procedures

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Fig.20
Details of the anatomy at the end of the work

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Fig.21
Details after finishing and polishing

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Fig.22
After removal of the rubber dam

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Fig.23
Occlusal check (cross bite)

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Fig.24
Two year follow-up

Conclusions

Modern materials can be of course used in old techniques, such as partial indirect aesthethic 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 DT Sebastiano Nardo for the lab work.

Bibliography

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.
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.
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.
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.
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.
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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