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.

styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.1

Preoperative picture of the old restorations that have to be removed due to secondary caries.
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.2

Isolation of the field with the rubber dam
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.3

Cleaning of decay and preliminary preparations
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.4

After cleaning and disinfection of the dentin, etching of the enamel for 20 seconds is performed
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

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.
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.6

The adhesive agent is brushed on the cavities for 20 seconds for each tooth
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.7

It’s then light cured for 40 seconds for each tooth
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.8

The build-up of cavities is done with a bulk flowable composite
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.9

The final preparations are done with finishing burs
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.10

Impression is taken with a polyvinylsiloxane material (Imprint 4)
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

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.
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.12

We then try the restorations again with the rubber dam in place.
styleitaliano style italiano inlays onlays composite restoration indirect cementation preparation build-up try in step how to rubber dam contact point

Fig.13

Details of the sandblasting of the inner surface of restorations which needs to be done too
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.14

The selective etching procedure is done for 20 seconds over the enamel only
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.15

The universal adhesive is applied both on the build up and on the enamel
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.16

Application of the adhesive on the inner surface of the restorations
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.17

The indirect restorations are bonded with a dual curing cement, two by two.
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.18

Details of the bonding procedures on the other two teeth. Excess material is accurately removed.
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.19

After cementation, spiral system is used for polishing, after the finishing procedures
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.20

Details of the anatomy at the end of the work
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.21

Details after finishing and polishing
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.22

After removal of the rubber dam
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

Fig.23

Occlusal check (cross bite)
styleitaliano style italiano inlays onlays composite restoration indirect cementation bonding procedure preparation build-up try in step how to rubber dam contact point

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.