Direct and indirect restorantion in posteriors

Community - Indirect posteriors - Direct posteriors
11 Oct 2017

Restorative procedure choice is often a cause of doubt for the dentist considering the loss of dental tissue and the different type of materials that we can use.

In case of extensive damage and tooth decay indirect restoration are preferred to avoid also fracture risk through cusp coverage.

Differently, whenever possible, a direct approach must be taken, when talking about restorative procedures in posteriors.

This clinical case shows how to treat teeth with direct and indirect restoration.

 

Fig. 1

Preoperative picture of old restorations in composite that have to be replaced for decay and secondary caries.

Fig. 2

Cleaning of old restorations and secondary caries and reduction of cusps of 15 to prepare for an overlay.

Fig. 3

Cleaning of old restorations and secondary caries and reduction of cusps of 15 to prepare for an overlay.

Fig. 4

Direct reatoration of secondary caries on 16 and 14 with composite (body and enamel), preparation and build up with composite on 15.

Fig. 5

After 10 days from the obturations, before the isolation with rubber dam for the adhesion of the overlay on 15 with dual curing cement.

Fig. 6

Isolation of 15 before cementation of the overlay. The tooth has been treated with etching of the enamel for 20 sec and sendblasting of the composite part of the build up.

Fig. 7

The overlay in lithium disilicate has been etched with fluoridric acid 5% for 20 second and then it has been cemented with dual curing cement

Fig. 8

After removal of rubber dam and polishing.

Fig. 9

Final RX of the direct restauration and overlays.

Fig. 10

Final RX of the direct restauration and overlays.

 

Conclusions

The loss of dental tissue is the main aspect to consider in case of direct or indirect restauration choice, above all in premolar where fracture risk is very high.
Nowadays new techniques and matherials can help dentistry in term of precision and esthetic aspects, also in indirect restaurations.

Bibliography

1. 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.
2. 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.
3.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.
4. 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.