Multiple overlays in sextant rehabilitation
Maria came into my office complaining of pain in the second sextant.
After clinical evaluation and a bite wing X-ray, the deep caries on tooth 25 was identified as the source of the pain. In addition, decay on teeth 24 and under the big restoration of 26 was found. First of all, root canal treatment of 25 was performed to eliminate the pain.
Occlusal view of the decayed sextant after root canal. The treatment plan included a direct restoration on 24, a lithium disilicate overlay on 25 and a composite overlay on 26.
Sextant isolated with rubber dam.
After having broken the interproximal wall of 25 down, I removed the caries on 24 without eliminating the ridge, under magnification, with ultrasound instruments.
The proximal restoration was performed with Bulk A3 mass in one application.
All the unsalvageable parts of the tooth were removed.
A3 Bulk composite resin build-ups.
Digital Impression taken with Omnicam.
Overlays milled and finished.
After removing of the Telio filling. Overlays were tried in, and occlusion and contact
areas were checked.
After checking the indirect restorations, the sextant was isolated with the rubber dam. The protocol for luting of the indirect restorations was:
Cleaning with a fuolrine-free abrasive paste Sandblasting with 50 um alumina particles
Air-blowing and rinding the powder
Etching, washing and drying
Lithium disilicate overlays were etched with 9% hydrofluoric acid, and then treated with two or three coats of silane and universal bonding agent, without light curing.
When the overlay is ready, a universal bonding agent is brushed on the tooth without light curing.
In this case, I used a highly charged flowable composite to lute the overlays.
The overlay was pressed and excess luting composite removed before and after light curing.
Excess abrasion after light curing.
Finishing and polishing with abrasive sof-lex discs.
The same procedure was carried out for tooth 25.
Premolar overlay cemented.
Light curing under air-blocking gel.
Proximal finishing by ultrasonic handpiece.
Final result after 3 days and x-ray check-up.
Occlusal view of the finished restorations.
Mini-invasiveness means seeking the most conservative and predictable treatment plan possible for our patient. Choosing the most appropriate materials and techniques is mandatory in the decision making process. In this case, the preservation of sound tissue was crucial in order to maintain the largest possible amount of healthy dental tissue of tooth 25 after root canal treatment. Composite was chosen as the best material for the overlay on tooth 26 to keep vitality of the tooth, and to leave easy access in case future intervention is needed.
Goldberg J, Güth JF, Magne P.: Accelerated Fatigue Resistance of Thick CAD/CAM Composite Resin Overlays Bonded with Light- and Dual-polymerizing Luting Resins. J Adhes Dent. 2016;18(4):341-8.
Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Özcan M.: Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis. J Dent Res. 2016 Aug;95(9):985-94
Fron Chabouis H, Smail Faugeron V, Attal JP.: Clinical efficacy of composite versus