rubber dam and build-up for overlay preparation

Multiple overlays in sextant rehabilitation

Maria came into my office complaining of pain in the second sextant.

intraoral x-ray of proximal decay and root canal

Fig.1

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.

Fig.2

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.

rubber dam isolation of upper left sextant

Fig.3

Sextant isolated with rubber dam.

magnification of minimal invasive cavity access

Fig.4

After having broken the interproximal wall of 25 down, I removed the caries on 24 without eliminating the ridge, under magnification, with ultrasound instruments.

proximal view of composite resin restoration

Video

proximal view of composite resin restoration

Fig.5

The proximal restoration was performed with Bulk A3 mass in one application.

rubber dam isolation and cavity preparation

Fig.6

All the unsalvageable parts of the tooth were removed.

rubber dam and build-up for overlay preparation

Fig.7

A3 Bulk composite resin build-ups.

cad cam digital impression for overlay

Fig.8

Digital Impression taken with Omnicam.

cad cam overlay restorations

Fig.9

Overlays milled and finished.

try in of overlays

Fig.10

After removing of the Telio filling. Overlays were tried in, and occlusion and contact
areas were checked.

surface treatment of overlay preparations

Fig.11

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

surface treatment of lithium disilicate overlay

Fig.12

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.

bonding cavity with microbrush

Fig.13

When the overlay is ready, a universal bonding agent is brushed on the tooth without light curing.

highly charged flowable composite resin

Fig.14

In this case, I used a highly charged flowable composite to lute the overlays.

luting of overlay indirect restoration

Fig.15

The overlay was pressed and excess luting composite removed before and after light curing.

abrasive metal strip

Fig.16

Excess abrasion after light curing.

soflex abrasive disc finishing

Fig.17

Finishing and polishing with abrasive sof-lex discs.

isolation with matrices and wedges for overlay cementation

Fig.18

The same procedure was carried out for tooth 25.

cemented overlay

Fig.19

Premolar overlay cemented.

glycerine gel for light curing

Fig.20

Light curing under air-blocking gel.

ultrasonic finishing tip

Fig.21

Proximal finishing by ultrasonic handpiece.

overlays on upper teeth and x-ray

Fig.22

Final result after 3 days and x-ray check-up.

overlays on molar and premolar

Fig.23

Occlusal view of the finished restorations.

Conclusions

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.

Bibliography

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