Overlay goes digital
Endodontically treated teeth need cusp protection, most of the times, be it with partial or complete restorations.
In this case, the tooth was reconstructed using a ﬁber post, but luckily quality and quantity of residual enamel allowed us to restore this tooth with a lithium disilicate overlay to protect it towards masticatory loads. This case was performed using a digital workﬂow.
After the RCT a ﬁber post was cemented and a composite build up was done to seal the tooth. Residual enamel was thick and good, so we decided to only proceed to cusp coverage by fabricating an overlay.
The shade for the indirect restoration was taken before preparing the cavity.
The tooth was prepared to achieve complete cusp coverage as it wasn’t vital, and neighboring teeth were polished.
A digital scan was taken, here you can see a screenshot from the .stl ﬁle and details of the preparation without the high deﬁnition
CAD ﬁle before the project showing contact points
CAD design showing unchanged occlusion on the neighboring teeth, and the onlay project.
After CAM processing, check of the physical wax project.
A pressed lithium disilicate overlay was fabricated and then colored and polished.
Isolation with rubber dam before adhesive cementation.
Try in was carried out under rubber dam isolation to check proximal and marginal ﬁt.
Marginal adaptation was checked on all sides.
Enamel and composite build-up were etched using 37% orthophosphoric acid.
A universal adhesive system (Scotchbond Universal, 3M) was used for bonding.
The surface of the overlay was treated using hydroﬂuoric acid, polish and adhesive.
After light curing and excess removal, before ﬁnishing.
Here you can see how similar the ﬁnal outcome is in reality compared to the digital project.
At check-up, 10 days later. Integration is satisfactory.
At check-up, 10 days later.
Adhesive indirect restorations are an excellent solution to give stability and resistance to endodontically treated teeth while saving sound tissue.
Using the correct build-up technique it is possible to preserve healthy enamel. New technologies and materials allow dentists to work in an aesthetic and accurate way.
Thanks to DT Alessandro Arnone for the fundamental contribution.
1. Boeddinghaus M, Breloer ES, Rehmann P, Wöstmann B. Accuracy of singletooth restorations based on intraoral digital and conventional impressions in patients. Clin Oral Invest. 2015;19:2027–2034.
2. Seelbach P, Brueckel C, Wöstmann B. Accuracy of digital and conventional impression techniques and workﬂow. Clin Oral Invest. 2013;17:1759–1764.
3. D’Arcangelo C, Vanini L, Casinelli M, Frascaria M, De Angelis F, Vadini M, D’Amario M. Adhesive Cementation of Indirect Composite Inlays and Onlays: A Literature Review. Compend Contin Educ Dent. 2015;36(8):570-7.
4. Zarow M, Devoto W, Saracinelli M. Reconstruction of endodontically treated posterior teeth with or without post? Guidelines for the dental practitioner. Eur J Esthet Dent. 2009 Winter;4(4):312-27.