Posterior Restoration Using Laboratory-Fabricated Composite Resin Inlays/Onlays
Robert A. Lowe, DDS • Nelson A. Rego
After reviewing this case study, the reader should:
- Understand the process of creating composite resin restorations to provide predictable aesthetic results
- Be aware of how to implement composite resin restorations in a patient presenting with amalgam restorations and visualize the aesthetic advantages
The variety of materials that can be used for the restoration or
replacement of the posterior dentition have increased dramatically. Implant
therapy, porcelain-fused-to-metal crowns and fixed partial dentures,
all-ceramic systems, and direct composite resin all present the restorative
team with numerous possibilities when considering the treatment of this region.
Due to advances in contemporary resin cements and adhesive formulations,
however, indirect porcelain and composite resin inlay/onlay restorations may
also be utilized.
Laboratory-fabricated composite resin restorations can provide
predictable aesthetic results when precise clinical and laboratory techniques
are strictly followed and communication protocols have been established among
the members of the restorative team. In comparison to metal-ceramic
alternatives, the preparation for these restorations is conservative in nature
- in essence, only damaged tissue is removed. In addition, they have
demonstrated minimal wear of the opposing dentition in preliminary studies,
which has traditionally been a limitation of porcelain inlays/onlays. This
reduced antagonist wear has been attributed to the revised composition of the
laboratory-fabricated composite material, which is a combination of ceramic
fillers and an organic matrix. Laboratory-fabricated composite resin can also
be adjusted chairside with relative ease.
A 27-year-old female patient presented with the initial complaint
of pain in the posterior left mandibular quadrant upon biting. The patient also
experienced sensitivity to sweets and cold stimuli in the region. The
comprehensive clinical and radiographic examinations revealed the presence of
several defective amalgam restorations on teeth #18(37) through #20(35),
although the patient's periodontal health was excellent. No contributory
debilitations were noted upon occlusal evaluation. Following consultation with
the members of the restorative team, the patient elected to have the defective
amalgam fillings replaced with laboratory-fabricated composite resin (ceromer)
inlay/onlay restorations. This would achieve the aesthetic expectations of the
patient and simultaneously deliver dental treatment that would not wear the
opposing natural dentition.
* Private practice, Vancouver, British Columbia, Canada.
† Laboratory technician, Rego Dental Laboratory, Downey,
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