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Case Study
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Posterior Restoration Using Laboratory-Fabricated Composite Resin Inlays/Onlays

Learning Objectives:

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.

 

Patient Presentation

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, California.

 

Related Reading:

  1. Stangel I, Nathanson D. An overview of the use of the posterior composites in clinical practice. Compend Contin Educ Dent 1987;8(10):800-806.
  2. Lacy AM. A critical look at posterior composite restorations. J Am Dent Assoc 1987;114(3):357-362.
  3. Swift EJ Jr. Wear of composite resins in permanent posterior teeth. J Am Dent Assoc 1987;115(4):584-588.
  4. Bausch JR, de Lange K, Davidson CL, et al. Clinical significance of polymerization shrinkage of composite resins. J Prosthet Dent 1982;48(1):59-67.
  5. Jensen ME, Chan DCN. Polymerization shrinkage and microleakage. In: Vanherle G, Smith DC, eds. International Symposium on Posterior Composite Resin Dental Restorative Materials. St. Paul, MN: Minnesota Mining + Mfg Co; 1985:243-272.
  6. Bouschlicher MR, Vargas MA, Boyer DB. Effect of composite type, light intensity, configuration factor and laser polymerization on polymerization contraction forces. Am J Dent 1997;10(2):88-96.
  7. Davidson CL, de Gee AJ, Feilzer A. The competition between the composite-dentin bond strength and the polymerization contraction stress. J Dent Res 1984;63(12):1396-1399.
  8. Nash RW, Radz GM. Single-appointment composite onlays. Compend Contin Educ Dent 1997;18(3):202-208.
  9. Touati B. The evolution of aesthetic restorative materials for inlays and onlays: A review. Pract Periodont Aesthet Dent 1996;8(7):657-666.
  10. Douglas RD. Color stability of new-generation indirect resins for prosthodontic application. J Prosthet Dent 2000;83(2):166-170.
  11. McLaren EA, Rifkin R, Devaud V. Considerations in the use of polymer and fiber-based indirect restorative materials. Pract Periodont Aesthet Dent 1999;11(4):423-432.
  12. Soderholm KJM. Filler systems and resin interface In: Vanherle G, Smith DC, eds. International Symposium on Posterior Composite Resin Dental Restorative Materials. St. Paul, MN: Minnesota Mining + Mfg Co; 1985:139-159.
  13. Suzuki S, Leinfelder KF, Kawai K, Tsuchitani Y. Effect of particle variation on wear rates of posterior composites. Am J Dent 1995;8(4):173-178.
  14. Braem M, Finger W, Van Dooren VE, et al. Mechanical properties and filler fraction of dental composites. Dent Mater 1989;5(5):346-348.
  15. St. Germain H, Swartz ML, Phillips RW, et al. Properties of microfilled composites resins as influenced by filler content. J Dent Res 1985;64(2):155-160.
  16. Bayne SC, Taylor DF, Heymann HO. Protection hypothesis for composite wear. Dent Mater 1992;8(5):305-309.
  17. Givan DA, O'Neal SJ, Suzuki S. Eight-year clinical performance of heat- and pressure-cured indirect composite. J Dent Res 2000;78(special issue):1523.
  18. Miara P. Aesthetic guidelines for second-generation indirect inlay and onlay composite restorations. Pract Periodont Aesthet Dent 1998;10(4):423-431.
  19. Olk C. Esthetics in the composite resin veneer technique. Quint Dent Tech 2000;23:159-167.
  20. Cook WD, Johannson M. The influence of postcuring on the fracture properties of photo-cured dimethacrylate based dental composite resin. J Biomed Mater Res 1987;21(8):979-989.
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