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Case Study
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Preparation Design and Considerations for Direct Posterior Composite Inlay/Onlay Restoration

Learning Objectives: 

This case study presents the factors that must be addressed when considering the type of tooth reduction required for contemporary inlay/onlay restoration. Upon completing this case study, the reader should:

  • Understand the role of correct preparation design on the success of a posterior composite restoration.
  • Recognize the preparation sequence associated with successful inlay/onlay restoration in the posterior region.
 

 

In order to ensure a functional, aesthetic, and long-lasting porcelain result, clinicians need to anticipate the strengths and limits of the restorative material, as well as the specific requisites of the presented case. As flaws in preparation design can have significant and detrimental effects on the final result, clinical comprehension of the dimensions and limitations during this step is of the utmost importance. This case study discusses a case presentation in which porcelain restorations were placed for two adjacent teeth. Although the clinician anticipated placing inlay or onlay restorations, the degree of decay and the location of hairline fractures would necessitate prophylactic removal of a weakened or undermined cusp.

The long-term success of an indirect posterior restoration is dependent upon many factors. The clinician must first assess the tooth being treated, and then select a restorative material that will provide a durable result, while preserving sound tooth structure wherever possible. Current materials and adhesive techniques have demonstrated predictable, aesthetic results. These bonded restorations, under the proper conditions, will serve patients for many years. Long-term intraoral success and the ability to create conservative preparations make bonded porcelain an ideal restorative material in many situations.

*Private practice, Seattle, Washington.

  

Related Reading: 

  1. Frankenberger R, Petschelt A, Krämer N. Leucite-reinforced glass ceramic inlays and onlays after six years: Clinical behavior. Oper Dent 2000;25(6):459–465.
  2. Reis B, Walther W. Clinical long term results and 10 year Kaplan-Meier estimation of computer-aided machined CEREC restorations. Int J Comput Dent 2000;3(1):9-23.
  3. Reich SM, Wichmann M, Rinne H, Shortall A. Clinical performance of large, all-ceramic CAD/CAM-generated restorations after three years: A pilot study. J Am Dent Assoc 2004;135(5):605-612.
  4. Shillingburg HT, Hobo S, Whitsett LD. Preparations for intra-coronal restorations. In: Hobo S, Whitsett L, Jacobi R, et al. Fundamentals of Fixed Prosthodontics. 2nd ed. Hanover Park, IL: Quintessence Publishing; 1981.
  5. Puri, S. Predictable preparation, staining, and cementation procedures for chairside CAD/CAM dentistry. Prac Proced Aesthet Dent 2008;20(4):209-214.
  6. Sato K, Matsumura H, Atsuta M. Relation between cavity design and marginal adaptation in machine-milled ceramic restorative system. J Oral Rehabil 2002;29(1):24-27.
  7.  Rosentritt M, Behr M, Lang R, Handel G. Influence of cement type on the marginal adaptation of all-ceramic MOD inlays. Dent Mater 2004;20(5):463-469.
  8.  Meerbeek B. Mechanisms of resin adhesion: Dentin and enamel bonding. Func Esthet and Restor Dent 2008;2(1):18-25.
  9. Edelhoff D, Sorensen JA. Tooth structure removal associated with various preparation designs for posterior teeth. Int J Periodont Rest Dent 2002;22(3):241-249.
  10. Hickel R, Manhart J. Longevity of restorations in posterior teeth and reasons for failure. J Adhes Dent 2001;3(1):45-64.
  11. Broderson SP. Complete crown and partial coverage tooth preparation designs for bonded cast ceramic restorations. Quint Int 1994;25(8):535-539.
  12. Magne P, Belser UC. Porcelain versus composite inlays/onlays: Effects of mechanical loads on stress distribution, adhesion, and crown flexure. Int J Periodont Rest Dent 2003;23(6):543-555.
  13. Conrad HJ, Seong WJ, Pesun IJ. Current ceramic materials and systems with clinical recommendations: A systematic review. J Prosthet Dent 2007;98(5):389-404.
  14. Shirai K, De Munck J, Yoshida Y, et al. Effect of cavity configuration and aging on the bonding effectiveness of six adhesives to dentin. Dent Mater 2005;21(2):110-124.
  15. Spreafico R. Direct vs. semidirect vs. indirect restorations: Establishing criteria for clinical decision making [interview]. In: Sadan A, ed. Quintessence of Dental Technology 2003. Hanover Park, IL: Quintessence Publishing; 2003.
  16. Fasbinder DJ. Clinical performance of chairside CAD/CAM restorations. J Am Dent Assoc 2006;137(suppl):22S-31S.
  17. Gemalmaz D, Ozcan M, Alkumru HN. A clinical evaluation of ceramic inlays bonded with different luting agents. J Adhes Dent 2001;3(3):273–283.
  18. Sjögren G, Molin M, van Dijken JW. A 5-year clinical evaluation of ceramic inlays (Cerec) cemented with a dual-cured or chemically cured resin composite luting agent. Acta Odontol Scand 1998;56(5):263–267.
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