Tooth Colored Inlays and Onlays - II

TOOTH COLORED INLAYS
AND ONLAYS - II
Dr. Nasrien Ateyah
Posterior Bonded Porcelain

Restorations
Ceramic inlays were introduced in 1913
but did not become popular
Difficulties in fabrication
High failure rate
In 1980s
Development of compatible refractory
materials made fabrication easier
Development of abrasive resin cements greatly
improved clinical success rates
Advantages
Porcelain is an excellent replacement
material for unaesthetic tooth substance
for some of the following reasons:
Color: Most porcelain systems use wellestablished techniques of effectively

blending in with the adjacent natural
dentition.
Advantages
Periodontal health: A porcelain

restoration may accumulate less plaque on
its surface than will other systems.
Resistance to abrasion: The wear-and

abrasion-resistance of these restorations is
high, although they have the potential to
create wear in the opposing arch.
Advantages
Radio
density: On radiographs, the
radio density of porcelain resembles

that of normal tooth structure, quite
often allowing for radiographic access
to areas that were previously shielded
by radiopaque restorations.
Advantages
The marginal integrity:
when ceramic restorations are
combined with resin bonding
and a composite resin luting agent,
is excellent with the result that
microleakage is decreased to an
absolute minimum.
Disadvantages
The amount of time and attention to detail

required when these restorations are fabricated
and placed (technique-sensitivity) makes
them of necessity an expensive alternative to
other modalities.
Moisture contamination and placement

procedures are all potentially problematic.
Disadvantages
The
strength of the individual

unbonded restoration is relatively
nominal, so that the try-in procedures
can result in fracture of the porcelain.
The
laboratory fee for this type of

restoration is an added factor when a
treatment plan is developed.
Disadvantages
The
potential wear of the teeth in the

opposing arch, particularly during Para
functional habits, is a contraindication.
A new generation of low-fusing porcelains

less wear of enamel
e.g.: Empress 2 pressable ceramics
almost no wear
Disadvantages
In
cast-glass or ceramic restorations

with superficical surface stain, occlusal
adjustment results in the loss of the
surface colorants. This obviously
results in a less attractive restoration,
when esthetics may well have been the
reason the patient sought treatment in
the first place.
Indication
When
one cusp of posterior tooth is being

covered with an esthetic bonded onlay
In
the restoration of a molar with a short

occlusogingival dimension (require 2mm
occlusal reduction. No axial reduction)
All
margin should be on enamel
Indication
Should
be amenable to rubber dam

placement
should exhibit no sign of a Para
functional habits
Patient
Contraindications:
1.
Bruxism patient
2.
Excessive tooth destruction with very

little dentin remaining
Failure
Bulk
fracture
Area of cuspal coverage ( 2mm thick)

At the isthmus adjacent to marginal ridges
(porcelain poorly supported by
tooth structure)
Marginal
breakdown because resin cement
not be heavily filled wear more quickly than

the adjacent restorations or tooth structure.
Ceramic Inlay vs. Resin

Composite Inlay

Leak less
Fit better
Adhesion of luting resin is more reliable and
durable to etched ceramic material
Porcelain inlay is quite fragile subject to fracture
during the try-in
Removed proximal contact can be replaced by
time-consuming
Porcelain Onlays vs. Resin

Composite Onlay
Has same disadvantages as porcelain inlay.
It is a cuspal coverage restoration cause
wear of opposing enamel

But provide long-term occlusal
stability
Ceramic Materials that can be used

for Posterior Inlays and Onlays
1.
Conventional ceramics
2.
Glass ceramics
a.
b.
c.
Castable glass ceramic

Injection molded glass ceramics
CAD-CAM and Copy milled materials
A. Conventional Ceramic
The concept of a ceramic inlay dates back to the
end of the last century, when the first
restorations of this type were fabricated. The
problems inherent with porcelain, such as:
Material weakness
Lack of Marginal integrity
Lack of an adequate cementing medium
Initially made this an unsuccessful
restoration.
Conventional Ceramic
Advantage
Ceramic restoration provide:
Color stability
Stain resistance
Marginal integrity (resin bonding and
composite resin luting agent)
Microleakage to absolute minimum
Disadvantage
time
Tend to fracture during porcelain try-in
Expensive
Wear of opposing teeth
Difficult to adjust
B. Glass Ceramics
1.
Castable glass ceramics (Dicor)
2.
Injection molded glass ceramic
3.
CAD-CAM and copy milled material
1. Castable Glass Ceramics

(Dicor)
Over the years castable glass-ceramic
systems have proved to be a viable
alternative ceramic system.
This systems have been used for a
variety of different clinical situations
as:
Core for ceramic crowns
Inlays and onlays
1. Castable glass ceramics (Dicor)
The immediate advantage of this type of

ceramic process over the conventional is that
a. It utilizes the conventional waxing on a

die.
b. Casting techniques similar to the
conventional lost wax technique used for
cast-metal restorations.
Indication:
For single unit
Advantages
The fit of cast-glass restorations reportedly

supersedes that of conventional porcelain.
This decreases the amount of resin luting
agent at the margins, in turn decreasing
the potential for ditching.
The wear on the opposing occlusion is

predicted to be less than that of
conventional porcelains.
Advantages
The
thermal cycling properties of cast

glass approximate those of enamel.
Flexural
strengths is reportedly
greater than it is for conventional
porcelain.
Disadvantages
The colorant is a surface stain, hence any

grinding on the restoration leaves an
unaesthetic opaque white area.
An additional chairside visit is necessary to

fit and adjust the contacts, anatomic form,
and occlusion prior to staining. Once stained,
the surface cannot be adjusted without
compromising the esthetics.
Disadvantages
The
whole process is techniquesensitive, from the casting of the

inlays through the staining of the
cerammed restorations.
2.
Injection molded glass ceramic

pressed-ceramic system
(IPS Empress)
A newer material of the all-ceramic type,

which is not cast but injection molded,
is IPS Empress.
This system uses high-temperature

pressing of a pre-cerammed glass ceramic
with hydrostatic pressure in a vacuum
unit.
IPS Empress II
Utilizes
veneering technique
The core is a glass ceramic
Veneer contains fluoroapatite crystals
Higher volume of crystals
Stronger than the original IPS Empress
Advantages of PressedCeramic Systems

The pressed-ceramic system involves

relatively simple processing procedures that
accurately reproduce the waxed pattern.
The cerammed restorations have a high

degree of stability during subsequent
shading or layering techniques.
The
precerammed porcelain has a

high degree of flexural tensile
strength (exceeding 200 MPa).

The
versatility of the process allows for the

development of very esthetic restorations
ranging from inlays and onlays to full
crowns and laminate veneers, even in
very thin sections of only 1mm

The
lost-wax technique and ceramic
injection molding allow for accurate fit.

The
preshaded base ingots with two

different characterization techniques allow
achievement of excellent harmony and
blending with adjacent teeth.
3- CAD-CAM Systems
The introduction of computer-aided
design/computer-aided
manufacturer (CAD/CAM)
systems to restorative dentistry
represents a major technological
breakthrough.
CAD-CAM Systems
New fabrication method in which the restoration
is milled out of a piece of ceramic that is
pre-manufactured.
Elimination of laboratory techniques
variables
Improvement in the properties of the
ceramic material
Less porosity
Extremely expensive
Component of the System

1.
2.
3.
4.
Three dimensional video camera

Electronic image processor
Three access-of rotating-milling
machine
Computer component and screen
of the cerec system
Material
1.
Dicor ceramic material
2.
Vita porcelain (Vita Mark II)
Advantages of the Cerec System
Ceramic-bonded restorations offer a wide

range of advantages over conventional
restorative materials.
Single
No
appointment
impression

Reduced
marginal gap
Wear hardness similar to enamel
Less fracture of the inlay, because it is
milled from a solid, homogeneous block
Excellent polishing characteristics
Improved esthetics
Less reduction to tooth structure, hence
better periodontal health

Bonded
restorations enhance tooth

strength
Preparation, fabrication, cementation,
and polishing normally accomplished in
1 to 1 hours
4- Copy Milling Celay

An innovative system, the celay technique
is a variation on the direct-indirect
restoration concept but without the
need for a laboratory technician.
This system duplicate the hard composite
resin patterns of the restoration from
the improved material mentioned in the
CAD-CAM
Advantages of the Celay System

A precisely fitting ceramic restoration can
be developed
In one patient session.
Without the need for a laboratory

technician.
In factory-fired high-grade porcelain.
Advantages of the Celay

System
The
processing time required is very short.

A small inlay can be milled in 3 minutes,
a mesio-occluso-distal inlay in less
than 8 minutes, and a complete onlay in
12 to 13 minutes.
The preparation should incorporate the

following features:
A 1.5 to 2.0mm reduction in vertical height
of the cusps and all occluding areas
Preparation finish lines on any supporting
cusps that are hollow-ground chamfers,
generally with no bevel
Well-rounded
angles on the cuspal

preparation, to prevent propagation of
porcelain fracture from these sharp
stress points
The specifically developed instrument with a newly

designed tip results in the following:
A
flat pulpal floor with the calculated divergent

axial walls
A rounded line angle between the pulpal and
axial wall
Highly retentive axial walls because of the hybrid

diamond on the shank, which increases the surface
area for bonding and develops mechanical retention.
A well-defined cavosurface margin at the

occlusal surface on which the hollow-ground chamfer
can be developed Fine-grit round instrument
Fabrication
The most common method of fabrication of porcelain
inlays and onlays refractory die
After a master die is poured in die stone

1.
Refractory die is made by:

2.
Duplicating the master die or

Repouring the impression in refractory material
The porcelain is backed on the refractory die,

recovered, and fit to the master die
Fabrication
The newer generation of pressed ceramic is
fabricated much differently
1. The restoration is waxed on a stone die
in the traditional manner and invested
in a special investment.
2. The invested wax pattern is burned out
as in the traditional lost-wax technique.
Fabrication
An ingot of the pressed ceramic
material is heated and pressed into the
lost-wax pattern space.
4. After cooling, the investment is
removed and the ceramic restoration is
retrieved and finished in the same
manner as a feldspathic porcelain
restoration.
3.
The Four-Stage
Try-In
Prior to final luting of the porcelain inlays, it is

important to follow the four-stage try-in. The
restorations need to be evaluated for the
following criteria:
Marginal integrity
The intimate adaptation of
all porcelain margins to the
prepared tooth surface must
be checked.
The Four-Stage
Try-In
Proximal
relations. The collective fit and

relationship of one restoration to the other or
the adjacent tooth must be evaluated.
Occlusal relations. The contact relations,
with the opposing arch in centric occlusion
and lateral excursive movements of the
mandible, are best evaluated
after inlay placement.
The Four-Stage
Try-In
Color:
Posterior restorations, their

basic shade should blend with the
surrounding teeth. The need for
individual characterization, such as
fissure staining or other such color
high-lights, must also be ascertained.
Inlay/Onlay Placement
Procedure
The porcelain restoration bonds to the tooth in
a series of individual links:
At
the tooth interface, etched

enamel micromechanically
bonds with dental bonding agent.
At the restoration interface,etched
porcelain is made reactive via
a silane, which mechanically and
chemically bonds to an unfilled
resin layer.
Inlay/Onlay Placement
Procedure
These
two reactive interfaces are joined

by an optimized dual-cure hybrid
composite resin luting agent.
THANK
YOU
The recent development of reinforcing

systems for porcelain, however, coupled
with the ability to etch and bond the
porcelain to the underlying etched tooth
structure.

The
precerammed porcelain has a high

degree of flexural tensile strength
(exceeding 200 MPa).
This
makes the material adequate for

most normal restorations, let alone those
bonded to the underlying tooth structure.

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What are some advantages of porcelain inlays and onlays?

What are some advantages of porcelain inlays and onlays?

How are porcelain inlays and onlays bonded to teeth?

How are porcelain inlays and onlays bonded to teeth?

TOOTH COLORED INLAYS

Dr. Nasrien Ateyah

Posterior Bonded Porcelain

Color: Most porcelain systems use wellestablished techniques of effectively

Periodontal health: A porcelain

Resistance to abrasion: The wear-and

density: On radiographs, the

radio density of porcelain resembles

The amount of time and attention to detail

Moisture contamination and placement

strength of the individual

laboratory fee for this type of

potential wear of the teeth in the

A new generation of low-fusing porcelains

cast-glass or ceramic restorations

one cusp of posterior tooth is being

the restoration of a molar with a short

margin should be on enamel

be amenable to rubber dam

Excessive tooth destruction with very

Area of cuspal coverage ( 2mm thick)

breakdown because resin cement

not be heavily filled wear more quickly than

Ceramic Inlay vs. Resin

Porcelain Onlays vs. Resin

wear of opposing enamel

Ceramic Materials that can be used

Castable glass ceramic

Castable glass ceramics (Dicor)

Injection molded glass ceramic

CAD-CAM and copy milled material

1. Castable Glass Ceramics

1. Castable glass ceramics (Dicor)

The immediate advantage of this type of

a. It utilizes the conventional waxing on a

The fit of cast-glass restorations reportedly

The wear on the opposing occlusion is

thermal cycling properties of cast

The colorant is a surface stain, hence any

An additional chairside visit is necessary to

whole process is techniquesensitive, from the casting of the

Injection molded glass ceramic

A newer material of the all-ceramic type,

This system uses high-temperature

Advantages of PressedCeramic Systems

The pressed-ceramic system involves

The cerammed restorations have a high

Advantages of PressedCeramic Systems

precerammed porcelain has a

Advantages of PressedCeramic Systems

versatility of the process allows for the

Advantages of PressedCeramic Systems

lost-wax technique and ceramic

injection molding allow for accurate fit.