Indirect restoration

maximum preservation of tooth structure minimal invasion conservative restorative dentistry one treatment appointment relatively low cost

advantages of direct compost ire resin restorations

no or less polymerization shrinkage better physical /mechanical properties ideal occlusal morphology proximal contouring

advantages of indirect composite resin restorations

composite restoration

build up

cast gold restoration

casting

bevel and flare you bevel for gold inlays to improve burnishability

cavosurface margin

0.5 - 1.0 mm wide bevel to improve marginal fit 0.5mm gingival bevel wide bevel for functional cusp coverage 45 degree to cavosurface

cavosurface margins for gold inlays and onlays

90 degree butt joint margin to ensure marginal strength of restorations

ceramic or composite inlay/onlay

high caries rate young patients esthetics small restorations

contraindications for cast gold restorations

heavy occlusal forces inability to maintain a dry field deep sub gingival preparation

contraindications for indirect tooth colored restorations

when the occlusal outline is extended more than 1/2 of the distance between primary occlusal groove to the cusp tip: capping the cusp tip should be considered

cuspal coverage

correct indication cavity preparation size type finishing handling and application technique curing mode mode of finishing and polishing of the restoration correct occlusion experience

dentist factors influencing the longevity of dental restorations

polymerization shrinkage low fracture and wear resistance

disadvantage of direct composite resin restorations

yes

do larger restorations exhibit more deterioration than moderate and small sized restorations?

yes

do you make a mechanical lock for inlays and inlays?

no you do need to worry about retention so you need to make the cuts big enough

do you need to worry about fracture with gold inlays?

yes you are more concerned with retention than stress

do you want a sharp internal line angle with gold?

au content > 40 wt% noble metal content >60%

high-noble

generally 20 years or more

ho long do cast gold alloys last?

2.0 depth cut to ensure strength

how deep should a ceramic or composite inlay only be?

1.5 mm depth cut to obtain appropriate retention

how deep should a gold inlay onlay be?

higher flexural strength and fracture toughness

how does lithium dislocate compare to ceramic reinforced composite resin?

it is the gold standard the most serviceable dental restoration available cast gold alloys are considered the standard against which other restorative materials are compared clinically in terms of fit, biocompatibility and clinical service

how good is gold?

adhesive cementation required fracture strength as high as that of lithium dislocate when adhesively cemented

hybrid ceramic reinforced composite

large restorations endodontically treated teeth teeth at risk for fracture dental rehabilitation with cast metal alloys diastema closure and occlusal plane correction removeable prosthetic abutment

indications for cast gold restorations

large restorations esthetics

indications for indirect tooth colored restorations

a fixed intracoronal restoration a dental restoration made outside of a tooth corresponding to the form of the prepared cavity which is then luted into the tooth no cusp coverage

inlay definition

more resistant "although overall contact induces breakage load is modest"

is it more or less resistant to sliding/impact induced coaching ?

fabricated by pressure casting or milling ivoclar vivadent ivovlar viva dent

lithium dislocate

strength (fractures) fatigue /degradation wear resistance bond strength chemical compatibility of restorative systems technique sensitivity caries inhibiting effects

material factors influencing the longevity of dental restorations

noble metal content > 25% wt

noble

a partial coverage restoration that restores one or more cusps and adjoining occlusal surfaces or the entire occlusal surface and is retained by mechanical or adhesive means

onlay definition

prep wax wax pattern = sprue casting - type II gold alloy try in burnishing

order of creating a cast

oral hygiene preventive measures compliance of recall oral environment -quality of tooth structure/saliva etc size shape location of the lesion and tooth -number of surfaces vital vs non vital tooth premolar vs molar cooperation during tx bruxism/habit

patient factors influencing the longevity of dental restorations

high strength and toughness low wear of both the restoration and opposing natural tooth chemically nonreactive (no adverse biologic response such as corrosion) restorations can be fabricated by casting, milling, or 3D printing

physical properties of gold alloy

noble metal content <25 wt%

predominantly base-metal

lithium dislocate

pressing

removal of weak enamel a lap sliding fit burnishabilitiy

purpose of gingival bevel

congenital anomalies tooth fracture dental caries wear

rationale for inlay or onlay

restoration failure tooth fracture postoperative sensitivity wear loss of retention secondary caries marginal deficiencies

reasons for failure

mixture of resin and ceramic incorporating of ceramic filler particles into a monomer mixture infiltration of a pre-sintered ceramic network by a monomer mixture restorations can be fabricated by machine - milling

resin nano-ceramic/resin infiltrated ceramic

the difference of the two techniques did not reach statistical significance in order to recommend one technique over the other the selection of the best treatment protocol still remains subjective

was there statistical significance?

occlusally divergent taper 2-5 degrees per wall

what angle should walls be?

low solubility marginal adaption comparale to zinc phosphate fluoride release improved retention higher tensile strength

what are desirable properties of RMGI?

polymers ceramics metals

what are materials for direct restorations?

time consuming (two appointments) extra cost

what are the disadvantages of indirect composite resin restorations?

modified taper diamond

what bur do you use to prep a ceramic inlay?

flat and taper bur tapered fissure bur

what burs do you use for cast gold inlays?

lithium disilicate

what ceramics do you use for direct and indirect restorations?

rounded to prevent fracture

what do line angles need to be like for ceramic or composite?

they create dislodging forces with occlusal forces

what do sloped or rounded edges do?

this combination of low hardness and modules couples with higher toughness enables rapid milling with minimal edge chipping consequences as well as greater ability to cope with sever occlusal contact fatigue loading

what do these properties do?

adhesive cementation HF etching + silane + resin cement adhesive cementation has been shown to increase fracture loads and improve longevity a glass ceramic restoration supported by a composite resin cement withstand higher masticatory forces and demonstrated improved clinical performance

what do you need to attach lithium dislocate?

any type of cement zinc phosphate has been chosen because of its low film thickness RMGI is becoming more popular because of is desirable properties

what do you need to cement cast gold restorations?

2.0 or more

what does the depth of the tooth preparation need to be increased to for gold inlays?

4 year survival rate = 98.17%

what is 4 year surivial rate or lithium dislocate on single crowns?

100%

what is 7year surivial rate or lithium dislocate on partial coverage restorations?

amalgam composite resin glass ionomer

what is a direct restoration?

inlay onlay veneer fixed dental prosthesis (crown/bridge)

what is an indirect restoration?

shoulder + bevel on chamber axial reduction 1.0mm or slightly more

what is gold onlay finish line design?

0.5mm

what is ideal clearance?

2.2%

what is the annual failure rate of direct composite?

2.9%

what is the annual failure rate of indirect composite inlay/onlays?

2mm for ceramic inlay

what is the best isthmus?

finish line design : rounded shoulder (deep chamber) axial reduction 1-1.5 finish line width = 1.0mm

what is the ceramic or composite onlay finish design?

comparable or higher fracture toughness lower hardness and elastic modules

what is the difference btw resin nano-ceramic and porcelain and glass ceramic?

1.5 mm

what is the minimal occlusal reduction for a gold onlay?

2.0 mm occlusal reduction

what is the minimal occlusal reduction for ceramic or composite onlay?

10 year survival rate: 65.3% 11.5 year survival rate: 50% 15 year survival rate: 72%

what is the survival rate of extensive amalgam restorations?

no long term clinical data available 3 yr survival rate - 87.7%

what is the survival rate of extensive composite resin restorations?

high noble alloy

what metals do you use for direct and indirect restorations?

composite resin ceramic reinforced composite resin

what polymers do you use for direct and indirect restorations?

flat perpendicular to the long axis of the tooth

what should pulpal and gingiva floors be?

when the preparation outline is extended 2/3 of this distance or more

when is capping absolutely necessary?

class I restorations

where are gold inlays/onlays not the best?

class II restorations

where are gold inlays/onlays the best?

longer margins and poor cleansibility leads to higher biologic risk stress bearing areas such as cusps and marginal ridges lead to higher mechanical risk

why consider an inlay or onlay?

soft - low stress

ADA type 1

moderate stress , light occlusion onlays and inlays

ADA type II

high stress, full occlusal load crowns, short-span FDPs

ADA type III

extra hard very high stress thin veneer crowns long span FDPs RPDs

ADA type IV