Porcelain Inlay and Porcelain Inlay and OnlayOnlay

Dr. Ignatius Lee

Preparation and Restoration

Restorative Options - Restorative Options - DirectDirect

1970’s– Posteriors: amalgam

– Anteriors: composite

2000’s– Posteriors: amalgam (material specific), composite (lesion specific)

– Anteriors: composite

Evolution of Cavity Evolution of Cavity Preparation Design for Preparation Design for Posterior CompositePosterior Composite

Taking into consideration the differences in the physical properties between the two materials (amalgam vs composite); and based on the rationale of the cavity preparation design for amalgam

Questions were asked: Do we need convergent walls? retention grooves? Worry about unsupported enamel? Extension for prevention? Do we need bulk?

New cavity preparation design for posterior composite was created; it was based on specific characteristic of the material.

Why are we talking Why are we talking about about

amalgam/compositeamalgam/composite Example of utilizing the skill/knowledge we acquired in using a specific material/procedure (amalgam restoration) and applying it on a new material/procedure (composite restoration)

Preparation skills should be easily transferable.

Knowledge on the rationale of cavity preparation will allow us to adapt to the new material based on the material’s specific characteristic.

Answer to your question on “why are we still teaching cast gold inlay/onlay”? - when only a few dentists are doing these kinds of procedures in their offices.

Restorative Options - Restorative Options - IndirectIndirect

1970’s– Cast gold inlay/onlay, 3/4 crown, full cast crown, PFM

2000’s– Cast gold inlay/onlay, 3/4 crown, full cast crown, PFM

– Porcelain/composite inlay/onlay

Differences between Differences between gold and porcelain gold and porcelain

restorationsrestorations Physical properties - porcelain more brittle

Mode of retention - bonding vs mechanical retention

Concept of margin

Based on these differences, can we design a cavity preparation for using porcelain intra-coronally??

Starting with cavity preparation design for cast gold inlay/onlay, what features do we have to modify for porcelain????

Physical PropertiesPhysical Properties

What cavity preparation features do we need to modify?

– Bulk - more occlusal clearance– Reinforcement - bonding– Bevels contraindicated

Mode of RetentionMode of Retention

Cast gold preparation rely on 6 to 7 degree of divergent walls and sharp internal line angles.

Porcelain rely on the bonding process, no need for 6 to 7 degree divergent wall and sharp internal line anlges.

Marginal AdaptationMarginal Adaptation

Cast gold - rely on close adaptation (20u); lack of adhesion between tooth structure/cement/gold interface

Porcelain - rely on the adhesion between tooth structure/resin cement/procelain to create a gap free continuous margin.

No gingival bevels needed to minimize the gap.

Empress Procelain Empress Procelain SystemSystem

All procelain restoration used for inlay, onlay, full crown

Castable Adequate marginal fit Better wear characteristic than conventional procelain

Similar to cast gold inlay/onlay in terms of cavity preparation design

Porcelain Fused to Porcelain Fused to Metal Crown vs Metal Crown vs

Empress: SimilaritiesEmpress: Similarities

Highly esthetic Wear

Brittle - reinforced through the bonding process

Composite vs Empress: Composite vs Empress: Similarities Similarities

Mode of retention - dentinal bonding agent

Apply skills you learn for composite on the bonding process.

Mechanism of AdhesionMechanism of Adhesion

Porcelain etched with hydrofluoric acid (micromechanical)

Bond between etched tooth and DBA - identical to composite/tooth

Silane coupling agent - chemical bond

Etched Porcelain

Etched Tooth

Silane Coupling agent Dentinal

Bonding Agent

Dentinal Bonding Agent

Resin Adhesive

Summary of Summary of CharacteristicsCharacteristics

Highly esthetic Acceptable marginal fit Conservation of tooth structure

Less occlusal wear Highly technique sensitive

IndicationsIndications High esthetic demand Replace moderate to large existing restoration

Fractured tooth/restoration Moderate to large primary caries

Contraindiations Unable to adequately isolate the field Parafunctional habits - bruxing, clenching, excessive wear

Empress vs Gold Empress vs Gold Inlay/OnlayInlay/Onlay

EmpressEmpressAdvantages ESTHETIC Conservation of tooth structure (gold onlay vs porcelain inlay)

Less complicated cavity design??

Disadvantages Expensive Technique sensitive - bonding process Abrasive to occluding dentition

Empress vs PFMEmpress vs PFMEmpressEmpress

Advantages Conservative cavity preparation Foundation restoration may not be necessary

Less abrasive to occluding dentition No metal collar

Disadvantages Expensive Technique sensitive

Cavity Preparation Cavity Preparation DesignDesign

1. Occlusal Depth/Cusp ReductionOcclusal Depth = 1.5 to 2.0 mmCusp Reduction:Functional cusp = 1.5-2.0mm

Nonfunction cusp = 1.5 mm

2. Internal/External Line AnglesRounded

Cavity Preparation Cavity Preparation DesignDesign

3. DrawDegree of draw = approximately 12 to 15 degree

4. BevelNo bevel

Mn first premolar- DO amalgam with fractured lingual cusp, deep pulpal floor

Existing amalgam removed, making all walls divergent, smoothed all cavosurface margins

Mx first molar - MOD amalgam with deep pulpal floor (4mm)

Existing amalgam removed

Proximal walls and gingival seats extended, occlusal wall divergent, clinical judgement was made to cover DL cusp (with shoulder)

No cavosurface bevel on shoulder

MOB amalgam on Mx first molar with deep pulpal floor

Existing amalgam removed, make all walls divergent and smoothed all cavosurface margins

Occl amalgam on Mn first molar, normal pulpal depth; patient complaining about pain on function- Dx: DB cusp fractured

Patient’s occlusion

Existing amalgam removed, DB cusp reduced by 2mm, all walls divergent

No shoulder on DB cusp - WHY???

MOD amalgam on Mn second molar with fractured Li cusp. Normal pulpal depth; all amaglam removed

Proximal box divergent, Li cusp - smoothed cavosurface margin

MOD amalgam on Mn first molar - occlusal fractured

Shade selection BEFORE rubber dam; need dentin shade (match shade at gingival third) and overall shade

Finished preparation; rubber dam removed; ready for impressioning; proximal box divergent, cusp reduction, buccal cusp with heavy bevel (no shoulder)

Buccal view

Wax up on working cast

Special die for shade matching/staining - reason for taking the dentin shade

Restoration on die/working cast

Trying in under rubber dam; adjust proximal contact; do not adjust occlusal contact

Cementation under rubber dam using resin cement; excess cement removed using cotton tip

Excess resin cement removed from proximal/gingival margins using an explorer

Rubber dam removed following cementation

Adjust occlusion using fine diamond in high speed hand piece

Laboratory Exercise - Mn first molar,

MOD onlay preparation for porcelain

Finished Preparation - MOD porcelain onlay preparation

Restoration on die, back from laboratory

Restoration seated under rubber dam

Bu view after cementation

Restoration on die, back from laboratory

Restoration seated under rubber dam