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TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYS TOOTH COLORED INLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYSAND ONLAYS -------- IIIIIIIIIIIIIIII
Dr. Nasrien AteyahDr. Nasrien Ateyah
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Posterior Bonded PorcelainPosterior Bonded PorcelainRestorations Restorations
Ceramic inlays were introduced inCeramic inlays were introduced in 19131913
but did not become popularbut did not become popular →→
Difficulties in fabricationDifficulties in fabrication
High failure rateHigh failure rate
InIn 1980s1980s
Development of compatibleDevelopment of compatible refractoryrefractorymaterialsmaterials made fabrication easiermade fabrication easier
Development ofDevelopment of abrasive resin cementsabrasive resin cements greatlygreatly
improved clinical success ratesimproved clinical success rates
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Advantages Advantages
Porcelain is an excellent replacementPorcelain is an excellent replacement
material for unaesthetic tooth substancematerial for unaesthetic tooth substance
for some of the following reasons:for some of the following reasons:
ColorColor:: Most porcelain systems use wellMost porcelain systems use well--established techniques of effectivelyestablished techniques of effectively
blending in with the adjacent naturalblending in with the adjacent natural
dentition.dentition.
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Advantages Advantages
Periodontal healthPeriodontal health:: A porcelain A porcelainrestoration mayrestoration may accumulate less plaqueaccumulate less plaque onon
its surface than will other systems.its surface than will other systems.
Resistance to abrasionResistance to abrasion:: The wearThe wear--andand
abrasionabrasion--resistance of these restorations isresistance of these restorations ishigh, although they have the potential tohigh, although they have the potential to
createcreate wear in the opposing arch.wear in the opposing arch.
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Advantages Advantages
Radio density:Radio density: On radiographs, theOn radiographs, the
radio density of porcelainradio density of porcelain resemblesresemblesthat of normal tooth structure,that of normal tooth structure, quitequite
often allowing for radiographic accessoften allowing for radiographic access
to areas that were previously shieldedto areas that were previously shieldedby radiopaque restorations.by radiopaque restorations.
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Advantages Advantages
The marginal integrity:The marginal integrity:when ceramic restorations arewhen ceramic restorations are
combined with resin bondingcombined with resin bondingand a composite resin luting agent,and a composite resin luting agent,
is excellent with the result thatis excellent with the result that
microleakagemicroleakage is decreased to anis decreased to anabsolute minimum.absolute minimum.
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Disadvantages Disadvantages
The amount of time and attention to detailThe amount of time and attention to detailrequired when these restorations are fabricatedrequired when these restorations are fabricated
and placedand placed ((techniquetechnique--sensitivitysensitivity)) makesmakes
them of necessity an expensive alternative tothem of necessity an expensive alternative toother modalities.other modalities.
Moisture contaminationMoisture contamination and placementand placementprocedures are all potentiallyprocedures are all potentially problematicproblematic..
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Disadvantages Disadvantages
TheThe strengthstrength of the individualof the individualunbonded restoration is relativelyunbonded restoration is relatively
nominal, so that the trynominal, so that the try
--in proceduresin procedures
can result incan result in fracturefracture of the porcelain.of the porcelain.
TheThe laboratory feelaboratory fee for this type offor this type ofrestoration is an added factor when arestoration is an added factor when a
treatment plan is developed.treatment plan is developed.
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Disadvantages Disadvantages
The potentialThe potential
wearwear
of the teeth in theof the teeth in the
opposing arch, particularly during Paraopposing arch, particularly during Para
functional habits, is a contraindication.functional habits, is a contraindication.
A new generation of A new generation of lowlow--fusing porcelainsfusing porcelains
→→→→→→→→ less wear of enamelless wear of enamele.g.:e.g.: Empress 2 pressable Empress 2 pressable ceramics ceramics → →→ → → →→ →
almost no wearalmost no wear
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Disadvantages Disadvantages
In castIn cast--glass or ceramic restorationsglass or ceramic restorations
with superficical surface stain, occlusalwith superficical surface stain, occlusal
adjustment results in theadjustment results in the lossloss of theof thesurface colorantssurface colorants. This obviously. This obviously
results in aresults in a less attractiveless attractive restoration,restoration,
when esthetics may well have been thewhen esthetics may well have been thereason the patient sought treatment inreason the patient sought treatment in
the first place.the first place.
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Indication Indication
WhenWhen one cusp of posterior toothone cusp of posterior tooth is beingis beingcovered with an esthetic bonded onlaycovered with an esthetic bonded onlay
In the restoration of a molar with a shortIn the restoration of a molar with a shortocclusogingival dimensionocclusogingival dimension ((requirerequire 2mm2mmocclusal reduction.occlusal reduction. No axial reduction)No axial reduction)
All margin should be on All margin should be on enamelenamel
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Indication Indication
Should be amenable toShould be amenable to rubber damrubber dam
placementplacement
Patient should exhibitPatient should exhibit no no sign of a Parasign of a Para
functional habitsfunctional habits
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Contraindications: Contraindications:
1.1. Bruxism patientBruxism patient
2.2. Excessive tooth destruction with veryExcessive tooth destruction with very
littlelittle dentin dentin remainingremaining
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Failure Failure
Bulk fracture Bulk fracture Area of cuspal coverage Area of cuspal coverage ((↓↓↓↓↓↓↓↓ 2mm thick)2mm thick)
At the At the isthmusisthmus adjacent to marginal ridgesadjacent to marginal ridges(porcelain poorly supported by(porcelain poorly supported by
tooth structure)tooth structure)
Marginal breakdown Marginal breakdown because resin cementbecause resin cement
not be heavily fillednot be heavily filled →→→→→→→→ wearwear more quickly thanmore quickly than
the adjacent restorations or tooth structure.the adjacent restorations or tooth structure.
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Ceramic Inlay vs. ResinCeramic Inlay vs. ResinComposite Inlay Composite Inlay
Leak lessLeak less
Fit betterFit better
Adhesion of luting resin is more reliable and Adhesion of luting resin is more reliable and
durable to etched ceramic materialdurable to etched ceramic material
Porcelain inlay is quitePorcelain inlay is quite fragilefragile subject to fracturesubject to fracture
during the tryduring the try--inin
Removed proximal contact can be replaced byRemoved proximal contact can be replaced by
timetime--consumingconsuming
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Porcelain Onlays vs. ResinPorcelain Onlays vs. ResinComposite Onlay Composite Onlay
HasHas samesame disadvantages as porcelain inlay.disadvantages as porcelain inlay.
It is a cuspal coverage restorationIt is a cuspal coverage restoration causecausewear of opposing enamelwear of opposing enamel
But provide longBut provide long--term occlusalterm occlusal
stabilitystability
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Ceramic Materials that can be usedCeramic Materials that can be usedfor Posterior Inlays and Onlays for Posterior Inlays and Onlays
1.1. Conventional ceramicsConventional ceramics
2.2. Glass ceramicsGlass ceramics
a.a. Castable glass ceramic Castable glass ceramic
b.b. Injection molded glass ceramics Injection molded glass ceramics c.c. CAD CAD - - CAM and Copy milled materials CAM and Copy milled materials
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A. A. Conventional Ceramic Conventional Ceramic
The concept of a ceramic inlay dates back to theThe concept of a ceramic inlay dates back to theend of the last century, when the firstend of the last century, when the firstrestorations of this type were fabricated. Therestorations of this type were fabricated. Theproblems inherent with porcelain, such as:problems inherent with porcelain, such as:
•• Material weaknessMaterial weakness
•• Lack of Marginal integrityLack of Marginal integrity
•• Lack of an adequate cementing mediumLack of an adequate cementing medium
Initially made this an unsuccessfulInitially made this an unsuccessfulrestoration.restoration.
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Conventional Conventional CeramicCeramic
Advantage AdvantageCeramic restoration provide:Ceramic restoration provide:
••
Color stabilityColor stability
•• Stain resistanceStain resistance
•• Marginal integrityMarginal integrity (resin bonding and(resin bonding and
composite resin luting agent)composite resin luting agent)•• Microleakage to absolute minimumMicroleakage to absolute minimum
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Conventional Ceramic Conventional Ceramic
DisadvantageDisadvantage
•• ↑↑ timetime
••
Tend to fracture during porcelain tryTend to fracture during porcelain try--inin•• ExpensiveExpensive
•• Wear of opposing teethWear of opposing teeth
•• Difficult to adjustDifficult to adjust
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B.B. Glass Ceramics Glass Ceramics
1.1. Castable glass ceramics (Dicor)Castable glass ceramics (Dicor)
2.2. Injection molded glass ceramicInjection molded glass ceramic
3.3. CADCAD--CAM and copy milled materialCAM and copy milled material
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1.1. Castable Glass Ceramics Castable Glass Ceramics (Dicor) (Dicor)
Over the years castable glassOver the years castable glass--ceramicceramic
systems have proved to be a viablesystems have proved to be a viable
alternative ceramic system.alternative ceramic system.This systems have been used for aThis systems have been used for a
variety of different clinical situationsvariety of different clinical situations
as:as:
Core for ceramic crownsCore for ceramic crowns
Inlays and onlaysInlays and onlays
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1.1. Castable glass ceramics (Dicor) Castable glass ceramics (Dicor)
−− The immediate advantage of this type ofThe immediate advantage of this type of
ceramic process over the conventional is thatceramic process over the conventional is that→→
a.a. It utilizes the conventionalIt utilizes the conventional waxing on awaxing on a
die.die.b.b. Casting techniques similar to theCasting techniques similar to the
conventionalconventional lost wax technique lost wax technique used forused forcastcast--metal restorations.metal restorations.
Indication:Indication:
For single unitFor single unit
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Advantages Advantages
TheThe fitfit of castof cast--glass restorations reportedlyglass restorations reportedlysupersedes that of conventional porcelain.supersedes that of conventional porcelain.This decreases the amount of resin lutingThis decreases the amount of resin lutingagent at the margins, in turnagent at the margins, in turn decreasingdecreasingthe potential forthe potential for ditching.ditching.
TheThe wearwear on the opposing occlusion ison the opposing occlusion ispredicted to be less than that ofpredicted to be less than that ofconventional porcelains.conventional porcelains.
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Advantages Advantages
TheThe thermal cyclingthermal cycling properties of castproperties of cast
glass approximate those of enamel.glass approximate those of enamel.
Flexural strengthsFlexural strengths is reportedlyis reportedly
greater than it is for conventionalgreater than it is for conventional
porcelain.porcelain.
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Disadvantages Disadvantages
TheThe colorantcolorant is a surface stain, hence anyis a surface stain, hence any
grinding on the restoration leaves angrinding on the restoration leaves an
unaesthetic opaque white area.unaesthetic opaque white area.
An An additional chairsideadditional chairside visit is necessary tovisit is necessary to
fit and adjust the contacts, anatomic form,fit and adjust the contacts, anatomic form,
and occlusion prior to staining. Once stained,and occlusion prior to staining. Once stained,
the surface cannot be adjusted withoutthe surface cannot be adjusted without
compromising the esthetics.compromising the esthetics.
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Disadvantages Disadvantages
The whole process isThe whole process is techniquetechnique--sensitivesensitive, from the casting of the, from the casting of the
inlays through the staining of theinlays through the staining of the
cerammed restorations.cerammed restorations.
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2.2. Injection molded glass ceramicInjection molded glass ceramic
– –
pressed pressed - - ceramic systemceramic system(IPS Empress) (IPS Empress)
A newer material of the all A newer material of the all--ceramic type,ceramic type,
which is not cast but injection molded,which is not cast but injection molded,
isis IPS EmpressIPS Empress..
−−
This system usesThis system uses highhigh--temperaturetemperaturepressing of a prepressing of a pre--cerammed glass ceramiccerammed glass ceramic
withwith hydrostatic pressurehydrostatic pressure in a vacuumin a vacuum
unit.unit.
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IPS Empress II IPS Empress II
Utilizes veneering techniqueUtilizes veneering technique
The core is a glass ceramicThe core is a glass ceramic
Veneer contains fluoroapatite crystals Veneer contains fluoroapatite crystals
Higher volume of crystalsHigher volume of crystals
Stronger than the original IPS EmpressStronger than the original IPS Empress
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Advantages of Pressed Advantages of Pressed - - Ceramic Systems Ceramic Systems
The pressedThe pressed--ceramic system involvesceramic system involvesrelativelyrelatively simplesimple processing procedures thatprocessing procedures that
accuratelyaccurately reproduce the waxed patternreproduce the waxed pattern..
The cerammed restorations have a highThe cerammed restorations have a high
degree ofdegree of stability stability during subsequentduring subsequent
shading or layering techniques.shading or layering techniques.
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Advantages of Pressed Advantages of Pressed - - Ceramic Systems Ceramic Systems
The precerammed porcelain has aThe precerammed porcelain has a
high degree of flexural tensilehigh degree of flexural tensile
strengthstrength (exceeding(exceeding 200 MPa).200 MPa).
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Advantages of Pressed Advantages of Pressed - - CeramicCeramic Systems Systems
The versatility of the process allows for theThe versatility of the process allows for thedevelopment of verydevelopment of very estheticesthetic restorationsrestorations
ranging fromranging from inlaysinlays andand onlaysonlays toto fullfull
crownscrowns andand llaminateaminate veneersveneers, even in, even invery thin sections of onlyvery thin sections of only 1mm1mm
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Advantages of Pressed Advantages of Pressed - - Ceramic Systems Ceramic Systems
TheThe lost lost - - wax technique wax technique andand ceramicceramicinjection moldinginjection molding allow forallow for accurate fitaccurate fit..
The preshaded base ingots with twoThe preshaded base ingots with two
different characterization techniques allowdifferent characterization techniques allow
achievement ofachievement of excellent harmonyexcellent harmony andandblending with adjacent teeth.blending with adjacent teeth.
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3 3 - - CAD CAD - - CAM Systems CAM Systems
The introduction of computerThe introduction of computer--aidedaideddesign/computerdesign/computer--aidedaided
manufacturermanufacturer (CAD/CAM)(CAD/CAM)
systems to restorative dentistrysystems to restorative dentistry
represents a major technologicalrepresents a major technological
breakthrough.breakthrough.
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CAD CAD - - CAM Systems CAM Systems
New fabrication method in which the restorationNew fabrication method in which the restoration
is milled out of ais milled out of a piece of ceramic that ispiece of ceramic that isprepre--manufactured.manufactured.
Elimination of laboratory techniquesElimination of laboratory techniquesvariablesvariables
Improvement in the properties of theImprovement in the properties of the
ceramic materialceramic material Less porosityLess porosity
Extremely expensiveExtremely expensive
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Component of the System Component of the System
1.1. Three dimensional video cameraThree dimensional video camera
2.2. Electronic image processorElectronic image processor
3.3. Three accessThree access--of rotatingof rotating--millingmilling
machinemachine4.4. Computer component and screenComputer component and screen
of the cerec systemof the cerec system
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Material Material
1.1. Dicor ceramic materialDicor ceramic material
2.2. Vita porcelain (Vita Mark II Vita porcelain (Vita Mark II))
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Advantages of the Cerec System Advantages of the Cerec System
CeramicCeramic--bonded restorations offer a widebonded restorations offer a wide
range of advantages over conventionalrange of advantages over conventional
restorative materials.restorative materials.
Single appointmentSingle appointment
No impressionNo impression
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Advantages of the Cerec System Advantages of the Cerec System
Reduced marginal gapReduced marginal gap Wear hardness similar to enamelWear hardness similar to enamel
Less fractureLess fracture of the inlay,of the inlay, becausebecause it isit ismilled from a solid, homogeneous block milled from a solid, homogeneous block
Excellent polishingExcellent polishing characteristicscharacteristics
Improved estheticsImproved esthetics Less reduction to tooth structureLess reduction to tooth structure, hence, hence
better periodontal healthbetter periodontal health
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Advantages of the Cerec System Advantages of the Cerec System
Bonded restorations enhance toothBonded restorations enhance toothstrengthstrength
Preparation, fabrication, cementation,Preparation, fabrication, cementation,
and polishing normally accomplished inand polishing normally accomplished in1 to 11 to 1½½ hourshours
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4 4 - - Copy Milling Celay Copy Milling Celay
An innovative system, the celay technique An innovative system, the celay techniqueis a variation on the directis a variation on the direct--indirectindirect
restoration concept butrestoration concept but without thewithout the
need forneed for a laboratory techniciana laboratory technician..
This systemThis system duplicateduplicate the hard compositethe hard composite
resin patterns of the restoration fromresin patterns of the restoration fromthe improved material mentioned in thethe improved material mentioned in the
CADCAD--CAMCAM
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Advantages of the Celay System Advantages of the Celay System
A precisely A precisely fittingfitting ceramic restoration canceramic restoration canbe developedbe developed
In one patient session.In one patient session.
Without the need for a laboratoryWithout the need for a laboratory
technician.technician.
InIn factoryfactory--fired highfired high--grade porcelain.grade porcelain.
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Advantages of the Celay Advantages of the Celay
System System
The processing time required is very short.The processing time required is very short. A A small inlay small inlay can be milled incan be milled in 33 minutesminutes,,
aa mesiomesio--occlusooccluso--distal inlaydistal inlay in lessin less
thanthan 88 minutesminutes, and a complete, and a complete onlayonlay inin1212 toto 1313 minutesminutes..
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The preparation should incorporate theThe preparation should incorporate the
following features:following features:
A A 1.5 to 2.0mm1.5 to 2.0mm reduction in vertical heightreduction in vertical height
of the cusps and all occluding areasof the cusps and all occluding areas
Preparation finish lines on any supportingPreparation finish lines on any supporting
cusps that arecusps that are hollowhollow--ground chamfers,ground chamfers,
generally withgenerally with no bevelno bevel
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WellWell--rounded anglesrounded angles on the cuspalon the cuspalpreparation, to prevent propagation ofpreparation, to prevent propagation of
porcelainporcelain fracturefracture from these sharpfrom these sharpstress pointsstress points
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The specifically developed instrument with a newlyThe specifically developed instrument with a newly
designed tip results in the following:designed tip results in the following: A A flatflat pulpal floor with the calculated divergentpulpal floor with the calculated divergent
axial wallsaxial walls
A A roundedrounded line angle between the pulpal andline angle between the pulpal and
axial wallaxial wall
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Highly retentive axial wallsHighly retentive axial walls because of thebecause of the hybridhybrid
diamonddiamond on the shank, which increases the surfaceon the shank, which increases the surface
area for bonding and developsarea for bonding and develops mechanical retention.mechanical retention.
A well A well--defined cavosurface margindefined cavosurface margin at theat the
occlusal surface on which the hollowocclusal surface on which the hollow--ground chamferground chamfercan be developedcan be developed FineFine--grit round instrumentgrit round instrument
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Fabrication Fabrication
The most common method of fabrication of porcelainThe most common method of fabrication of porcelaininlays and onlaysinlays and onlays →→→→→→→→ refractory dierefractory die
After a master die is poured in die stone After a master die is poured in die stone
1.1. Refractory die is made by:Refractory die is made by:
Duplicating the master die or Duplicating the master die or
Repouring the impression in refractory material Repouring the impression in refractory material
2.2. The porcelain is backed on the refractory die,The porcelain is backed on the refractory die,
recovered, and fit to the master dierecovered, and fit to the master die
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Fabrication Fabrication
The newer generation of pressed ceramic isThe newer generation of pressed ceramic is
fabricated much differentlyfabricated much differently
1.1. The restoration isThe restoration is waxed on a stonewaxed on a stone diediein the traditional manner and investedin the traditional manner and invested
in ain a special investmentspecial investment..
2.2. The invested wax pattern is burned outThe invested wax pattern is burned outas in the traditionalas in the traditional lostlost--wax technique.wax technique.
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Fabrication Fabrication
3.3. An ingot of the pressed ceramic An ingot of the pressed ceramic
material ismaterial is heatedheated andand pressedpressed into theinto the
lostlost--wax pattern space.wax pattern space.4.4. After After coolingcooling, the investment is, the investment is
removed and the ceramic restoration isremoved and the ceramic restoration is
retrieved and finished in the sameretrieved and finished in the samemanner as a feldspathic porcelainmanner as a feldspathic porcelain
restoration.restoration.
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The FourThe Four--StageStageTryTry--InIn
Prior to final luting of the porcelain inlays, it isPrior to final luting of the porcelain inlays, it isimportant to follow the fourimportant to follow the four--stage trystage try--in. Thein. Therestorations need to be evaluated for therestorations need to be evaluated for the
following criteria:following criteria:
Marginal integrityMarginal integrityThe intimate adaptation ofThe intimate adaptation of
all porcelain margins to theall porcelain margins to theprepared tooth surface mustprepared tooth surface mustbe checked.be checked.
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The FourThe Four
--StageStage
TryTry--InIn
Proximal relationsProximal relations.. The collective fit andThe collective fit andrelationship of one restoration to the other orrelationship of one restoration to the other or
the adjacent tooth must be evaluated.the adjacent tooth must be evaluated.
Occlusal relations.Occlusal relations. The contact relations,The contact relations,with the opposing arch in centric occlusionwith the opposing arch in centric occlusion
and lateral excursive movements of theand lateral excursive movements of the
mandible, aremandible, are best evaluatedbest evaluatedafter inlay placement.after inlay placement.
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The FourThe Four
--StageStage
TryTry--InIn
Color:Color: Posterior restorations, theirPosterior restorations, their
basic shade should blend with thebasic shade should blend with the
surrounding teeth. The need forsurrounding teeth. The need forindividual characterization, such asindividual characterization, such as
fissure stainingfissure staining or other such coloror other such color
highhigh--lights, must also be ascertained.lights, must also be ascertained.
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Inlay/Onlay PlacementInlay/Onlay Placement
Procedure Procedure
The porcelain restoration bonds to the tooth inThe porcelain restoration bonds to the tooth in
a series of individual links:a series of individual links: At the tooth interface At the tooth interface, etched, etched
enamelenamel micromechanicallymicromechanically
bonds with dental bonding agent.bonds with dental bonding agent.
At the restoration At the restoration interfaceinterface,etched,etched
porcelain is made reactive viaporcelain is made reactive viaaa silanesilane,, whichwhich mechanically andmechanically and
chemicallychemically bonds to an unfilledbonds to an unfilled
resin layer.resin layer.
I l /O l Pl tI l /O l Pl t
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Inlay/Onlay PlacementInlay/Onlay Placement
Procedure Procedure
These two reactive interfaces are joinedThese two reactive interfaces are joinedby an optimizedby an optimized dualdual--cure hybridcure hybrid
composite resin luting agent.composite resin luting agent.
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THANKTHANK
YOU YOU
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Conventional Ceramic Conventional Ceramic
−− The recent development of reinforcingThe recent development of reinforcing
systems for porcelain, however, coupledsystems for porcelain, however, coupled
with the ability towith the ability to etchetch andand bondbond thetheporcelain to the underlying etched toothporcelain to the underlying etched tooth
structure.structure.
Ad t f P dAd t f P d
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Advantages of Pressed Advantages of Pressed - -
Ceramic Systems Ceramic Systems
The precerammed porcelain has aThe precerammed porcelain has a highhighdegree of flexural tensile strengthdegree of flexural tensile strength
(exceeding(exceeding 200 MPa).200 MPa).
This makes the material adequate forThis makes the material adequate for
most normal restorations, let alone thosemost normal restorations, let alone thosebonded to the underlying tooth structure.bonded to the underlying tooth structure.
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