Uncommon Restoration on Nonvital Premolar with Porcelain Inlay: A Case Report with Five-year Follow-up

Abstract

Introduction: In fixed prosthodontics, the old paradigm on endodontically treated teeth leads to more fragilization due to the architectural preparation needed for a full coverage crown. Endodontically treated premolars with class II defects are common in daily practice. When only one proximal surface is affected, direct adhesive restorations are the most used. The use of porcelain inlay is quite uncommon in this situation despite its advantages. Case Presentation: This article illustrates a clinical case of a 31-year-old female with healthy teeth except for the non-vital first maxillary premolar, presenting a class II mesio-occlusal cavity. The occlusion exam revealed functional anterior guidance and canine guidance on both sides during lateral mandibular translation. Based on mini-invasive dentistry principles, the decision was to restore the nonvital bicuspid with a porcelain inlay. Although scientific literature did not report restoration of the premolars with a ceramic inlay in clinical practice, this option was retained. The realization of a porcelain inlay was described step by step. A follow-up up to 5 years was done. Results: The iatrogenic tooth fragilization was avoided by a mini-invasive approach. At the end of this follow-up period, there was no complication or complaint. The patient was satisfied with the final result. Conclusion: Porcelain inlay seems to be a good option to restore the occluso-proximal cavity on nonvital premolars in a context of a favourable occlusion. Porcelain inlay is respectful of the principles of minimally invasive dentistry and allows to achieve the objectives of function, aesthetics and biocompatibility. However, clinical studies should be conducted to investigate the longevity of porcelain inlay on ETPs.