Inlay Restorations Research Articles

Comparison of composite resin and porcelain inlays for restoration of noncarious cervical lesions: An In vitro study

Composite resin (CR) currently is one of the most commonly used material in restoring noncarious cervical lesions (NCCL) due to its strength and esthetics color but has microleakage problem. The aim of this study is to compare in vitro the microleakage depth between CR and porcelain in restoring NCCL. This an in vitro study was done by preparing cavities on the buccocervical surface of 62 extracted premolar teeth which randomly assigned to two groups (n = 31) where Group 1 was restored with nanocomposite and Group 2 was cemented with porcelain cervical inlays. They were then subjected to thermocycling before immersion in 2% methylene blue dye for 24 h. Dye penetration depths were measured using Leica imaging system For statistical analysis, independent t-test was used to analyze the results (P < 0.05). Porcelain cervical inlay restorations demonstrated statistically lesser microleakage depth for the cervical margins (P = 0.018) when compared to CR. Deeper microleakage depth at the cervical compared to coronal margins of CR (P = 0.006) but no significant difference of both margins for porcelain cervical inlays (P = 0.600). Porcelain cervical inlays show lesser microleakage than CR which could be alternative treatment option in restoring NCCL with better marginal seal and esthetics.

FRACTURE RESISTANCE AND FAILURE MODE OF TWO RESTORATION DESIGNS MADE OF MONOLITHIC HYBRID AND GLASS MACHINABLE CERAMICS ; IN VITRO STUDY

Statement of the problem: Monolithic hybrid and glass ceramics are indicated for intracoronal and extracoronal ceramic restorations. Available data regarding selection of the appropriate ceramic type for each preparation design and its influence on fracture resistance of tooth restoration complex is still scarce.Purpose: The purpose of this study was to evaluate in vitro the fracture resistance and investigate failure mode of two restoration designs (crowns and inlays) made from lithium disilicate glass ceramic and hybrid ceramic constructed by the CAD /CAM technique.Materials and Methods: A total of twenty ceramic restorations restoring lower molars were designed and fabricated in this study. The restorations were divided into two groups; Group 1: Ten full coverage crowns and Group 2: Ten inlays. Each of the previous groups was further subdivided into two equal subgroups; Subgroup 1: Five restorations constructed from lithium disilicate glass ceramics (e.max CAD) and Subgroup 2: Five restorations constructed from hybrid ceramic (VITA ENAMIC) by the CAD/CAM technology. Two ivorine teeth were prepared following the guidelines for full coverage and inlay ceramic restorations, they were duplicated into stone dies followed by scanning, designing and milling of restorations. The stone dies were duplicated into epoxy dies where the restorations were adhesively cemented on them. All cemented samples were exposed to 2000 thermal cycles (5°C and 55°C in water) with a dwell time of 25 seconds in a computer controlled thermocycler. All specimens were loaded in a universal testing machine where fracture test was done by compressive mode of load applied occlusally using a metallic rod with round tip at cross-head speed of 1mm/min until fracture occurred. Fracture resistance values were recorded in Newtons then they were statistically evaluated and failure modes were analyzed. Results: For group 1 representing crown restorations, a statistically significant difference was found between (e.max CAD) and (VITA ENAMIC) subgroups at (p=0.05) where the highest mean value of maximum load was found in (VITA ENAMIC) (951.77 N ± 81.05) and the lowest mean value of maximum load was found in (e.max CAD) (709.35 N± 49.51). While for the second group representing inlay restorations, no statistically significant difference was found between (e.max CAD) and (VITA ENAMIC) subgroups at (p=0.307) where the highest mean value of maximum load was found in (e.max CAD) (627.71 N ± 80.01) and the lowest mean value of maximum load was found in (VITA ENAMIC) (581.26 N± 51.74). For the e.max CAD subgroup, a statistically significant difference was found between (Crown) and (Inlay) groups at (p=0.005) where the highest mean value of maximum load was found in the crown group (790.35 N± 49.51) and the lowest mean value of maximum load was found in the inlay group (627.71N ± 80.01).Regarding the VITA ENAMIC subgroup, a statistically significant difference was found between (Crown) and (Inlay) groups at (p<0.001) where the highest mean value of maximum load was found in the crown group (951.77 N ± 81.05) and the lowest mean value of maximum load was found in the inlay group (581.26N±51.74).Conclusions: 1. All inlays and crowns constructed from hybrid and glass ceramics in this study revealed fracture load values falling in the range of physiologic masticatory forces 2. When considering restoration of molars with full coverage crowns, VITA ENAMIC is more preferred than e.max CAD ceramic in terms of fracture resistance as it showed a higher statistical significant mean values.3. When planning to restore molars with minimally invasive intracoronal restorations, both ceramics can be used as there was insignificant statistical difference between them , however e.max CAD can be recommended due to its more favorable mode of fracture compared to VITA ENAMIC.4. Irrespective of preparation designs, both ceramics showed insignificant difference regarding fracture resistance mean values.

Computer-aided design of dental inlay restoration based on dual-factor constrained deformation

Computer-aided design technology has been applied extensively in the field of dental restoration. Inlay is a commonly used restoration type for reconstructing the partially destroyed teeth and restoring occlusal function. The designed occlusal surface should fit the anatomy of each defect region, and the modeling process should be efficient for clinical applications. This paper presents a robust dual-factor constrained deformation framework for dental inlay modeling, consisting of four necessary steps: cavity contour extraction using a heuristic search strategy, semi-automatic template tooth positioning through a four-step affine transformation involving ``Translation-Rotation-Rotation-Scaling”, tooth surface segmentation by means of sampling ray-tracing collisions, and occlusal surface reconstruction based on dual-factor constrained deformation, which was implemented by defining a segmentation constraint and cavity contour constraint. We demonstrate the effectiveness and robustness of the proposed method by presenting several clinical applications. The designed 3D inlay model can retain the morphological features of generic teeth and match well with the residual tooth surface.

Mechanical properties and internal fit of 4 CAD-CAM block materials

Statement of problemRecent polymer-based computer-assisted design and computer-assisted manufacturing (CAD-CAM) materials have been commercialized for inlay restorations, a polymer-infiltrated ceramic-network (PICN) and composite resin nanoceramics. Little independent evidence regarding their mechanical properties exists. Internal adaptation is an important factor for the clinical success and longevity of a restoration, and data concerning this parameter for inlays made with these blocks are scarce. PurposeThe purpose of this in vitro study was to evaluate and compare the mechanical properties (flexural strength, flexural modulus, Vickers hardness, fracture toughness) and the internal adaptation of these recent polymer-based blocks with a lithium disilicate glass-ceramic block. Material and methodsThe materials tested in this study were a PICN material (Vita Enamic), 2 composite resin nanoceramics (Lava Ultimate; 3M ESPE and Cerasmart; GCDental Products), and a lithium disilicate glass-ceramic (IPS e.max CAD). Mechanical properties were evaluated according to ISO norm DIS 6872:2013. Bar-shaped specimens (18×3×3 mm) were prepared and submitted to a 3-point bend test using a universal testing machine at a cross-head speed of 0.5 mm/min. In addition, identical cavities were prepared in 60 human mandibular extracted molars (n=15) and optically scanned to receive mesioocclusodistal inlays milled with the 4 materials tested in a CEREC Inlab milling machine. The replica technique and a stereomicroscope (×20) were used to measure the internal fit of the inlays at 9 preselected locations. All data were statistically analyzed using 1-way ANOVA and the post hoc Tukey multiple comparison or Games-Howell test (α=.05). ResultsThe mean flexural strength of the tested blocks ranged from 148.7 ±9.5 MPa (Vita Enamic) to 216.5 ±28.3 MPa (Cerasmart). The mean flexural modulus ranged from 23.3 ±6.4 GPa (Vita Enamic) to 52.8 ±10.5 GPa (IPS e.max CAD). The mean Vickers hardness ranged from 0.66 ±0.02 GPa (Cerasmart) to 5.98 ±0.69 GPa (IPS e.max CAD). The mean fracture toughness ranged from 1.2 ±0.17 MPa.m1/2 (Cerasmart) to 1.8 ±0.29 MPa.m1/2 (IPS e.max CAD). The values for internal discrepancy ranged from 119 ±55 μm to 234 ±51 μm. The mean internal discrepancy was significantly higher for Lava Ultimate (P<.05) than IPS e.max CAD and Cerasmart but not for Vita Enamic. The factor ‘‘material’’ was statistically significant in relation to the mechanical properties evaluated in this study (P<.05). The Pearson correlation was negative between the flexural strength results and the internal discrepancy of the materials tested (R2=0.941; P<.05). ConclusionsThe mechanical properties of the CAD-CAM block materials tested were within the acceptable range for fabrication of single restorations according to the ISO standard for ceramics (ISO 6872:2008). IPS e.max CAD and Cerasmart were observed to have superior flexural strength and better internal fit.

Mechanical behavior of bulk direct composite versus block composite and lithium disilicate indirect Class II restorations by CAD-FEM modeling

ObjectivesTo study the influence of resin based and lithium disilicate materials on the stress and strain distributions in adhesive class II mesio-occlusal-distal (MOD) restorations using numerical finite element analysis (FEA). To investigate the materials combinations in the restored teeth during mastication and their ability to relieve stresses. MethodsOne 3D model of a sound lower molar and three 3D class II MOD cavity models with 95° cavity-margin-angle shapes were modelled. Different material combinations were simulated: model A, with a 10μm thick resin bonding layer and a resin composite bulk filling material; model B, with a 70μm resin cement with an indirect CAD-CAM resin composite inlay; model C, with a 70μm thick resin cement with an indirect lithium disilicate machinable inlay. To simulate polymerization shrinkage effects in the adhesive layers and bulk fill composite, the thermal expansion approach was used. Shell elements were employed for representing the adhesive layers. 3D solid CTETRA elements with four grid points were employed for modelling the food bolus and tooth. Slide-type contact elements were used between the tooth surface and food. A vertical occlusal load of 600 N was applied, and nodal displacements on the bottom cutting surfaces were constrained in all directions. All the materials were assumed to be isotropic and elastic and a static linear analysis was performed. ResultsDisplacements were different in models A, B and C. Polymerization shrinkage hardly affected model A and mastication only partially affected mechanical behavior. Shrinkage stress peaks were mainly located marginally along the enamel-restoration interface at occlusal and mesio-distal sites. However, at the internal dentinal walls, stress distributions were critical with the highest maximum stresses concentrated in the proximal boxes. In models B and C, shrinkage stress was only produced by the 70μm thick resin layer, but the magnitudes depended on the Young’s modulus (E) of the inlay materials. Model B mastication behavior (with E=20GPa) was similar to the sound tooth stress relief pattern. Model B internally showed differences from the sound tooth model but reduced maximum stresses than model A and partially than model C. Model C (with E=70GPa) behaved similarly to model B with well redistributed stresses at the occlusal margins and the lateral sides with higher stress concentrations in the proximal boxes. Models B and C showed a more favorable performance than model A with elastic biomechanics similar to the sound tooth model. SignificanceBulk filling resin composite with 1% linear polymerization shrinkage negatively affected the mechanical behavior of class II MOD restored teeth. Class II MOD direct resin composite showed greater potential for damage because of higher internal and marginal stress evolution during resin polymerization shrinkage. With a large class II MOD cavity an indirect composite or a lithium disilicate inlay restoration may provide a mechanical response close to that of a sound tooth.

Effect of immediate dentine sealing on the fracture strength of lithium disilicate and multiphase resin composite inlay restorations

PurposeLimited information is available on the effect of Immediate Dentin Sealing (IDS) on the fracture strength of indirect partial posterior restorations. This study evaluated the effect of IDS on the fracture strength and failure types of two indirect restorative materials. Materials and methodsStandard MOD inlay preparations were made on sound molars (N=40, n=10 per group) and randomly divided into four groups to receive the inlay materials with and without the application of IDS: Group L-IDS-: Li2Si2O5 (Lithium disilicate, IPS e.max) without IDS; Group L-IDS+: Li2Si2O5 with IDS; Group MR-IDS-: Multiphase resin composite (MR, Lava Ultimate) without IDS; MR-IDS+: MR with IDS. Inlays made of L were etched with 5% hydrofluoric acid, and MR inlays were silica coated. After silanization, they were cemented using adhesive resin cement (Variolink Esthetic DC). The specimens were thermo-mechanically aged (1.2×106 cycles, 1.7Hz, 8000 cycles, 5–55°C) and then subjected to load to failure (1 mm/min). Failure types and locations of debondings were classified. Data were statistically analyzed using ANOVA, Mann Whitney U-test and Chi-square tests (α=0.05). Two-parameter Weibull distribution values including the Weibull modulus, scale (m) and shape (0), values were calculated. ResultsAfter aging conditions, no apparent changes were observed in marginal integrity but occlusal wear facets were more common with MR than with L (p<0.001). Material type and the application of IDS significantly affected the results (p=0.013). While group L-IDS- showed the lowest mean fracture strength (1358±506N) among all groups (p<0.05), application of IDS significantly increased the results significantly (L-IDS+: 2035±403N) (p=0.006). MR groups with and without IDS, did not show significant difference (MR-IDS-: 1861±423, MR-IDS+: 1702±596 N) (p=0.498). When materials without IDS are compared, L showed significantly lower results than that of MR (p=0.035). With the application of IDS, no significant difference was noted between L and MR materials (p=0.160). Weibull distribution presented the highest shape (0) for L-IDS+ (5.66) compared to those of other groups (3.01–4.76). Neither the material type (p=0.830), nor the application of IDS (p=0.54) affected the severity of the failure types. In 95% of the cases, the IDS layer left adhered on the tooth surface after fracture tests. In groups where no IDS was used, resin cement remained on the tooth surface in 44% of the cases (p=0.001). No significant differences were observed between the materials with respect to cement remnants or IDS after fracture (p=0.880). The incidence of repairable failure types (83%) was more common with L than with MR (75%) material (p>0.05). ConclusionImmediate dentin sealing improves adhesion, and thereby the fracture strength of inlays made of lithium disilicate but not that multiphase resin composite.

A comparative study of additive and subtractive manufacturing for dental restorations

Statement of problemDigital systems have recently found widespread application in the fabrication of dental restorations. For the clinical assessment of dental restorations fabricated digitally, it is necessary to evaluate their accuracy. However, studies of the accuracy of inlay restorations fabricated with additive manufacturing are lacking. PurposeThe purpose of this in vitro study was to evaluate and compare the accuracy of inlay restorations fabricated by using recently introduced additive manufacturing with the accuracy of subtractive methods. Material and methodsThe inlay (distal occlusal cavity) shape was fabricated using 3-dimensional image (reference data) software. Specimens were fabricated using 4 different methods (each n=10, total N=40), including 2 additive manufacturing methods, stereolithography apparatus and selective laser sintering; and 2 subtractive methods, wax and zirconia milling. Fabricated specimens were scanned using a dental scanner and then compared by overlapping reference data. The results were statistically analyzed using a 1-way analysis of variance (α=.05). Additionally, the surface morphology of 1 randomly (the first of each specimen) selected specimen from each group was evaluated using a digital microscope. ResultsThe results of the overlap analysis of the dental restorations indicated that the root mean square (RMS) deviation observed in the restorations fabricated using the additive manufacturing methods were significantly different from those fabricated using the subtractive methods (P<.05). However, no significant differences were found between restorations fabricated using stereolithography apparatus and selective laser sintering, the additive manufacturing methods (P=.466). Similarly, no significant differences were found between wax and zirconia, the subtractive methods (P=.986). The observed RMS values were 106 μm for stereolithography apparatus, 113 μm for selective laser sintering, 116 μm for wax, and 119 μm for zirconia. Microscopic evaluation of the surface revealed a fine linear gap between the layers of restorations fabricated using stereolithography apparatus and a grooved hole with inconsistent weak scratches when fabricated using selective laser sintering. In the wax and zirconia restorations, possible traces of milling bur passes were observed. ConclusionsThe results indicate that the accuracy of dental restorations fabricated using the additive manufacturing methods is higher than that of subtractive methods. Therefore, additive manufacturing methods are a viable alternative to subtractive methods.

To evaluate and compare postcementation sensitivity under Class II composite inlays with three different luting cements: An In vivo study

Aim: The purpose of this study is to evaluate and compare postcementation sensitivity under Class II composite inlay with three different luting cements. Materials and Methods: A comparative prospective study was carried out in 45 patients age ranged from 18 to 28 years for 2 years, who fulfilled the criteria. Clinically and radiographically, presence of mild initial dental caries on proximal surface of maxillary and mandibular first molar. Tooth preparation for composite inlay was performed and composite inlay restorations were made by indirect technique. Three different luting cements were used for cementation of composite inlay. Cold water test, compressed air test, and biting pressure test were used to measure the tooth sensitivity in this study. Results: As per the findings of this study, there was no significant difference between all the three groups immediately after cementation. We noted a significant difference between Group I and Group III and Group I and Group II and Group II and Group III after 1 and 6 months. Conclusions: Based on the results of this study, we concluded that restorations cemented with self-adhesive resin cements showed least postoperative sensitivity followed by Resin-modified glass ionomer cement (GIC) and GIC has the highest sensitivity at all intervals of time evaluated using different tests.

Clinical effect of CEREC chairside on atypical ceramic inlay restoring class II cavity

Objective To evaluate the clinical effect of CEREC chairside on atypical porcelain inlay restoring class Ⅱ cavity. Methods 30 patients that required re-treatment because of resin restoration failure and early posterior proximal caries were selected randomly. The original fillings, secondary carious tissues and undercut parts were removed. The clear and round edge lines were prepared. With Sirona CEREC Blocs, 35 atypical ceramic inlays were produced in accordance with CEREC AC CAD/CAM standard procedures. After clinical trial and modification, the inlays were bonded with 3M Veneer resin adhesive cement. Evaluation was done immediately and 3, 6, 12 and 24 months after restoration. Two senior prosthodontists did the evaluation according to the modified USPHS criteria. Results The evaluation results were all A when estimated immediately after restoration. None inlay falled off during the first two years. However, 3 inlay were found to be damaged when reviewed at the 24th month. There exsited two patients having mild symptoms of dentine hypersensitivity which appeared at the beginning and died out gradually. Generally speaking, more than 90% of inlay restorations had reached the USPHS criteria A. Color match and retention represented better effects. Conclusions CEREC atypical ceramic inlays can effectively restore Class Ⅱ cavity, short-term effect is good, but long-term effect still needs further observations. Key words: Ceramic inlay; Computer aided design/computer-aided manufacturing; CEREC

Cement Thickness of Inlay Restorations Made of Lithium Disilicate, Polymer-Infiltrated Ceramic and Nano-Ceramic CAD/CAM Materials Evaluated Using 3D X-Ray Micro-Computed Tomography.

To evaluate the marginal and internal cement thicknesses of inlay restorations made of various CAD/CAM materials using 3D X-ray micro-computed tomography (micro-CT) technique. Caries-free extracted mandibular molars (N = 30) with similar size were randomly assigned to three groups (N = 10 per group). Mesio-occlusal-distal (MOD) cavities were prepared, and inlay restorations were obtained by milling out CAD/CAM materials namely, (a) IPS: monolithic lithium disilicate (control), (b) VE: polymer-infiltrated ceramic, and (c) CS: nano-ceramic using a CAM unit. Marginal and internal cement thicknesses were measured using 3D micro-CT. Data were analyzed using 1-way ANOVA and Tukey's tests (alpha = 0.05). The mean marginal and internal cement thickness were not significant in all inlay materials (p > 0.05). Mean marginal cement thickness (μm) was the lowest for the IPS group (67.54 ± 10.16) followed by VE (84.09 ± 3.94) and CS (95.18 ± 10.58) (p > 0.05). The internal cement thickness (μm) was the lowest in the CS group (54.85 ± 6.94) followed by IPS (60.58 ± 9.22) and VE (77.53 ± 12.13) (p > 0.05). Marginal and internal cement thicknesses of MOD inlays made of monolithic lithium disilicate, polymer-infiltrated ceramic, and nano-ceramic CAD/CAM materials were similar and all less than 100 μm, which could be considered clinically acceptable. MOD inlays made of different CAD/CAM materials presented similar cement thickness, less than 100 μm.

Fracture strength of composite resins for endodontically treated molars

Objectives: The purpose of this study was to evaluate the effect of different fabrication techniques on the fracture strength of the composite resin-based inlay restorations of endodontically treated molars. Methods: Sixty mandibular molars were divided into six groups (n = 10) designated according to the treatment as: Group-1: Control group, intact teeth; Group-2: Filtek Ultimate Universal restorative with incremental technique; Group-3: Filtek Bulk Fill Posterior restorative; Group-4: Biodentine with Filtek Ultimate Universal restorative; Group 5: everX Posterior with Filtek Ultimate Universal restorative; and Group-6: Lava Ultimate CAD/CAM restorative. The standard mesio-occluso-distal cavities were prepared and the roots filled for all the teeth, except those of the control group. Following the placement of the restorations, the fracture resistance of the specimens was measured. The data were analyzed by the one-way analysis of variance and Tukey’s post hoc test. Results: While Group-1 (2815.80 N) exhibited significantly higher fracture strength than the other groups (p < 0.05), Groups-2 (2062.20 N), 3 (2166.00 N), 5 (2355.60 N), and 6 (2340.70 N) exhibited statistically similar results (p > 0.05). The Biodentine group (1480.50 N) exhibited significantly lower fracture strength than the rest of the groups (p < 0.05). Conclusions: The CAD/CAM and manual build-up techniques exhibited statistically similar results with the exception of Biodentine, which exhibited a significantly lower in vitro performance compared to the other composites used in the study. The fiber-supported composite everX Posterior increased the fracture strength of the endodontically treated teeth.

Quantitative analysis of metallic artifacts caused by dental metallic restorations: Comparison between four CBCT scanners

PurposeThe objective of this study was to quantitatively evaluate the artifacts produced by different metallic restorations using four cone-beam computed tomography (CBCT) scanners. MethodsEight extracted teeth (four mandibular premolars and four mandibular molars) were randomly divided into four groups. Each group compromised one premolar and one molar. One group was prepared and restored with occluso-mesial amalgam restorations (MO), the second group with mesio-occluso-distal amalgam restorations (MOD), the third group with porcelain fused to metal full coverage restoration, and the fourth group with occluso-mesial indirect metallic restorations (inlays). The restored teeth were then placed in the sockets of dried mandible. Images were obtained using four different cone beam computed tomography (CBCT) scanners, with exposure parameters 85 kVp and 8 mA. Volumes of artifacts were then measured by segmentation using volumetric and8i thresholding methods. ResultsQuantitative evaluation of metallic artifacts using the volumetric method showed the greatest mean value obtained from J Morita for all types of restorations studied while when using the thresholding method Gallileos yielded the greatest mean value for crown, MO, and inlay restoration while scanora produced the greatest mean value for MOD restorations. ConclusionIn cases of scanning patients with multiple fixed restorations Scanora is recommended. In cases of patients with MO or inlay restorations Planmeca AINO™ is recommended. Gallileos and J Morita are acceptable for scanning patients with metallic restorations and recommended in cases of MOD amalgam restorations.

In Vitro Comparative Analysis of Fracture Resistance in Inlay Restoration Prepared with CAD-CAM and Different Systems in the Primary Teeth.

Objective. The aim of this study was to compare to fracture resistance test of inlay restorations prepared using direct inlay technique (Gradia® Direct Composite) and Indirect Restoration System® (Gradia Indirect Composite) and CAD/CAD system (Vita Enamic® Block). Study Design. 48 noncarious extracted maxillary second primary molars were randomly divided into 4 groups with 12 in each group. All the teeth were prepared based on inlay class II preparations except for the control group. Other groups were restored with Gradia Direct Composite, Gradia Indirect Composite, and Vita Enamic Block, respectively. All restorations were cemented self-adhesive dual cure resin (3M Espe, RelyX™ Unicem Aplicap). A fracture test was performed using a compressive load. Results were analyzed using one-way analysis of variance and Duncan's post hoc multiple comparison tests (α = 0.05). Results. Vita Enamic Block and Gradia Indirect Composite showed significantly higher fracture resistance than Gradia Direct Composite (p < 0.05). There was no significant difference fracture resistance between Vita Enamic Block and Gradia Indirect Composite (p > 0.05). All restorations tested led to a significant reduction in fracture resistance (p < 0.05). Conclusion. In inlay restorations, Indirect Restoration Systems and CAD/CAM systems were applied successfully together with the self-adhesive dual cure resin cements in primary molars.

Influence of different composite materials and cavity preparation designs on the fracture resistance of mesio-occluso-distal inlay restoration.

The aim of the study to evaluate the fracture resistance of a computer-aided design/computer-aided manufacturing (CAD/CAM) and three indirect composite materials for three different mesio-occluso-distal (MOD) inlay cavity designs. A total of 120 mandibular third molar were divided into three groups: (G1) non-proximal box, (G2) 2-mm proximal box, and (G3) 4-mm proximal box. Each cavity design received four composite materials: Estenia, Epricord (Kuraray, Japan), Tescera (Bisco, USA), and Cerasmart CAD/CAM blocks (GC, USA). The specimens were subjected to a compressive load at a crosshead speed of 1 mm/min. The data was analyzed using the two-way analysis of variance and Bonferroni post hoc test (p<0.05). Estenia exhibited significantly higher fracture strength than Epricord and Cerasmart in G1. In G2 and G3, there was no significant difference among the four materials. Using a non-proximal box design for the cavity can improve the fracture resistance of the inlay restoration.

The adhesive bridge inlay retained in the therapy of minimal partial edentulism

In care of minimal partial edentulism, ie the lack of a tooth, as an alternative method can be used inlay retained adhesive restorations. The aim of this paper is to present possibilities for the application ceramic systems used for adhesive prosthetic restorations. In the making inlay restorations in the region of the posterior teeth can be applied ceramic system of higher strength which can be veneered with translucent ceramics. With the development of adhesive dentistry, it is possible to establish a strong link between restoration and teeth by means of composite cements and thus ensure sustainability of recovery. The clinical procedure is simple, minimally invasive, and provides a glimpse into a way of making inlay retained fixed restorations.

Fracture resistance of endodontically treated teeth restored with indirect composite inlay and onlay restorations - An in vitro study.

ObjectiveThe purpose of this in vitro study was to evaluate and compare the fracture resistance and fracture mode of extensive indirect inlay and onlay composite resin restorations performed for endodontically treated premolars.Materials and methodsA total of 55 extracted maxillary premolars were randomly divided into four groups. The first group (n = 15) remained untreated to serve as a positive control; the second group (n = 15) was endodontically treated with inlay cavities prepared and restored with indirect composite inlay restorations; the third group (n = 15) was also endodontically treated with onlay cavities prepared and restored with indirect composite onlay restorations; and the fourth group (n = 10) was endodontically treated with mesio-occlusodistal (MOD) cavities prepared and left unrestored to serve as negative controls. Dual cure indirect composite resin was used to fabricate the inlay and onlay restorations performed for the second and third groups, respectively. All teeth were subjected to compressive axial loading test using a metal ball (6 mm in diameter) in a universal testing machine (Instron 1195) with a cross-head speed of 0.5 mm/min until a fracture occurred. Statistical analysis of fracture resistance and fracture mode were performed with analysis of variance (ANOVA) (α = 0.05) and Kruskal–Wallis (α = 0.05) tests, respectively.ResultsFor the four treatment groups, the mean fracture resistance values were 1326.9 N, 1500.1 N, 1006.1 N, and 702.7 N, respectively. Statistical analyses showed no significant differences between the mean fracture resistance of the intact tooth group and the inlay restoration group (p > 0.05), while significant differences were observed between the mean fracture resistance of all the other groups (p < 0.05). The Kruskal–Wallis test showed statistically significant differences between the fracture modes of the four groups.ConclusionWithin the limitations of this study, endodontically treated teeth were successfully restored with indirect composite inlay and onlay restorations. However, the fractures that accompanied the inlay restorations were more severe and were unable to be restored.

Five-year clinical outcome of posterior zirconia ceramic inlay-retained FDPs with a modified design

ObjectivesTo evaluate the 5-year clinical outcome of posterior inlay-retained fixed dental prostheses (IRFDPs) with a modified design made from zirconia ceramic (Vita In-Ceram YZ, Vita Zahnfabrik, Bad Säckingen, Germany). MethodsThirty 3-unit IRFDPs were placed in 30 patients. Seven IRFDPs replaced the second premolars (4 in the maxilla, 3 in the mandible), and 23 replaced the first molars (15 in the maxilla, 8 in the mandible). Preparations were performed in accordance with general principles for ceramic inlay restorations and modified with a short retainer-wing bevel preparation within the enamel at the buccal and oral sides. The frameworks were milled from zirconia ceramic, and the pontics were veneered with feldspathic ceramic. After air-abrasion of bonding surfaces, IRFDPs were bonded with an adhesive composite resin. The patients were recalled 6–12 months after placement, and then annually. Kaplan–Meier analysis was used to calculate the survival and complication rates of the IRFDPs. ResultsAfter a mean observation time of 64.4 (SD=17.6) months (min 15, max 95.6), the 5-year cumulative survival of IRFDPs was 95.8%. Debonding was reported for two IRFDPs (6.9%), one of them failed finally after 49.4 months due to repeated debonding. Chipping of the veneering ceramic was reported in three cases (10.5%). Secondary caries were reported in 2 patients (8.1%). Nevertheless, the latter complications did not affect the clinical function of the involved IRFDPs. ConclusionThe 5-year clinical outcome of zirconia-based IRFDPs fabricated in the modified design is encouraging, so that they may represent a treatment alternative to replace posterior single missing teeth, taking into consideration the appropriate case selection.

Color Stability of CAD/CAM Fabricated Inlays after Accelerated Artificial Aging.

To investigate the influence of accelerated artificial aging on the color stability of three different inlay restorations produced with a CAD/CAM system. Thirty non-carious human mandibular molar teeth were used. The teeth were embedded in autopolymerizing acrylic resin blocks. Standard Class I inlay cavities were prepared, and the teeth were randomly divided into three groups (n = 10) to fabricate inlay restorations: (1) a feldspathic-ceramic group, (2) a resin nano-ceramic group, and (3) a leucite glass-ceramic group. Optical impressions were made with CEREC software, and the restorations were designed and then milled. The inlays were adhesively cemented with a dual-polymerizing resin cement and left in distilled water at room temperature for 1 week. Color measurements were performed with a spectrophotometer before and after accelerated aging in a weathering machine with a total energy of 150 kJ/m(2) . Changes in color (∆E, ∆L, ∆a, ∆b, ∆C) were determined using the CIE L*a*b* system. The results were assessed using a one-way ANOVA and Tukey's HSD test (p = 0.05). The color changes of the materials ranged from 2.1 to 9.29. The highest color change was seen in the resin nano-ceramic material. This change was not clinically acceptable (∆E > 5.5). No significant differences were found in the ∆L and ∆a values of the test groups. Color changes were observed in each evaluated material after accelerated aging. All CAD/CAM inlays became darker in appearance, more saturated, a little reddish, and more yellow.

English

The improvement of digital dentistry such as the intraoral scanners and indirect restorations that can be fabricated with computer-assisted design/ computer-assisted manufacturing (CAD/CAM) technology, have changed clinicians approach for treating patients. This case report describes the fabrication of lithium disilicate inlay on an endodontically treated mandibular second molar with CAD/CAM restoration offering a conservative alternative for patients. The purpose of this article is to provide information on a particular technique to manage a case of an endodontically treated tooth by performing a treatment combining digital dentistry with conventional laboratory work. This technique demonstrated efficiency on the fabrication and adjustment of lithium disilicate inlay restoration.

Effect of Base and Inlay Restorative Material on the Stress Distribution and Fracture Resistance of Weakened Premolars.

The purpose of this study was to evaluate the influence of direct base and indirect inlay materials on stress distribution and fracture resistance of endodontically treated premolars with weakened cusps. Forty healthy human premolars were selected; five were left intact as controls (group C+), and the others were subjected to endodontic treatment and removal of buccal and lingual cusp dentin. Five teeth were left as negative controls (group C-). The remaining 30 teeth were divided into two groups according to the direct base material (glass ionomer [GIC] or composite resin [CR]). After base placement, each group was subjected to extensive inlay preparation, and then three subgroups were created (n=5): no inlay restoration (GIC and CR), restored with an indirect composite resin inlay (GIC+IR and CR+IR), and restored with a ceramic inlay (GIC+C and CR+C). Each specimen was loaded until fracture in a universal testing machine. For finite element analysis, the results showed that the removal of tooth structure significantly affected fracture resistance. The lowest values were presented by the negative control group, followed by the restored and based groups (not statistically different from each other) and all lower than the positive control group. In finite element analysis, the stress concentration was lower in the restored tooth compared to the tooth without restoration, whereas in the restored teeth, the stress concentration was similar, regardless of the material used for the base or restoration. It can be concluded that the inlay materials combined with a base showed similar behavior and were not able to regain the strength of intact tooth structure.