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Composite restorations shrink most during curing. In large cavities more shrinkage may be expected. The composite inlay is especially developed to overcome these disadvantages. After curing of the composite inlay causes secondary polymerization increasing several material properties such as wear resistance and stress relaxation. Clinical results are reviewed and the benefits of the composite inlay technique discussed.
This in vitro study evaluated the effect of metal alloys on three-body wear resistance of enamel and dentin, and vice versa. Three-body wear of human enamel, dentin, a soft gold alloy (BiOcclus Inlay), a CoCr alloy (Remanium 2000), a resin cement (Variolink II) and a zinc oxide phosphate cement (Harvard) was investigated using the ACTA-machine. Sample chambers of eight sample wheels were prepared with pure materials or combinations of human tooth substance, alloys and cement, simulating an inlay-like situation. After 100,000 and 200,000 cycles in a millet suspension with a spring force of 20 N, the amount of abraded material was profilometrically measured and evaluated by 3D surface data analysis. After 200,000 cycles, the materials demonstrated a mean loss of 0.41 microm for CoCr, 51 microm for gold, 57 microm for enamel, 164 microm for dentin, 79 microm for Variolink and 369 microm for Harvard. Using ANOVA and the Games-Howell-test, resin cement, enamel and gold were a subset not shown to differ, as was zinc phosphate cement and dentin. CoCr demonstrated the least wear and differed significantly from all materials. Enamel wear was significantly reduced in mixed chambers with CoCr, and gold after 200,000 cycles compared to enamel in pure chambers. In summary, a soft gold alloy can be recommended for inlays when considering three-body abrasion since the wear rate of the "soft" gold alloy corresponded to that of human enamel.
PURPOSE: The objective of this follow-up study was to examine the performance of Cerec inlays and onlays in terms of clinical quality over a functional period of 10 years. MATERIALS AND METHODS: Of 200 Cerec inlays and onlays placed in a private practice between 1989 and early 1991, 187 restorations were observed over a period of 10 years. The restorations were fabricated chairside using the Cerec-1 computer-aided design/manufacturing (CAD/CAM) method and Vita MK I feldspathic ceramic. An adhesive technique and luting composite resin were used for seating the restorations. After 10 years, the clinical performance of the restorations was evaluated using modified USPHS criteria. The results were used to classify success and failure. RESULTS: According to Kaplan-Meier analysis, the success rate of Cerec inlays and onlays dropped to 90.4% after 10 years. A total of 15 (8%) failures were found in 11 patients. Of these failures, 73% were caused by either ceramic fractures (53%) or tooth fractures (20%). The reasons for the remaining failures were caries (20%) and endodontic problems (7%). The three-surface Cerec reconstructions were found to have the most failures. CONCLUSION: The failure rate of 8% and the drop of the survival probability rate to 90.4% after 10 years of clinical service of Cerec-1 CAD/CAM restorations made of Vita MK I feldspathic ceramic appear to be acceptable in private practice. This is particularly true in light of the very high patient satisfaction.
OBJECTIVE: The treatment procedures used in conjunction with two different metal-free restorative systems are illustrated on the basis of clinical examples. In addition, a report on the initial clinical findings is provided. METHOD AND MATERIALS: Metal-free restorative materials are opening doors to new preparation methods because of their close link to the adhesive cementation technique. As a result of the developments over the past few years, various metal-free systems that can be used to fabricate short-span fixed partial dentures (FPD) are now available. Certain guidelines, however, must be observed in the process. Because of their minimal invasiveness, inlay-retained FPDs offer an interesting solution in cases where the residual dentition exhibits low caries activity. Since the beginning of 1997, a total of 23 metal-free inlay-retained FPDs made of two different types of framework material (11 of high-strength pressed ceramic and 12 of fiber-reinforced composite) have been examined in a clinical study. RESULTS: One inlay-retained FPD made of pressed ceramic had to be replaced because of a fracture. Because the materials have only been on the market for a short time, long-term results are not yet available. CONCLUSION: This type of restoration provides excellent esthetics and reduced invasiveness compared with complete crown-retained FPDs, although indications are limited by the special mechanical properties of the material.
PURPOSE: To clinically evaluate conservative fiber-reinforced composite inlay fixed partial dentures (IFPDs) bonded to inlay abutments. MATERIALS AND METHODS: Forty fiber-reinforced composite IFPDs were made for 29 patients. Restorations were manufactured with the composite Targis reinforced by Vectris prefabricated glass-fiber elements and were inserted with a high viscosity insertion technique. Forty bonded IFPDs were examined clinically after 1 year, and 25 after 2 years, using modified USPHS criteria. Twenty-five abutment inlays and 12 pontics were analyzed quantitatively by scanning electron microscopy SEM. Results were tested for statistical significance with ANOVA. RESULTS: Although most clinical criteria were rated "alpha", four IFPDs had to be replaced: two retainers debonded and two presented total delamination of veneering material from fiber framework. Two partial delaminations were repaired intraorally. No fractures of framework were observed. SEM marginal analysis of tooth-composite interface exhibited 96.5 +/- 3.0% continuous margin at baseline, 91.0 +/- 5.7% at the 1-year and 89.6 +/- 5.2% at the 2-year recall. Decrease of marginal quality was statistically significant between baseline and 1 year (P= 0.001), but not between 1- and 2-year recalls.
Glass-fiber-reinforced composite resin systems may be used as conservative alternatives to conventional fixed partial dentures (FPDs) for the replacement of a single missing tooth. This article describes a clinical technique and 4-year evaluation of an inlay bonded FPD. The patient presented with a missing maxillary right second premolar. A high-caries risk and moderate-to-advanced attachment loss around the abutment teeth, which were clinically stable, were noted. The patient had a strong desire to maintain his remaining dentition. Advantages of supragingival margins and minimal tooth structure removal made the bonded inlay bridge a viable alternative to a conventional FPD for this compromised restorative situation. The clinical performance of this glass-fiber-reinforced resin inlay FPD at the 4-year follow-up is provided. The restoration has served satisfactorily for more than 4 years and holds promise as a conservative, esthetic alternative to the conventional FPD in certain clinical cases.
PURPOSE: This study compared the fatigue life of human maxillary premolars restored with direct composites and indirect ceramic inlays in mesio-occlusodistal (MOD) cavities. MATERIALS AND METHODS: Ten human maxillary premolars were divided into two groups of five and restored with (1) direct composite restorations, or (2) pressed ceramic restorations. Standardized MOD cavities were prepared for both groups. Teeth in the direct composite group were restored with Z250 composite and Single Bond adhesive, and those in the ceramic group were restored with IPS Empress ceramic inlays. The ceramic inlays were luted with Single Bond and RelyX ARC cement. Under the applied test load of 11.17 kg, strain measurements were recorded from an electric resistance stain gauge bonded to the buccal surface. These strains were recorded for the (1) intact tooth, (2) cavity preparation, and (3) restored tooth. These strain measurements were used to calculate the relative tooth compliance values for each tooth. The fatigue loading was applied until reinforcement loss was registered by the strain gauge. RESULTS: A one-way ANOVA showed no significant compliance difference between the intact and restored tooth conditions, and no significant difference in fatigue cycles to failure between the two groups. CONCLUSION: There were both adhesive and cohesive failures in both restoration groups, indicating that the adhesive joint is not the only weak link in these restorations.
This in vitro study evaluated the marginal adaptation of bonded inlays of lucite-reinforced glass ceramic (Empress) to dentin as influenced by different bonding systems and by luting resin composites (LRCs) with different curing modes. Forty-eight Empress inlays etched with 5% hydrofluoric acid and treated with a silane-coupling agent (Monobond-S) were bonded to two-surface Class II cavities. Two total-etch bonding systems (OptiBond FL, Nexus) and one bonding system with selective enamel etching and a self-conditioning dentin primer (ART Bond) were included in the study. ART Bond was tested with and without the pre-curing of a first layer of adhesive resin selectively applied to the cervical cavity floor (selective double-bond technique). Each bonding system was used in combination with a light-cured resin composite (Prodigy) and a dual-cured LRC (Nexus or Vita Cerec Duo Cement). Marginal integrity was evaluated before and after thermocycling (TC) in a scanning electron microscope (SEM). Dye penetration tests were performed after TC was completed. The median percentages of continuous margin in dentin ranged from 80% to 100% before TC and from 53.5% to 96.1 % after TC. After TC, the influence of the bonding system was more pronounced than that of the LRC. In combination with the LC resin composite, ART Bond with precuring was significantly higher and the Nexus bonding system had significantly lower proportions of continuous margin than all the other bonding systems investigated. Swelling of the adhesive along the gingival margins was frequently found with the Nexus bonding system and with ART Bond without pre-curing. Microleakage was detected with all bonding system/LRC combinations, with somewhat lower rates in specimens completed using the selective double-bond technique. With the exception of the Nexus bonding system, post-TC marginal integrity was not influenced by the curing mode of the LRC (LC vs DC). In conclusion, the marginal quality of dentin bonded ceramic inlays can be improved by proper selection of the bonding sys- tem/LRC combination. The results of this study indicate the use of the Nexus luting system as directed without substitution.
Fired porcelain inlays were cemented in class II cavities with either a dual cured composite or a glass ionomer luting cement. Clinically evaluation according to modified USPHS criteria was done at baseline and after 6, 12 and 24 months. Inlays bonded with the composite resin showed a 2% failure rate, while 15% of the inlays cemented with the glass ionomer were lost or fractured during the evaluation period. The failures were in most cases due to an adhesive bond failure at the cement-porcelain interface.
This study evaluated the clinical performance of ceramic inlays and onlays made with two systems: sintered (Duceram, Dentsply-Degussa)--D and pressable (IPS Empress, Ivoclar-Vivadent)--IPS after two years. Eighty-six restorations, 44 IPS and 42 D, were cemented into the mouths of 35 patients. Twenty-seven premolars and 59 molars received Class II preparations totaling 33 onlays and 53 inlays. All restorations were cemented with dual-cured resin cement (Variolink II, Ivoclar-Vivadent) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at the baseline and after one and two years using the modified USPHS criteria. Additionally, radiographs and slides were made. After two years, 100% of the restorations were assessed and all the restorations were considered clinically excellent or acceptable. Among the analyzed criteria, the following received Bravo ratings: marginal discoloration--IPS (31.82%), D (23.81%); marginal integrity--IPS (18.18%), D (11.9%), color match-IPS (4.55%), D (9.52%) and surface texture-IPS (2.27%); D (14.29%). No "Charlie" or "Delta" scores were attributed to the restorations. The results were subjected to the Fisher and McNemar Statistical Tests. No significant differences were noticed between the two ceramic materials. Among the analyzed criteria, only marginal discoloration presented an increased percentage of "Bravo" scores that increased with time for both ceramic materials. Compared with the baseline data, the difference was statistically significant (p < 0.05). No difference was found between inlay and onlay restorations or between restorations placed in premolars or molars. In conclusion, these two types of ceramic materials demonstrated excellent clinical performance after two years.
Fracture resistance of dentin-bonded inlays may be influenced by the restorative material used. The purpose of this study was to evaluate, in vitro, the fracture resistance of teeth restored with four tooth-colored materials: feldspathic ceramic, Duceram LFC, and three laboratory resins, Solidex, Artglass, and Targis. Sixty mandibular molar teeth were placed in resin cylinders, reproducing the periodontal ligaments. Mesial-occlusal-distal (MOD) inlay preparations were made in a standard cavity preparation appliance. Subsequently, the teeth were molded, and the restorations were prepared following the manufacturer's instructions. The inlays were cemented with resin composite cement, Rely X, and stored at 37 degrees C and 100% humidity for 24 hours. The samples were then submitted to an axial compression load at a speed of 0.5 mm/minute. Statistical analysis by one-way ANOVA and Tukey's multiple comparison test revealed that the teeth restored with Duceram LFC (205.44 +/- 39.51 kgf) showed statistically inferior fracture resistance than the three other groups restored with indirect resin composites (Solidex [293.16 +/- 45.86 kgf], Artglass [299.87 +/- 41.08 kgf], and Targis [304.23 +/- 52.52 kgf]).
In everyday dentistry practice cases with diffuse destruction of masticatory teeth are common. In the study presented the possibilities of their restoration with metal or metal-ceramic inlays are reviewed. Twenty-one inlays were fabricated, 16 from metal and 5 from metal-ceramic. The quality of the fabricated obturations were assessed immediately after they were cemented and one year later. The results showed that this is a reliable method. During the studied period there were no changes in the inlays, the teeth tissues and marginal adaptation.
24 composite inlays placed and documented for post-graduate education purposes in 1990 were reassessed clinically and by means of SEM. The clinical examination after 1 year of clinical service gave excellent results. The quantitative SEM evaluation of the marginal adaptation in the replicable areas revealed 6.6% of marginal gaps at the tooth/cement- and 27.1% at the cement/inlay-interface. To be able to compare these findings to the initial situation, additional five inlays were placed and examined in the SEM immediately after placement. This group exhibited next to gap-free margins. The results were selectively analyzed according to fabrication technique, type and localization of the restorations. No significant difference was found among molars and premolars. On the other hand, higher percentages of marginal gaps at the cement/inlay interface were observed with multi-surfaced, indirect lab-made inlays.
We present a 29 years old female patient treated with an all ceramic inlay. The IPS Empress system has been used to make an optimal, esthetic and morpho-functional restoration. An inlay restoration is a biological prosthetic solution that is indicated as a proper treatment possibility for the young patients. The IPS Empress inlays are characterized by a good biomechanical behavior, law abrasion rate and perfect chromatic integration.
The present in vivo study assessed the marginal behaviour of in total 43 "SR-Isosit" composite inlays. SEM-analysis of replica models indicated a continuous loss of marginal adaptation within the one year period of clinical use. Cavomarginal degradation predominantly took place on the contact surface between composite resin inlay and resin luting agent by (micro-)fractures of thin and instable inlay margins.
The pin-technique in the application of inlays offers two important advantages: once the possibility to prepare with the utmost preservation of dental substance and highest stability and then to have more indications for inlays. Compared to the general technique in using inlays there are two major difficulties: keeping the parallelism of several pins and the danger of hurting the pulp. After a certain period of training both can be managed.
For a proper radiographic diagnosis of secondary caries and interproximal overhangs or undercuts, tooth colored inlays and their appropriate luting agents have to be radiopaque. With the help of a spectrophotometer the radiopacity of 1 mm thick samples made of enamel, dentin, seven tooth colored inlay materials and seven composite cements was quantitated and related to 99.5% pure aluminum. The mean radiopacity values of three inlays (two of them significantly, p less than 0.05) and of three composite cements (one of them significantly, p less than 0.05) were lower than enamel. All other materials tested exhibited a higher radiopacity than enamel. A radiopacity value of 1 mm thick samples greater than 2.5 mm of 99.5% pure aluminum is advocated by the authors. Four of the materials tested fulfilled this requirement.
The purpose of this study was to: 1) determine the most effective combination of composite resin and adhesive resin cement in the cementation process when fabricating esthetic inlays in severely broken down posterior primary teeth; 2) evaluate the pulpal response to adhesive resin cement in the primary teeth of young dogs. In Part I of the study, P-30 and Dentacolor composite resin inlays were evaluated with regard to their bonding strengths with Panavia-EX and Chemiace adhesive resins. Test samples of the composite resin inlays were prepared in molds according to the manufacturer's instructions. Each sample was polished on a flat, wet surface of 320 grit carborundum until a uniformly flat surface, perpendicular to the long axis of the cylinder was attained. Composite resin plugs, similarly fabricated, were bonded to the test samples using either Panavia-EX or Chemiace adhesive resin cements. A total of 160 samples were divided into four groups. Three of the groups were tested for bonding strength at intervals of 24 hours, 7 days and 30 days. The fourth group was thermocycled through 4 degrees C and 60 degrees C immersion periods. The results were analyzed using Tukey's studentized range test with an alpha (significance level) of 0.05. In Part II of the study, the pulpal response to Panavia-EX as a luting medium was compared with that of HY-Bond polycarboxylate cement. Cavities were prepared in 92 teeth from 8 young dogs and contralateral pairs of teeth were restored with Panavia-EX and HY-Bond polycarboxylate cement respectively.(ABSTRACT TRUNCATED AT 250 WORDS)