3a

Indirect method for fillings (Classification, Procedure)

Materials Cast Metal o Traditional material for inlays is gold (high-gold alloys) o Some alloys contains only 20% gold, other no gold at all (low-gold alloys) o High-gold alloys are easier to work with than low-gold alloys Porcelain o Porcelain inlay and veneers 1. The impression of the tooth cast in refractory material which can be heated to very high temperatures without damages is taken 2. Porcelain powder is mixed to a paste with a liquid and placed into the inlay cavity 3. Fired in the furnace 4. The process is repeated until the required color is acquired o The lost wax technique can also be used Advantages and disadvantages of cast metal and porcelain restorations Strength o Cast Metal Cast metal in thin sections is stronger than amalgam, composite or GIC Thus it is the material of choice to protect weakened cups where a metal thickness of 1.0mm or less is sufficient compared with a minimum thickness of 3 mm for amalgam Cast metal is ideal for extracoronal restorations, such as onlay and complete and partial crowns Preparation for cast metal restorations are finished with beveled or chamfered margins o Porcelain Relatively brittle in thin sections, until it is bonded to the tooth and supported by it Thus porcelain restorations should not be beveled For a conventional porcelain crown minimum thickness is 1.5mm (due to occlusal forces) For porcelain veneer 0.5mm or less (no occlusal forces) Abrasion resistance o Amalgam is similar to enamel is resisting abrasion, composite and GIC are less resistant to abrasion o Cast metal and porcelain are at least as resistant as enamel, and porcelain may be more resistant that enamel (the opposing tooth may be worn down)

Indications Cast metal onlays o As part of bridge Porcelain inlays o Used in the past, not anymore o In occlusal fillings where large occlusal forces were present Composites inlays o Avoid large-volume polymerization shrinkage o Tougher restoration than the direct-placed composites o Problem with cementation Porcelain and composited veneers o Composite need much less preparation (the process is reversible) Color discoloration o Porcelain needs more preparation Level of success is disappointing Over time, breakage of luting cement lute at the margins occur and stains

Appearance o Cast metal has inferior appearance compared to resin and GIC o Porcelain, can have a very natural appearance and is very durable (does not stain) Versatility o Cast metal is a very versatile material Accurate shaping in the laboratory and many possible additions Cost o Major disadvantage of cast metal and porcelain

 Preparation for a mesial-occlusal-distal (MOD) inlay with cuspal protection First we remove old filling (if it exists) and the caries o Retention for inlay cavities Preparation of opposing walls as near parallel as practically possible, but without undercuts (angle should be 7-10 but clinically it is usually 20) With a straight-cut taper-fissure tungsten carbide bur in air turbine o Cuspal coverage The main reason for choosing this type of restoration is to prevent the weakened cusps from breaking under occlusal forces Should be reduced about 0.5-1.5mm Increased reduction when lateral movements of the mandible are present o Checking for undercuts No undercuts To check use probe at the deep margin at check with a mirror, if the point is lost then undercut is present Undercuts are eliminated either by further preparation or by application of GIC o Finishing lines Some form of bevel or chamfer is the finishing line for intracoronal restorations Cavosurface angle 135 in metal and 45 in gold When this thin margin (metal or gold) is fitted it can be burnished onto the enamel Any functional cusp can be finished with a chamfer finishing line to bring the margin of the gold away from the area of occlusal forces With a tungsten carbide chamfer finishing bur in air turbine With large boxes, bevels should be placed along the axial walls of the box and at the cervical margin With a straight-cut tapered tungsten carbide bur at a 1:4 ratio handpiece

Procedure for indirect cast metal inlay

o Cavity lining A deep cavity is sub-lined with calcium hydroxide cement GIC can be placed to line out any undercuts o Impression With a elastomeric impression material o A temporary inlay is placed o Trying in the casting If the casting does not seat, check in the following sequence Debris or temporary cement still in the preparation Gingival overgrowth into the restoration Mistake in the shape of the restoration o Cementing the restoration With GIC, zinc phosphate, resin-based cement

 Retentive design of the cavity is less important Sufficient tooth or GIC surface should be present for bonding Margins should not be beveled Calcium oxide is can be placed then, on top a thick base of GIC for bonding together and strengthening the dentine remaining in the cusps Special luting composite resins are used (chemically curing, or both light and chemically) The inlay returned (from the laboratory) inlay is etched or sandblasted, we then etch the cavity (dentine, enamel, GIC) The surfaces are then polished with composite finsishing discs or rubber wheels

Procedure for porcelain inlay

 Preparation Is needed A chamfer is produced at the gingival margin without penetrating the enamel Enamel is removed from the remainder of the buccal surface and into the contact area without going through to the lingual side The approximal finishing line is important o If left too labially it will show and eventually stain o If left too lingually it will increase difficult of cleaning the junction and thus there is increased risk or caries The incisal edge may be o Left unprepared o Prepared by rounding off the incisal-buccal edge so that the veneer extends over it Impression Same as others (elastomeric) Cementing restoration With thin porcelains the color of the cement influences the appearance of the final restoration With a resin-based cement

Procedure for porcelain veneer