OPD 2 P2 CHAPTER 10 (INDRECT TOOTH COLORED RESTORATIONS)

Indirect tooth-colored restorations

are esthetic dental restorations (such as inlays, onlays, and overlays)

-inlay

-onlay

-overlay/crowns)

EXample of Indirect tooth-colored restoration

-In dental laboratory

-CAD/CAM systems

inderct tooth-colored restorations are fabricated with the use of?

-fabicated outisde patient's mouth ---> In dental laboratory or CAD/CAM system ----> cemented or bonded to prepared tooth.

Explain fabrication of indrect tooth colored restorations

-ceramics

-resin

-composites

-hybrid ceramics

What materaisl do indirect tooth colored restorations use to mimic natural tooth appearance

Class 1 & 2

Indirect tooth colored restorations are typically used for what class of cavities

-Esthetic importance in psoterior teeth

-LArge defects needing cusp coverage

-Replacement of large compromised restorations

-Need for contour development and occlusal form

list the indications of indirect tooth colored restorations

-Heavy occlusa lforce

-Inabiltiy to have dry field

-Deep gingival margins difficult to bond, record or finish

List 3 contraindications for INdrect tooth colored restorations

Ceramic material

Most indirect tooth-colored inlays and onlays are made from what material?

-esthetics

-strength

-compatiblity (CAD/CAM and Laboratory)

Reason for use of ceramic material in indirect inlays and onlays

-Feldspathic porcelain

-Leucite-reinforced pressed ceramics

-Lithium disilicate

List the 3 main ceramic types

Partially crystalline minerals (Feldspar, silica, alumina)

Composition of Feldspathic porcelain

Hand-layered on refractory dies ---> fired in a furnace.

Fabrication of feldspathic porcelain

Feldspathic porcelain

THis type of indirect tooth colored inlays and onlays are less common now but still used by some labs

-Technique senstive

-Weak: prone to fractures

-TIme consuming

Cons of feldspathic porcelain

-Excellent esthetics

-Low equipment cost

-Compatible (traditional lab setups)

Pros of feldspathic porcelain

Glass ceramic strengthened with leucite crystals

COmposition of leucite reinforce pressed ceramics

LOst wax method--> pneumatic pressing into molds

Fabrication of leucite reinforced pressed ceramics

-Good marginal fit

-higher strenght than feldspathic

-Familiar wax up texhnique

-Aesthetic with minimal staining method

Pros of leucite reinforced pressed ceramics

-Fragile: need adhesive bonding

-Slighly lower strength

Cons of leucite reinforced pressed ceramics

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High-strength glass-ceramic with lithium disilicate crystals.

Compostion of lithium disilcate

Lithium disilicate

This ceramic inlay and onlay type is increasingly favored for its durability and appearnce

-inlay

-onlay

-ultra thin veneers

Uses of lithium disilcate

-High strength

-Versatile applications

-Excellent esthetics and translucency

Pros of lithium disilicate

-relatively new

-Lack long term clinical data

Cons of lithium disilicate

CAD/CAM

This technology enables the rapid design and fabrication of high-quality ceramic restorations, either chairside or in a dental laboratory

-Chairside systems

This key system allow same-visit restorations

-CEREC, 3D, E4D

Example of chairside system

Laboratory system

THis type of key ssytem requires submission of impressions (elastomeric or digital) for lab fabrication

-Tooth preparation

-Optimal impression

-Design (CAD)

-Milling (CAM)

-Finalization

Workflow of chairside CAD/CAM

-Vitablocs MArk 2, CEREC blocs

Materials used for Feldspathic ceramics

IPS Empress CAD, Paradigm C

Materials used for leucite-reinforced ceramics

IPS e.max CAD

Materials used for lithium disilicate

-Anesthesize and isolate -> remvoe old restorattiosn and caries ->ELiminate external stains

In clinical technique tooth preparation, explain initial steps

>2mm

In clinical technique tooth preparation, what is the occlusal thickness

>0.5mm

In clinical technique tooth preparation,waht is the proximal clearance in design principles

tapered/diamond carbide burs

In clinical technique tooth preparation, what are the burs used in instrumentation

Lab-fabricated

THis type of impression is Elastomeric or digital impressions and Take interocclusal records

Chairside CAD/CAM

THis type of impression is Use optical scanning - No need for physical cast

Bi-acryl compostie material

In provisional restoration, what material is used?

Eugenol based

In provisional restoration, what should be avoided that can interfere with bonding

-Non-eugenol

-ZInc phosphate

-Resin based

What are some cement types in provisional restoration should be used instead?

-use rubber dam

-Remove all proviosnal cement/debris

In try-in bonding, what should be done in preparation

-Check proximal contacts (with floss, articulating paper)

-Adjust with abrasive disks/points

IN try-in bonding, what should be done in evaluation & adjustment

-Verify internal and marginal fit

-Remake if significant interferance

In try in bonding, what must be done in final check?

Remove excess and finish with diamond burs

In try-in bonding, what must be done in post bonding

Hydrofluoric acid(HF)

In bonding, the internal ceramic surface is etched with waht material?

Micromechanical retention

In bonding, what does etching increase

White and opaque

In bonding, the etched surface appears what?

Silane coupling agent

In silane application, what should be applied after etching to improve chemical bonding

Selective enamel etching

In tooth surface preparation (bonding), what is recommended to avoid decreased dentin bond strength

TRue

TRue or false: in adhesive system, you should apply adhesive to internal surfaces of the restoration

Dual cure resin cement

In resin cement application, what type of cement must be used and insert into preparation and coat internal surface of the restoration

-Light pressure

-Ball burnisher

In resin cement application, seat restoration using _________ and a _______________ with gentle vibration

-Remove with composite instrument, brushes, microbrushes or explorer

-Avoid disturbing marginal interface

In excess cemetnt removal (bonding), explain the process

Multiple direction light curing

(occlusal, facial, lingual)

In light curing, what type of light curing msut be performed and which part of the tooth?

-Inital checks

-Excess cement removal

-Smoothing

-Contouring & polishing

-FInal steps

LIst the 6 steps in finishing & polishing

-Remove rubber dam and check resin cement settings

In finishing & polishing , explain the inital checks

Medium/fine grit diamond burs

In finishing & polishing(excess cement removal), what type of bur is used to remove excess cement?

30-fluted carbide burs

In smoothing, what bur is used for smoother finish

Abrasive straps

In smoothing, what material is used in interproximal areas to protect the gingiva/root

FIne grit diamond burs

In contour & polish, what burs are used in adjusting contours

Carbide burs

In contour & polish, what burs are used in smoothing

-diamond polishing paste

-Bristle brush

In contour & polish, 2 materials are used in final polish

-Inappropriate case selection

-Inadequate restoration thickness

-Poor prep or occlusal interferences

In common problems, 3 causes of bulk fracture

replacement of restoration

SOLution for bulk fracture

Airborne particle abrasion wiht aluminum oxide

In repair of ceramic inlays & onlays, what is used for mechanical roughening

Aplly 5-10% hydrofluric acid (HF) gel for 2 minutes

In repair of ceramic inlays & onlays, what material is used in etching and how long?

SIlane coupling agent

What agent is use to promote chemical bonding between ceramic and resin