Evaluating interfacial gaps for esthetic inlays

A clinical evaluation of resin nanoceramic CEREC Omnicam restorations associated with several factors

PURPOSE

The aim of this study was to assess the clinical performance of computer-aided design and computer-aided manufacturing resin nanoceramic posterior restorations fabricated by CEREC Omnicam system.

MATERIALS AND METHODS

Fifty-seven Lava Ultimate posterior restorations were placed in 44 patients by one operator. Restorations were cemented using a resin cement system (Duo-Link). The clinical performance of the restorations was evaluated with USPHS guidelines in a mean time of 45-month. Data were statistically analyzed using Kaplan-Meier and Log Rank (Mantel-Cox) tests (SPSS 22.0, α = 0.05).

RESULTS

Thirty-eight restorations in 26 patients were evaluated at recall examinations by two evaluators other than the clinician who had placed the restorations who were blinded to groups. The survival rates of Lava Ultimate were 86.8%. A total of 5 (13.2%) failures were found. After a mean time of 45-month survival rate of vital and non-vital teeth were 90 and 83.3% respectively. The failures were not significantly influenced by gender, tooth arch, restoration size, the treated region and vitality.

CONCLUSION

Chair-side posterior resin nanoceramic restorations were clinically successful restorations with a survival rate of 86.8% after a mean time of 45-month.

CLINICAL SIGNIFICANCE

Chair-side CAD/CAM resin nanoceramic restorations can be a successful choice for vital and non-vital teeth with acceptable survival rates.

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique

Objective

The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups (n=15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal–Wallis for marginal gap data (p=0.05).

Results

The mean marginal gap size of EC, LU, EL, and EP were 33.54 µm, 33.77 µm, 34.23 µm, and 85.34 µm, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30).

Conclusion

Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique.

Micro-CT Evaluation of Ceramic Inlays: Comparison of the Marginal and Internal Fit of Five and Three Axis CAM Systems with a Heat Press Technique

OBJECTIVES

To evaluate the marginal and internal adaptation of CAD/CAM lithium-disilicate inlay restorations fabricated by two milling systems (Five and Three-axis), and a traditional heat-press technique.

METHODS

Fifteen premolar teeth with an MOD cavity preparation were fabricated. Lithium-disilicate inlay restorations were obtained by three fabrication techniques and fitted to their dies (n = 15/gp) as follows: Group-1, three-axis milling system, Group-2, five-axis milling system, Group-3, conventional heat-press technique. Gaps were evaluated by X-ray microtomography. Marginal gap (MG), occlusal-marginal gap (OMG), proximal-marginal gap (PMG), gingival-marginal gap (GMG), absolute marginal discrepancy (AMD), axial-internal gap (AIG), and occlusal-internal gap (OIG) were evaluated at 120 different points per inlay. Data were analyzed using repeated measures ANOVA. Pairwise comparisons were conducted for post-hoc testes and the Bonferroni correction was used to adjust for multiple comparisons (α = 0.007).

RESULTS

The heat-press group demonstrated significantly smaller mean-values amongst all outcomes compared with CAD/CAM groups except for GMG, where there was no statistically significant difference between groups in the ANOVA (p = 0.042). Within the CAD/CAM groups, the five-axis group showed significantly lower OMG mean-value compared with the three-axis group p < 0.001, and lower AIG mean-value compared with the three-axis group p < 0.001. There was no significant difference between the five-axis and the three-axis groups' AMD, MG, PMG, and OIG locations.

CONCLUSION

Different fabrication techniques affected the marginal and internal adaptation of ceramic inlay restorations. The heat-press group showed the best marginal and internal adaptation results; however, in every group, all samples were within the clinically acceptable MG limit (100 μm).

CLINICAL SIGNIFICANCE

The marginal fit and internal adaptation of inlay ceramic restorations fabricated by a five-axis milling system have not been tested or compared with those fabricated by three-axis machines and the conventional heat-press method. The preferred method of inlay fabrication, whether in the lab or chair side, may be influenced by the results of this study and could affect future clinical decision-making. (J Esthet Restor Dent 29:49-58, 2017).

An In vitro Evaluation of Flexural Bond Strength of Indirect Composites Fused to Metal

With the advent of newer indirect composite resin materials for crown and bridge prosthesis, it has become imperative to evaluate their strength to serve as long term replacements as a substitute to metal ceramic restorations. This study aimed to evaluate and compare the flexural bond strength of three composite resin veneering material to metal, cured by different methods. Specimen were fabricated with pattern resin by duplicating it with machined metal die and divided into three groups. Three composite resin materials were used in this study. Group (A) received Adoro, Group (B) received Targis and Group (C) received Tescera. The bond strength of all specimens was tested with Lloyd's universal testing machine under three point loading. The highest values for fracture resistance were displayed by light, heat and pressure cured composites followed by composites cured using a temperature of 104 °C and composites with curing temperature of 95 °C. The results indicate that there is a significant difference between the three groups, with the Tescera group specimens exhibiting the highest flexural bond strength. Of the other two groups, Adoro group exhibited higher flexural bond strength than Targis group. The results of this study suggest that Tescera group with curing temperature of 130 °C and pressure of 80 Psi, cured with metal halide unit exhibited the highest flexural bond strength when compared to Adoro and Targis groups.

Indirect resin composites

Aesthetic dentistry continues to evolve through innovations in bonding agents, restorative materials, and conservative preparation techniques. The use of direct composite restoration in posterior teeth is limited to relatively small cavities due to polymerization stresses. Indirect composites offer an esthetic alternative to ceramics for posterior teeth. This review article focuses on the material aspect of the newer generation of composites. This review was based on a PubMed database search which we limited to peer-reviewed articles in English that were published between 1990 and 2010 in dental journals. The key words used were 'indirect resin composites,' composite inlays,' and 'fiber-reinforced composites.'

The influence of the cavity preparation design on marginal accuracy of laboratory-processed resin composite restorations

The aim of this study was to evaluate the influence of different cavity preparation designs on marginal accuracy of laboratory-processed resin composite restored teeth. Eighty mandibular human third molars were selected. There were two experimental factors, occlusal isthmus width (narrow vs wide) and cuspal coverage (inlay, one-cusp onlay, two-cusp onlay, and all-cusp onlay), resulting on eight groups (N = 10). Indirect composite restorations (SR Adoro, Ivoclar-Vivadent) were manufactured and positioned over each respective preparation. Marginal accuracy evaluation was accomplished using a stereomicroscope at three points on buccal, lingual, mesial, and distal regions with 40x magnification. The results showed significant differences (P = 0.00) with wide inlay showing the best overall marginal accuracy and narrow inlay the worst one. Two-way analysis of variance (ANOVA) showed significant differences when considering the factor occlusal isthmus width (P = 0.00). In general, preparations with wide occlusal isthmus presented better results than narrow ones, except for wide all-cusp onlays; however, the test failed to show differences when considering the cuspal coverage (P = 0.42) or the interaction between both factors (P = 0.30). The effect of occlusal width extension on marginal accuracy of indirect composite resin restorations is significant, with lower values of gaps width in wide preparations, but since in a clinical situation this would mean greater removal of sound tooth structure, less-aggressive preparations combined with other restorative procedures seem to be more feasible.

Clinical performance of bonded leucite-reinforced glass ceramic inlays and onlays after eight years

OBJECTIVE

Ceramic inlays and onlays are a tooth colored alternative to metallic restorations. Clinical long-term data are scarce though, especially about inlays and onlays having proximal margins in dentin. The present prospective controlled clinical study evaluated the clinical performance of IPS Empress inlays and onlays with cuspal replacements and proximal margins below the cementoenamel junction over eight years.

METHODS

Ninety six ceramic restorations were placed in 34 patients by six dentists. The restorations were bonded with an enamel/dentin bonding system (Syntac Classic) and four different resin composite systems. The restorations were assessed after placement by two calibrated investigators using modified USPHS codes and criteria at the following time periods: baseline, 1,2,4,6 and 8 years.

RESULTS

Eight of the 96 restorations investigated had to be replaced (failure rate 8%; Kaplan-Meier): Six inlays suffered cohesive bulk fractures, two teeth required endodontic treatment. After eight years of clinical service, significant deterioration (Friedman 2-way ANOVA; P < 0.05) was found for marginal adaptation of the remaining restorations. 98% of the surviving restorations exhibited marginal deficiencies, independent of the luting composite.

CONCLUSIONS

IPS Empress inlays and onlays demonstrated to be successful even in large defects. Neither the absence of enamel margins, nor cuspal replacement significantly affected the quality of the restorations.

Ceramic Inlays and Onlays: Clinical Procedures for Predictable Results

The use of ceramics as restorative materials has increased substantially in the past two decades. This trend can be attributed to the greater interest of patients and dentists in this esthetic and long-lasting material, and to the ability to effectively bond metal-free ceramic restorations to tooth structure using acid-etch techniques and adhesive cements. The purpose of this article is to review the pertinent literature on ceramic systems, direct internal buildup materials, and adhesive cements. Current clinical procedures for the planning, preparation, impression, and bonding of ceramic inlays and onlays are also briefly reviewed. A representative clinical case is presented, illustrating the technique.

CLINICAL SIGNIFICANCE

When posterior teeth are weakened owing to the need for wide cavity preparations, the success of direct resin-based composites is compromised. In these clinical situations, ceramic inlays/onlays can be used to achieve esthetic, durable, and biologically compatible posterior restorations.

Tensile bond strengths of five luting agents to two CAD-CAM restorative materials and enamel

STATEMENT OF PROBLEM

CAD-CAM restorative materials are popular because they have high esthetic value and short fabrication time. Unfortunately these materials are brittle and tend to fracture under heavy occlusal load.

PURPOSE

The purpose of this in vitro study was to investigate the tensile bond strengths of 5 luting agents to 2 CAD-CAM restorative materials and enamel. Material and methods One hundred truncated cones, with a 3-mm diameter bonding surface and 5-mm diameter base, were fabricated with Dicor MGC (n=50) or Cerec Vitablocs Mark II (n=50) with the Cerec system. Enamel surfaces of the crowns of 100 freshly extracted noncarious, anterior teeth, stored in 0.9% saline solution with 0.25% sodium azide (NaN(3)) as disinfectant, were prepared with sandpaper disks (320-grit size) on the Buehler Variable Speed Grinder-Polisher. The bonding surfaces of the Dicor MGC or Cerec Vitablocs Mark II truncated cones from each of the 2 tests systems were airborne particle abraded, chemically etched, and cemented on the prepared enamel surface of the tooth specimens with 5 luting agents: Vita Cerec Duo Cement, EnForce, Panavia 21, C&B Metabond, and Fuji Duet. All specimens were thermocycled 1000 times, in 5 degrees C and 55 degrees C water with a dwell time of 30 seconds in each temperature. Tensile force (MPa) was applied perpendicular to the bonding surfaces of the specimens with a universal testing machine until fracture. Fracture patterns were examined with a microscope at original magnification x10. The differences in the tensile bond strengths were analyzed with the Tukey-Kramer test (alpha=.05).

RESULTS

The mean tensile bond strengths of Dicor MGC bonding to enamel with luting agents in descending order in MPa were EnForce (10.12 +/- 2.25), Panavia 21 (7.28 +/- 1.77), Cerec Duo (5.32 +/- 1.65), Fuji Duet (3.73 +/- 1.78), and C&B Metabond (3.11 +/- 1.11). EnForce had a significantly higher bond strength than C&B Metabond, Fuji Duet, Cerec Duo, and Panavia 21 (P=.05). The mean tensile bond strengths of Cerec Vitablocs Mark II bonding to enamel with luting agents in descending order in MPa were as follow: Fuji Duet (11.51 +/- 2.79), EnForce (9.44 +/- 2.03), C&B Metabond (8.98 +/- 3.29), Cerec Duo (8.66 +/- 4.71), and Panavia 21 (5.10 +/- 2.49). Within this group, there was no significant difference between Fuji Duet and EnForce, but the bond strength of Fuji Duet was significantly higher than that of C&B Metabond, Panavia 21, and Cerec Duo (P=.05). The mean tensile strength of all the luting agents bonded to Cerec Vitablocs Mark II and enamel (8.74 MPa) was higher than Dicor MGC and enamel (5.91 MPa).

CONCLUSION

In this in vitro study; within the Dicor MGC group, the mean bond strength of Panavia 21 with enamel was significantly higher than C&B Metabond, Panavia 21, Cerec Duo, and Fuji Duet. Within the Cerec Vitablocs Mark II group, the mean bond strength of Fuji Duet was significantly higher than C&B Metabond, Panavia 21, and Cerec Duo but was not significantly higher than EnForce.

In vitro wear simulation measurements of composite versus resin-modified glass ionomer luting cements for all-ceramic restorations

BACKGROUND

Although composite cements are generally indicated for cementation of all-ceramic restorations, some manufacturers of dental cements propose that resin-modified glass ionomers (RMGIs) may be used for cementation of high-strength ceramic restorations.

PURPOSE

This study was undertaken to compare the in vitro abrasion and attrition wear of two dual-cure cements (in dual-cure and self-cure modes) and two RMGI cements when placed between ceramic and enamel to simulate the margin of a restoration.

METHODS

Rectangular fragments of pressed ceramic (Empress 2) were cemented between the halves of bovine incisors sectioned mesiodistally, using one of the following materials: RelyX ARC, Variolink II, RelyX Luting, or ProTec CEM. The two resin cements were tested in dual-cure and self-cure modes. A three-body wear test was performed in the new Oregon Health Sciences University (OHSU) oral wear simulator (100,000 cycles; abrasion load: 20 N; attrition load: 90 N). Degree of conversion of resin cements was determined by Fourier transform infrared spectroscopy. Results were analyzed by analysis of variance and Tukey's test (p = .05). Epoxy replicas of wear specimens were observed in the scanning electron microscope.

RESULTS

No significant differences in abrasion wear (RelyX ARC dual-cure: 11 +/- 4.4 microm; RelyX ARC self-cure: 17 +/- 7.0 microm; Variolink dual-cure: 14 +/- 8.6 microm; Variolink self-cure: 23 +/- 10.7 microm) or attrition wear (RelyX ARC dual-cure: 18 +/- 6.4 microm; RelyX ARC self-cure: 31 +/- 4.5 microm; Variolink dual-cure: 32 +/- 6.8 microm; Variolink self-cure: 39 +/- 15.9 microm) were found between activation modes of the resin cements. ProTec CEM (32 +/- 8.7 microm) showed abrasion similar to that of Variolink II and RelyX ARC self-cure. Resin-modified glass ionomers showed more attrition wear than the resin cements (ProTec CEM: 62 +/- 13.0 microm; RelyX Luting: 69 +/- 7.1 microm). RelyX ARC showed a similar degree of conversion for both activation modes (dual-cure: 70 +/- 4.3%; self-cure: 68 +/- 1.2%), but Variolink II had a higher degree of conversion in dual-cure mode (67 +/- 0.5% vs 60 +/- 1.0%). Cement wear was accompanied by marginal breakdown and increased surface roughness of enamel and ceramic.

CONCLUSIONS

The activation mode of resin cements did not influence their wear resistance. The RMGIs underwent higher attrition wear than the resin cements.

CLINICAL SIGNIFICANCE

Increased submargination associated with marginal breakdown and increased roughness of the surrounding structures may be expected when ceramic inlays are cemented with resin-modified glass ionomers.

Effects of two silane coupling agents, a bonding agent, and thermal cycling on the bond strength of a CAD/CAM composite material cemented with two resin luting agents

STATEMENT OF PROBLEM

Surface treatment of CAD/CAM-generated composite material is important for a strong bond of resin luting agents to composite material. Purpose. This study evaluated the shear bond strengths of 2 dual-cured resin luting agents to a CAD/CAM composite material and the effect of silane coupling agent and bonding resin on the bond strength.

MATERIAL AND METHODS

Rectangular- and disk-shaped CAD/CAM composite materials were untreated or treated with 1 of the 2 silane coupling agents or bonding resin and then cemented together with 1 of the 2 dual-cured resin luting agents. Half of the specimens were stored in water at 37 degrees C for 24 hours, the other half thermocycled 50,000 times before shear bond strength testing. Shear bond strengths were measured with a servohydraulic mechanical testing machine, and results were analyzed with 2-way analysis of variance.

RESULTS

Surface treatment by silane coupling agent improved the shear bond strength when compared with nontreatment. Specimens treated with bonding resin showed significantly greater shear bond strength than the untreated groups. However, all specimens had the same adhesive failures at the composite-luting agent interface as untreated groups. When the CAD/CAM composite material was treated with 1 of the 2 silane coupling agents, no significant differences in bond strength were noted between water storage alone and after 50,000 thermocycles. For the 2 groups treated with bonding resin or silane coupling agent and cemented with 1 of the 2 dual-cured resin luting agents, there were significant increases in bond strength after 50,000 thermocycles, compared with specimens that were not subjected to thermal cycling. On the other hand, for the 2 untreated groups, there were significant decreases in bond strength after thermocycling. After 50,000 thermocycles, all specimens treated with silane coupling agent and then cemented with 1 of the 2 resin luting agents showed cohesive failures within the composite material.

CONCLUSION

The application of a silane coupling agent to the CAD/CAM composite surface provided the highest bond strength between the resin luting agent and composite after long-term thermal cycling.

Margin gap size of ceramic inlays using second-generation CAD/CAM equipment

OBJECTIVE

The goal of this study was to determine if the fit of second-generation computer-assisted design/computer-assisted manufacturing (CAD/CAM) (CEREC 2, Sirona Dental Systems, Bensheim, Germany) inlays within Class II cavity preparations were within the range of 50 to 100 microns and were equal or better to CEREC 1 inlays.

MATERIALS AND METHODS

Extracted human molars free of surface defects and caries were prepared with standard mesio-occlusodistal cavity preparations. Ceramic inlays were fabricated with CEREC 2 CAD/CAM equipment and seated into cavity preparations. Digital images were captured at 100 times magnification. Marginal gaps were measured with an image analysis program. For each restoration, gaps were measured at 12 locations along interproximal margins and 10 locations along occlusal margins.

RESULTS

No difficulty occurred in seating any of the milled inlays. Average marginal gaps for occlusal (59 +/- 35 microns) and interproximal (97 +/- 66 microns) margins were statistically different (t-test, p < or = .01). Average marginal gap for all sites combined was 80 +/- 57 microns. Marginal gap widths were smaller than those obtained from a similar study done earlier with the CEREC 1 unit for occlusal (89 +/- 65 microns) and interproximal (105 +/- 81 microns) margins. Ease of seating with CEREC 2 inlays was much better than with CEREC 1.

CLINICAL SIGNIFICANCE

Improvements in software and hardware allow the CEREC 2 to adapt well to standard inlay cavity preparations. The ability of the device to create inlays that seat without interference is remarkable. The improved fit and ability to create the occlusal surface in a variety of ways make CEREC 2 an attractive restorative option for all-ceramic restorations.

Margin adaptation of indirect composite inlays fabricated on flexible dies

STATEMENT OF PROBLEM

Indirect composite restorations can be made in 1 appointment using a flexible die. Interactions between different impression materials and flexible die materials may affect the accuracy of fit and margin adaptation of the restoration.

PURPOSE

This study compared the margin adaptation of composite inlays made using the following 5 impression/flexible die material combinations; condensation silicone/polyvinyl siloxane (CS/PVS), wash viscosity polyvinyl siloxane/medium or heavy viscosity polyvinyl siloxane (PVS/PVS), irreversible hydrocolloid impression/medium viscosity polyvinyl siloxane (IH/PVS), wash viscosity polyvinyl siloxane impression/polyether (PVS/PE), with composite inlays made using a control system of a wash viscosity polyvinyl siloxane impression and a type IV stone die.

MATERIAL AND METHODS

For each test and control system, 10 impressions were made of a class II composite inlay preparation in a metal master die. One die was made from each impression and one composite inlay was made and finished on each die (a total of 60 inlays). Inlays were placed on the master die and the margin opening at the buccal, distal, and gingival sites was recorded with a measuring microscope (x40 magnification).

RESULTS

The overall mean +/- SD margin openings of inlays made from the systems were as follows: PVS wash/PVS heavy viscosity 149.5 +/- 107. 4 microm; PVS wash/PVS medium viscosity 87.4 +/- 63.0 microm; IH/PVS medium viscosity 76.7 +/- 48.9 microm; CS/PVS 73.3 +/- 48.7 microm, PVS wash viscosity/PE 64.0 +/- 44.3 microm, PVS wash viscosity/stone 53.9 +/- 48.3 microm. Composite inlays made using the PVS wash viscosity/PVS heavy viscosity system had significantly larger distal, gingival, and overall mean margin openings than all other inlays (ANOVA and Fisher PLSD test; P =.05). The separating medium required between some impression and die materials did not work consistently. Composite inlays fabricated on dies made of material different than the impression material had mean buccal, distal, gingival, and overall margin openings < or =100 microm.

CONCLUSION

Composite inlays made on the CS/PVS, IH/PVS medium viscosity, PVS wash viscosity/PE flexible dies, and control PVS wash viscosity/stone dies had statistically similar (P =.05) mean buccal, distal, gingival, and overall mean margin openings that were < or =100 microm. Composite inlays made on dies that were made of the same type of material as the impression material (PVS/PVS) had mean gingival margin openings >100 microm that were significantly larger than all other systems tested (P =.05).

Ceramic restorations for posterior teeth: guidelines for the clinician

Metal-free ceramic restorations are increasingly popular for restoring posterior teeth. These restorations are generated through a variety of techniques (e.g., CAD-CAM, copy-milling, heat-pressing, and firing). When appropriately indicated and made, ceramic inlays or onlays can be reliable and provide a highly serviceable restoration. The aim of this article is to review and present updated information regarding indications, restorative technique, and maintenance for this class of restorations, with emphasis to fired ceramic inlays or onlays. The information presented is based on 15 years of controlled clinical experience with this category of restorations. Clinical cases that represent some applications also are presented.

CLINICAL SIGNIFICANCE

The fired ceramic inlay/onlay technique is presented as a viable option for the esthetic and adhesive restoration of posterior teeth.

The clinical performance of ceramic inlays: a review

The availability of improved ceramic materials, bonding techniques, new technology and issues of amalgam safety have led to a revival of interest in ceramic inlays in dentistry over the past ten years. Clinical studies have been carried out during this time using various evaluation techniques to assess the clinical performance of these restorations. In this paper, recent clinical studies are examined and a review of the current state of knowledge regarding the clinical performance and survival statistics of ceramic inlays is presented. The major problems associated with ceramic inlay therapy appear to be fracture, hypersensitivity, degree of fit, maintenance of marginal integrity, microleakage, bond failures and cement wear. Other areas which also affect the clinical performance of ceramic inlays are ceramic wear, opposing tooth wear, plaque accumulation, gingivitis, secondary caries, colour stability, anatomic form and radiopacity. Recommendations based on the findings of clinical studies are also presented and whilst no specific material or technique has been shown to be clearly superior, certain principles which predispose to success can be identified. When compared with other forms of aesthetic intracoronal restorations, ceramic inlays perform well. However, their high cost and extreme technique sensitivity would appear to restrict their use to certain limited clinical situations.

IPS Empress inlays and onlays after four years--a clinical study

OBJECTIVE

Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined.

MATERIALS AND METHODS

Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear.

RESULTS

Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p < 0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations.

CONCLUSION

After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

Marginal breakdown of 5-year-old direct composite inlays

OBJECTIVES

The marginal fit of tooth-coloured inlays luted with composite resin luting materials has been considered to be the weak link of the inlays. The marginal breakdown of 5-year-old direct composite resin inlays was evaluated by scanning electron microscopy.

METHODS

Replica impressions were made of the occlusal, axial-proximal and accessible cervical-proximal margins of 21 inlays and the marginal quality was quantified.

RESULTS

More than 84% of the total investigated length of the enamel/luting composite agent-luting composite/composite inlay interfaces revealed gap free margins. Proximal margins showed the largest breakdown at the enamel/composite resin interface, while the occlusal margin interfaces showed only a slight difference between the interfaces. The composite inlay and the luting composite resin showed a similar degree of wear in more than 50% of the evaluated marginal length. Medium gap width varied between 60 microns for the occlusal and axial-proximal and 87 microns for the cervical-proximal margins, with a range of 7.6-266 microns.

CONCLUSIONS

The direct composite inlays investigated showed good marginal integrity after 5 years in clinical service.