- Dr Shivangi Gajwani Jain
Introduction
Although direct resin composites are the most common restorative option for missing tooth structure, the indirect composite restorative techniques are still not our go to option in many practices. The indirect composites, used to rehabilitate large defects owing to decay or fracture of the tooth help the clinician to overcome practical issues such as time management, difficulty in building the occlusal anatomy and tight proximal contacts. In theory, the indirect way should also reduce polymerization shrinkage, micro leakage and color instability in comparison with the direct composite restorations, though further long term studies are needed.
Case Report
A 48 year old male patient visited our practice with a chief complaint of sensitivity and difficulty in chewing hard food. On clinical examination it was observed that all four cusps needed build up while there was no pulpal involvement. Due to the need for complete occlusal coverage, an indirect restoration was planned and composite was the material chosen.
Fig 1. Pre operative clinical picture, occlusal view
Fig 2. Preoperative clinical picture, buccal view showing food lodgment
It was decided to fabricate an indirect restoration in the clinic and bond to the prepared tooth at the same appointment to reduce the number of sittings and cost to the patient.
Onlay tooth preparation - We began with anesthetizing the tooth. The undermined enamel and the proximal caries were removed as we achieved a 360 degree enamel margin for enhanced bonding. The clinical tooth height was 6 mm, and an occlusal clearance of 2mm on the non functional cusps, and of 2.5 mm on the functional cusps was achieved. The proximal contacts were broken. The margins were placed supragingivally, away from the gingival zenith by 3 mm (buccally) and 2 mm (palatally & proximally).
Fig 3. Cuspal reduction with a clearance of 2-2.5mm
Indirect restoration fabrication -Post the onlay preparation, an alginate impression was made and poured immediately in die stone to retain all the details. Once the stone was set, a dye separator (Shofu Dental) was painted on the cast to ensure that the resin does not stick to the dye.
Fig 4. Alginate impression of the prepared tooth
Fig 5 Impression poured in Dye
A light cured composite resin (Ivoclar Vivadent), was used to build the onlay in an incremental fashion and each layer was cured for 20 secs with a curing light (3M). In the final composite layer dark brown tints (Color plus, Kerr) were used to mimic pits and fissures of a natural tooth. Composite complete coverage restoration was fabricated and removed from the dye. Then the intaglio surface was further cured for 60 secs to minimize shrinkage.
Onlay conditioning & Bonding protocol - Once the restoration was ready, the patient was seated, and the tooth prepared for bonding. Heavy rubber dam sheet placed for isolation and the indirect composite onlay checked for fit and marginal integrity.
Fig 6. Heavy rubber dam sheet placed for isolation
Free for members
Keep reading — it's free
The rest of this article is open to DentalReach members. Create a free account, or sign in, and every article on the site opens in full.
