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Objective: To investigate the longevity and reasons for failure of posterior cast Class II gold inlays and onlays among a group of Norwegian adults. The term inlay was used for both inlays and onlays., Methods: A cohort of 138 patients regularly attending a general practice for check-up were examined in 2016. The patients had a total of 391 posterior gold inlays placed in the period 1970-2015. The inlays were categorized as successful, repaired or failed. Reasons for failure were classified as either "secondary caries", "fractures", "lost inlay" or "other". Participation was voluntary and no compensation was given., Results: The mean age of the patients at placement was 50.8 years (SD: 12.7 yr). Most gold inlays were placed in molars (85.9%) and 14.1% in premolars; 49.4% of the inlays were in the maxilla and the 50.6% in the mandibula. Average length of follow-up was 11.6 years (range: 1-46 years, SD: 7.9); 82.9% were classified as successful, 10.7% as repaired and 6.4% as failed. Reasons for failure were secondary caries (41.3%), lost inlay (25.4%), fractures (23.8%) and other (9.5%). Mean annual failure rate (AFR) was 1.69% for repaired and failed inlays combined. However, if repaired inlays were considered as success, the AFR decreased to 0.57%. Multi-level Cox regression analyses identified low age of the patient and high number of restored surfaces as risk factors for failure., Conclusion: The present retrospective clinical study demonstrated an acceptable annual failure rate for Class II cast gold inlays., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: To clinically evaluate the performance of indirect composite resin restorations cemented with conventional and self-adhesive resin cements over a 12-month period., Materials and Methods: Ten patients fulfilled all the inclusion criteria. Twenty-four composite resin restorations were performed using an indirect technique and cemented with a resin cement (RelyX ARC) or a self-adhesive resin cement (RelyX U100). Two independent evaluators analyzed the restorations using modified USPHS criteria after periods of two weeks and 6 and 12 months. Statistical significance between the cements at each timepoint was evaluated with the Wilcoxon test and between timepoints with the Mann-Whitney test, both at a significance level of 5%. Fisher's exact test was used to assess the occurrence of absolute failures., Results: No statistically significant differences were found between the groups at the same timepoint nor between groups at different timepoints. The only significant difference was found for color match for both groups after 12 months., Conclusion: After 12 months, indirect composite resin restorations cemented with self-adhesive resin cement performed similarly to those cemented with conventional resin cement.

The purpose of this study is to review the available literature related to composite inlays. Electronic databases published up to November 2013 were searched. Studies that evaluate composite resin inlays for the restoration of posterior teeth were selected. The studies should compare composite inlays against gold inlays, ceramic inlays and direct composite fillings regarding longevity, aesthetic quality and postoperative sensitivity or comparing the clinical effectiveness of them on premolars versus molars or on 1-2 surface preparations versus multi-surface preparations. Despite the heterogeneity of the available clinical trials composite inlays seem to be an effective method for the restoration of posterior teeth.

The purpose of this randomized clinical trial was to determine the clinical wear behavior of three nanofilled composites (Filtek Supreme XT [FS], Tetric EvoCeram [TEC], and Aelite Aesthetic [AA]) with two indirect composites (Estenia [E] and Tescera ATL [TATL]) on permanent molar teeth. Fifty-four patients whose treatment plans included moderate Class I and/or II restorations on molar teeth were selected for inclusion in this study. Wear was measured by use of gypsum replicas at baseline and 6 and 12 months using three-dimensional scanning and rapid-form software to elucidate the wear mechanisms. For statistical analyses, one-way analysis of variance and the Scheffe test were used. Statistical results revealed that wear behavior of TATL was significantly different from that of AA (P < .05). No significant differences were detected between AA and E (P > .05) or between TEC, FS, and TATL composite resins (P > .05). The results showed similar clinical performance between the five composite resins evaluated. Therefore, composite resins may be indicated for the restoration of posterior teeth. However, the composition of the composite resin did affect the wear behavior of the composite material.

In endodontically treated teeth, cuspal coverage plays a fundamental role in reducing the risk of fracture. However, the adhesive techniques with or without fiber post increased the possibilities in restoring root-filled teeth. The aim of this study was to determine the effect of the fiber post and/or post length and/or cuspal coverage on the fracture resistance of endodontically treated maxillary premolars. Seventy intact single-rooted maxillary premolars were selected and divided in seven groups of ten each: "intact teeth" (control), "inlay without fiber post" (G1), "inlay with long fiber post" (G2), "inlay with short fiber post" (G3), "onlay without fiber post" (G4), "onlay with long fiber post" (G5), and "onlay with short fiber post" (G6). Except for intact teeth, all specimens were prepared with a mesio-occluso-distal (MOD) cavity, endodontically treated and restored with or without long or short post, with or without cusp coverage. All specimens were thermal-cycled, exposed to a cyclic loading, and then submitted to the static fracture resistance test. Fracture loads and mode of failure were evaluated. A statistically significant difference in fracture resistance was found between group 1 and the other groups (p < 0.001). χ2 test showed statistically significant differences in the patterns of fractures between the groups (p < 0.001). The highest number of favorable fractures was observed in groups 3 and 4. Similar fracture resistance was detected in maxillary premolars endodontically treated with MOD cavity preparations, restored with either direct resin composite with fiber post or cusp capping. The "short post" direct restoration may be a valid alternative in the restoration of root-filled premolars.

Aim: The aim of this study was to evaluate the in vitro fracture resistance of teeth restored with bonded ceramic inlay and direct composite resin restoration in comparison to the normal tooth., Materials and Methods: This study evaluated the fracture strength of the teeth restored with bonded ceramic inlay and direct composite resin restoration in comparison to the normal teeth. Thirty intact human maxillary first premolars were assigned to three groups: Group 1 - comprising sound/unprepared teeth (control). Group 2 - comprising of Class-II direct composite resin restored teeth and Group 3 - comprising Class-II ceramic inlay restored teeth. Cavities were prepared with occlusal width of 1/3 intercuspal distance and 2 mm deep pulpally. Group 2 teeth were restored with hybrid composite resin (Z350 3M ESPE, USA) and group 3 teeth were restored with Vitadur Alpha alumina (Ivoclare Vivadent, Liechtenstein, Europe). Ceramic inlay was bonded with adhesive cement (rely X resin cement of 3MESPE, USA). The specimens were subjected to a compressive load until they fractured. Data were analyzed statistically by unpaired Student's t test., Results: The fracture resistant strength, expressed as kilonewton (KN), was group 1 - 1.51 KN, group 2 - 1.25 KN, and group 3 - 1.58 KN. Statistically, group III had highest fracture resistance followed by group I, while group II had the lowest average fracture resistance., Conclusion: The fracture resistant strength of teeth restored with ceramic inlay was comparable to that of the normal intact teeth or slightly higher, while teeth restored with direct composite resin restoration showed less fracture resistant strength than that of the normal teeth.

The study was aimed at assessing the influence of the cement manipulation and ultrasounds application on the bonding potential of self-adhesive resin cements to dentin by microtensile bond strength testing and microscopic observations of the interface. Fifty-six standardized mesio-occlusal class II cavities were prepared in extracted third molars. Class II inlays were made using the nano-hybrid resin composite Gradia Forte (GC Corp, Tokyo, Japan), following the manufacturer's instruction. The sample was randomly divided into two groups (n = 28) according to the luting technique. Half of the specimens were luted under a static seating pressure (P), while the other ones were cemented under vibration (V). The inlays were luted using the following self-adhesive resin cements: G-Cem (G, GC Corp., Tokyo, Japan) Automix (GA) and Capsule (GC); RelyX Unicem (RU, 3 M ESPE, Seefeld, Germany) Clicker (RUC) and Aplicap (RUA). Microtensile sticks and specimens for scanning electron microscope (SEM) observations were obtained from the luted teeth. The interfacial strengths measured for the cements under static pressure or ultrasonic vibration were [median (interquartile range)]: GC/V 4 (2.3-7.9); GC/P 6.8 (4.1-10.1); GA/V 3 (1.9-6.7); GA/P 1.9 (0-5.1); RUC/V 6.6 (4.6-9.8); RUC/P 4.1 (1.8-6.4); RUA/V 6.2 (2.4-10.4); RUA/P 3.4 (0-5.4). The cement formulation influenced dentin bond strength of G. RU bond strength was affected by the luting technique. SEM analysis revealed a homogeneous structure and reduced porosities for both cements as a result of ultrasonic vibration. RU benefited from the application of ultrasounds, while GC achieved higher bond strengths than GA.

Objective: To evaluate the effect of resin coating and occlusal loading on microleakage of class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic restorations., Material and Methods: Molars were prepared for an mesio-occlusal-distal (MOD) inlay and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement). After 24 h of water storage, the restored teeth in each group were divided into two subgroups: unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM) was used for evaluation of microleakage. The locations of the measurements were assigned to the cavity walls and floor., Results: Loading did not have a significant effect on microleakage in either the resin-coated or non-coated group. Resin coating significantly reduced microleakage regardless of loading. The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation also revealed that microleakage at the enamel surface was minimal regardless of resin coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated dentin showed decreased leakage., Conclusions: Resin coating with a combination of a dentin-bonding system and a flowable resin composite may be indicated prior to impression-taking when restoring teeth with CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

The purpose of this study was to establish a geometric design method for the occlusal outlines of complex inlay cavities as a continuation study of a previous design method for simple class I inlay cavity. A method for extending the occlusal outline to the buccal or lingual groove and to three preparation types of the proximal portions of class II inlay cavities -namely, straight line preparation, sweeping curve preparation, and reverse curve preparation- was investigated. To ensure the smoothness of the occlusal outline, a Bézier curve was introduced in the design. A minimal number of control points for the curve was applied to define each preparation type. The design method was experimentally applied to mandibular and maxillary first molars. Smooth outlines of the complex inlay cavities in the molars with tool accessibility throughout the cavities were achievable by using the present method.

Objectives: To evaluate the hypothesis that a process of hydrofluoric acid precipitate neutralization and fatigue load cycling performed on human premolars restored with ceramic inlays had an influence on microtensile bond strength results (MTBS)., Methods: MOD inlay preparations were performed in 40 premolars (with their roots embedded in acrylic resin). Forty ceramic restorations were prepared using glass-ceramic (IPS Empress). The inner surfaces of all the restorations were etched with 10% hydrofluoric acid for 60 seconds, rinsed with water and dried. The specimens were divided into two groups

This study evaluated the effect of cyclic loading on the marginal adaptation and microtensile bond strength of direct vs indirect Class II composite restorations in an in-vitro model. Forty Class II cavities were prepared on the mesial surface of extracted human maxillary first premolars and divided into two groups: Group I--direct composite restorations and Group II--indirect composite restorations. Groups I and II were further divided into subgroups: A (without cyclic loading) and B (with cyclic loading of 150,000 cycles at 60N). The gingival margin of the proximal box was evaluated at 200x magnification for marginal adaptation in a low vacuum scanning electron microscope. The restorations were sectioned perpendicular to the bonded surface into 1 mm thickslabs. The slabswere further trimmed at the interface to produce a cross-sectional surface area of approximately 1 mm2. All specimens were subjected to microtensile bond strength testing. The marginal adaptation was analyzed using descriptive studies and bond strength data were analyzed by one-way ANOVA test. The indirect composite restorations performed better under cyclic loading.

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.

Objective: The aims of this prospective clinical study were (1) to evaluate the clinical performance of Signum composite inlays over a 3-year period; (2) to investigate the clinical efficacy of composite inlays in premolars versus molars; and (3) to evaluate differences between 1- or 2-surface inlays and multisurface inlays., Method and Materials: One hundred thirteen composite inlays were placed in 30 patients by a clinician. All the inlays were made by the same laboratory technician using only one composite material (Signum, Heraeus Kulzer). All the restorations were bonded with a 3-step bonding system and a composite luting cement. The restorations were assessed after placement by a clinician who had not been involved with the placement of the restorations, in accordance with the modified US Public Health Service criteria., Results: Three of the 113 experimental restorations had to be replaced; the total failure rate was 2.6% after 3 years. At baseline, 88.5% to 100% of the inlay restorations were rated as excellent (Alpha). Statistically significant (P < .05) differences were observed during the study for surface roughness, anatomic form at the margin, marginal integrity, and inlay integrity. The comparison of the clinical outcome of inlays in premolars versus molars and with 1 or 2 surfaces versus multisurfaces showed no significant differences, except for the parameters anatomic form at the margin and marginal integrity., Conclusion: Composite inlays demonstrated a very high success rate (97.4%) after 3 years. Neither the size of the restorations nor the tooth type significantly affected the clinical outcome of the restorations.

Wear phenomena of ceramic inlays are not fully understood. The aim of the present study was to evaluate ceramic wear, antagonist enamel wear, and luting cement wear over 8 years. The two-fold null hypothesis was that there would be (1) no difference in wear behavior between ceramic and enamel, and (2) no influence of filler content of luting composites on composite wear. From 96 restorations, 36 Class II inlays from 16 participants were selected. For inlays with opposing enamel cusps (n=17), replicas of inlays and enamel were scanned with a 3-D laser scanner. Luting gaps of inlays (n=36) were analyzed with a profilometer, including 3-D data analysis. Ceramic and enamel wear increased between 4 and 8 years, with significantly higher values for enamel after 6 years (p<0.05). Luting gap wear increased continuously up to 8 years (p<0.05), with no influence of luting composites (p>0.05) and location of teeth (p>0.05).

Statement of Problem: Controversy exists concerning the preferred cavity design for posterior ceramic restorations to improve their resistance to fracture under occlusal load., Purpose: The aim of this study was to assess the resistance to fracture of leucite-reinforced ceramic restorations placed on molars with different cavity preparation designs., Material and Methods: Ninety noncarious molars were selected, stored in 0.2% thymol solution, and divided into 9 groups (n = 10): IT, intact teeth; CsI, conservative inlay; ExI, extensive inlay; CsO/mb, conservative onlay with mesio-buccal cusp coverage; ExO/mb, entensive onlay with mesio-buccal cusp coverage; CsO/b, conservative onlay with buccal cusp coverage; ExO/b, entensive onlay with buccal cusp coverage; CsO/t, conservative onlay with total cusp coverage; ExO/t, extensive onlay with total cusp coverage. Teeth were restored with a Leucite-reinforced ceramic (Cergogold). The fracture resistance (N) was assessed under compressive load in a universal testing machine. The data were analyzed with 1-way and 2-way analyses of variance, followed by the Tukey HSD test (alpha = .05). Fracture modes were recorded, based on the degree of tooth structure and restoration damage., Results: One-way analysis showed that intact teeth had the highest fracture resistance values. Two-way analyses showed no significant differences for the isthmus extention factor, but showed a significant difference for the preparation design type of fracture (P = .03), and also for the interaction between both factors (P = .013). The fracture mode observed in all groups tended to involve only restorations., Conclusion: Within the limitations of this study, it was observed that cuspal coverage does not increase fracture resistance of the posterior tooth-restoration complex restored with leucite-reinforced ceramics.

Objective: The aim of the present study was to investigate the effect of manual and ultrasonic insertion of standardized class I inlays (Cerana) using three composite resin materials of different viscosity (Tetric Flow, Tetric, and Tetric Ceram) on time to seat inlays, film thickness, and filler distribution within the materials., Methods: In a preliminary test, mean loads for manual and ultrasonic insertion were measured using the high viscosity composite resin material (Tetric Ceram). These loads were then applied with all composite resin materials to evaluate the times required to seat the inlays. In addition, film thickness was assessed using scanning electron microscopy, and filler distribution (wt% silicon, barium, ytterbium) was monitored using energy-dispersive spectroscopy., Results: Ultrasonic insertion significantly reduced mean load applied to seat inlays (6.4+/-1.4 N; mean+/-SD) as compared to manual insertion (18.9+/-3.1 N; p < 0.001). Using an ultrasonic device, times for insertion values were significantly lower in the high and medium viscosity composite resin material groups compared to manual insertion (p < 0.05). The widest film thickness was recorded for the high viscosity composite resin material in combination with manual insertion (p < 0.05). However, when ultrasound was applied, there was no difference in film thickness between the three materials at any levels. Furthermore, the analysis of filler distribution revealed no significant differences between groups., Conclusion: Highly filled viscous composite resin materials may be used in combination with the ultrasonic insertion technique without untoward effects on film thickness or filler distribution.

The objectives of this study include establishing a method for quantitative measurement of marginal change in ceramic inlays and clarifying their marginal disintegration in vivo. An accurate CCD optical laser scanner system was used for morphological measurement of the marginal change of ceramic inlays. The accuracy of the CCD measurement was assessed by comparing it with microscopic measurement. Replicas of 15 premolars restored with Class II ceramic inlays at the time of placement and eight years after restoration were used for morphological measurement by means of the CCD laser scanner system. Occlusal surfaces of the restored teeth were scanned and cross-sections of marginal areas were computed with software. Marginal change was defined as the area enclosed by two profiles obtained by superimposing two cross-sections of the same location at two different times and expressing the maximum depth and mean area of the area enclosed. The accuracy of this method of measurement was 4.3 +/- 3.2 microm in distance and 2.0 +/- 0.6% in area. Quantitative marginal changes for the eight-year period were 10 x 10 microm in depth and 50 x 10(3) microm2 in area at the functional cusp area and 7 x 10 microm in depth and 28 x 10(3) microm2 in area at the non-functional cusp area. Marginal disintegration at the functional cusp area was significantly greater than at the non-functional cusp area (Wilcoxon signed-ranks test, p < 0.05). This study constitutes a quantitative measurement of in vivo deterioration in marginal adaptation of ceramic inlays and indicates that occlusal force may accelerate marginal disintegration.

In response to an increased public demand for esthetic restorations, dentists are using computer-aided design/computer-aided manufacture (CAD/CAM) technology to fabricate inlay/onlay, crown, and laminate veneers. This study evaluated the fit at the gingival margin of surface inlay restorations milled by the CEREC II as well as the more recently developed CEREC III. The marginal fit of inlays milled by the CEREC III was more accurate than the fit of those milled by the CEREC II, although both were within the ADA specifications of 50 micro.

Unlabelled: 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.

Statement of Problem: Demineralized dentin beneath set cement may adversely affect microleakage under fixed restorations., Purpose: Microleakage of direct composite inlays cemented with acid-base cements and a methyl methacrylate resin cement were evaluated to determine their effect on the integrity of the underlying hybridized dentin., Materials and Methods: Sixty Class V box preparations (3 mm x 3 mm x 1.5 mm) were precisely prepared in previously frozen bovine teeth with one margin in enamel and another margin in dentin. Direct composite inlays (EPIC-TMPT) for each preparation were divided into 4 groups of 15 specimens each and cemented with 3 acid-base cements (control group): Elite, Ketac-Cem, Hy-Bond Carbo-Cem, and 1 adhesive resin cement: C&B Metabond. All specimens were stored in distilled water for 24 hours at 37 degrees C before immersion in 0.5% basic fuchsin for 24 hours. The dye penetration was measured on the sectioned specimens at the tooth-cement interface of enamel and cementum margins and recorded with graded criteria under light microscopy (Olympus Vanox-T) at original magnification x 50, 100, and 200. A Kruskal-Wallis and the Mann-Whitney test at P<.05 were used to analyze leakage score., Results: All cementum margins of the 3 acid-base cements tested demonstrated significantly higher leakage scores than cementum margins for inlays cemented with the resin cement tested(P<.01). No leakage along the tooth-cement interface was found for inlays retained with the adhesive resin cement., Conclusions: Within the limitations of this study, the 3 acid-base cements tested exhibited greater microleakage at the cementum margins than did the adhesive resin cement that was tested.

Objective: The aim of this study was to evaluate the resistance to fracture of intact and restored human maxillary premolars., Method and Materials: Thirty noncarious human maxillary premolars, divided into three groups of 10, were submitted to mechanical tests to evaluate their resistance to fracture. Group 1 consisted of intact teeth. Teeth in group 2 received mesio-occlusodistal cavity preparations and were restored with direct resin composite restorations. Teeth in group 3 received mesio-occlusodistal cavity preparations and were restored with ceromer inlays placed with the indirect technique. After restoration, teeth were stored at 37 degrees C for 24 hours and then thermocycled for 500 cycles at temperatures of 5 degrees C and 55 degrees C., Results: Statistical analysis revealed that group 3 (178.765 kgf) had a significantly greater maximum rupture load than did group 1 (120.040 kgf). There was no statistically significant difference between groups 1 and 2 or between groups 2 and 3., Conclusion: Class II cavity preparations restored with indirect ceromer inlays offered greater resistance to fracture than did intact teeth. The fracture resistance of teeth restored with resin composite was not significantly different from that of either the ceromer or intact teeth.

Objectives: Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity., Methods: In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and Löe, 0-3), Gingival Index (Löe and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively., Results: The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner., Conclusions: It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.

Objective: The aim of this investigation was to evaluate the clinical performance of 4 types of tooth-colored inlays., Method and Materials: Fifteen direct ceramic inlays (Cerec Cos 2.0), 15 direct resin composite inlays (Brilliant Direct Inlay), 14 indirect ceramic inlays (Vita Dur N), and 14 indirect resin composite inlays (Estilux) were made in 37 patients, according to the manufacturers' instructions. The inlays were evaluated 1 week (baseline) and 6, 12, 36, 48, and 60 months after cementation (modified CDA Quality Evaluation System)., Results: Two Vita Dur N inlays fractured after 1 and 4 years in function, and one Cerec inlay fractured after 4.5 years. Two Brilliant DI inlays needed replacement because of secondary caries (after 1 and 5 years), and one inlay (Estilux) needed replacement due to persisting hypersensitivity. Three inlays (1 Estilux and 2 Brilliant DI) were repaired due to chipping or minor fractures. During the observation period, the surface texture of Brilliant DI and Vita Dur N inlays became significantly rougher. After 5 years, the Estilux inlays had significantly lower ratings for morphology compared to baseline ratings. In general, the occlusal marginal adaptation did not show further disintegration of the luting cement after 1 year., Conclusion: Eighty-eight percent of the inlays were in function after 5 years. No significant differences were revealed among the survival rates of the different types of inlays.

A plethora of choices is available as potential tooth-colored restoratives for the posterior dentition. Advances in adhesive technology and esthetic chairside microhybrid composite resins have permitted clinicians to perform inlay/onlay restorations. The use of adhesive indirect procedures offers advantages such as better control of polymerization shrinkage and anatomical form, when compared to conventional, direct restorative techniques. This article describes the use of a new chairside microhybrid composite system as an indirect restorative material, using semidirect and indirect techniques that can be accomplished within the realm of a dental operatory.

Wear of luting composites is still an unsolved problem with adhesive inlays. However, only limited clinical research has been conducted regarding this phenomenon. This study evaluated the substance loss within the luting gap over a six-year period in vivo. In the course of a controlled prospective clinical study, 16 patients received 39 Class-II IPS Empress inlays. Variolink Low (Vivadent; n = 18) was used as conventional low-viscosity luting composite, the hybrid-type restorative resin composite Tetric (n = 21; Vivadent) was applied according to the ultrasonic insertion technique. The restorations were clinically assessed after 6, 12, 24, 36, 48 and 72 months and replicas were made. The contact-free occlusal areas of the replicas were scanned by use of a computer-controlled profilometer (Perthen S3P), the analysis of the data was computed using a newly developed software (Xpert for Windows 95) and statistically analyzed with non-parametric tests. After six months all restorations exhibited marginal ditching. The percentage of detectable luting gap abrasion increased between each recall appointment (32% after six months, 48% after 12 months, 46% after 24 months, 55% after 36 months, 59% after 48 months and 65% after 72 months). Except for the 48-months results, no significant difference between the materials used for luting was evident (p > 0.05). Between the width and the depth of the luting space a linear regression was computed. The quantitative evaluation clearly demonstrated that hopes of relevantly reduced wear of luting composites were not confirmed when using the higher filled luting material.

This study evaluated the quality of fired ceramic inlay restorations consisting of a feldspathic porcelain system (G-Cera Cosmotech II, GC Co, Tokyo, Japan) after eight years in vivo. Forty-five fired ceramic inlays (for 26 premolars and 19 molars; Class I in 12 teeth, Class II in 31 teeth and onlay in two teeth) were placed in 25 patients. All restorations were evaluated at the time of placement and at 6 months, 1, 2, 4, 6 and 8 years after placement using modified USPHS criteria. Replicas of the restorations were observed with a scanning electron microscope (SEM) to evaluate the degradation of the marginal area and wear loss of the restoration. Longevity was observed in 80% of the fired ceramic inlay restorations at eight years (Kaplan-Meier method), although it was 92% at the six-year observation. Marginal fracture was detected in 11 restorations (22%), including bulk fracture in five (11%), which had first occurred during the last two years. Recurrent caries was observed in three (7%) cases and marginal discoloration in 14 (31%). SEM evaluation disclosed marginal microfractures in 77% of the restorations, wear in 36% and wear of the resin cement along the margin in 74% at eight years. No significant difference was observed in each of these three characteristics between molars and premolars. This longitudinal eight-year clinical observation suggested that fired ceramic inlay restorations made by the G-Cera Cosmotech II system are clinically acceptable. However, critical failure as bulk fracture may become a future problem since marginal disintegration was detected in 77% of the restorations from microscopic and macroscopic perspectives.

This study investigated the effects of cavity divergence and setting expansion of refractory die material on the adaptability of Class II (MO and MOD) fired ceramic inlays. Standardized Class II (MO and MOD) cavities with two kinds of lateral wall divergence (10 and 20 degrees) were prepared in epoxy resin blocks. A refractory die was prepared from an impression of the epoxy resin cavity in which the setting expansion ranged from 0.04 to 1.14%. A ceramic inlay was fired on each die. The fabricated inlay was inserted into the epoxy resin cavity, and the interfacial distance between the ceramic inlay and the cavity wall at the margin was measured using a reflecting microscope at x100 magnification. The internal fit was measured after sectioning the specimen longitudinally. The results indicate that the setting expansion of the refractory die materials and the divergence of the lateral walls had significant effects on the adaptability of Class II (MO and MOD) fired ceramic inlays. The inlays fabricated on the refractory dies with small setting expansion showed small internal gaps in Class II (MO) cavities. Significantly good adaptation was achieved when the setting expansion was 0.32% or less (p < 0.05). The inlays fabricated on the refractory dies with large setting expansion showed small internal gaps in Class II (MOD) cavities. Significantly good adaptation was achieved when the setting expansion was 0.87% and greater (p < 0.05).

Objectives: To obtain an estimate of working times of Class II copy-milled ceramic inlays as an indication of their efficiency, and to analyse factors of influence., Methods: In a controlled clinical trial, 173 MO/DO or MOD ceramic inlays of the Celay system were constructed in 101 patients. Treatment was carried out by seven dentists. The inlays were replacements of existing amalgam restorations in both molar and premolar teeth. Net-times needed for the treatment and for the laboratory stage were registered. Variables of influence on the working time were assessed by using ln-working times in ANOVA. Differences of working times were expressed as the relative difference between the upper and lower value of each variable (Delta)., Results: The mean clinical treatment time was 67(+/-22)min. The laboratory stage required 60(+/-17)min working time. 'Cavity modification technique' (composite basing/conventional, Delta=17%), 'clinical operator' (seven dentists, Delta=57%), and 'size of the restoration' (large/medium, Delta=16%) significantly influenced the clinical treatment time (p<0.001). Although the dentists were familiar with inlay construction, they showed a 25% decrease in working time towards the end of the study., Conclusions: Class II copy-milled ceramic inlays in this time-and-motion study required about 125min of working time. Working time increased by applying composite basing and making large restorations. The dentist influenced working times, while efficiency increased over time. Dentists needed more laboratory time to produce an inlay than the dental technician.

Purpose: To examine the bond strength of Cerec 2 inlays both to dentin surface by microtensile testing and to cavity walls by cavity adaptation in Class II restorations, using three luting materials., Material and Methods: VitaMark II disc was bonded to the coronal dentin surface with Clapearl DC (Clearfil DC)/Linerbond IIsigma (Linerbond 2V), AP-X/Linerbond IIsigma or Fluorocement (Panavia F)/ED Primer. After 24-hr storage in water, microtensile bond strengths (MTB) were measured. Additionally, Cerec inlays were luted to the MO cavities prepared in molars with the same materials. After thermocycling (x2000), the restorations were sectioned mesio-distally. Gap formation was microscopically examined along the cavity walls., Results: There was no significant difference in MTB among the materials (Clapearl DC: 20.89 +/- 4.58 MPa, AP-X: 24.22 +/- 5.97 MPa, Fluorocement: 19.82 +/- 6.43 MPa, Scheffé, P > 0.05). The frequency of gap formation was higher in AP-X than in Clapearl DC and Fluorocement (chi2-test, P < 0.05). Debonding occurred more often at the luting material/dentin interface than at the inlay/luting material interface (Sign test, P < 0.05).

Purpose: To evaluate the effect of fatigue loading on the quality of the cement around the margins of adhesive ceramic MOD inlays., Materials and Methods: Non-metal IPS Corum porcelain inlays were made and cemented either with the resin-based composite Variolink, the compomer Dyract-Cem or the glass-ionomer cement Ketac-Cem. For each system, half of the specimens were subjected to thermal and mechanical load cycling to simulate fatigue loading. All teeth were then sectioned and evaluated by SEM on topography and by optical microscopy for dye penetration., Results: Before loading, all systems showed good marginal integrity. After loading, inlays cemented with Variolink and Dyract-Cem showed no significant (P > 0.05) increase in marginal break down, however restorations cemented with Ketac-Cem, showed a significant (P < 0.05) deterioration at the margins.

The drive for alternative to amalgam as a restorative material is led by concerns about the safety of mercury within amalgam and also by aesthetic demands from patients. Early attempts to address these issues produced disappointing results in terms of performance from directly-placed resin composites in posterior teeth. While directly-placed posterior restorative materials have improved in recent years the indirect constructed inlay may more readily meet the functional requirements of premolar/molar teeth. This article seeks to review the history, development and clinical success of porcelain when used as an inlay material. A case is included to demonstrate the clinical application of this aesthetic technique and the author's personal recommendations.

Objective: The purpose of this study was to evaluate the clinical performance of preformed beta-quartz glass-ceramic insert restorations., Methods and Materials: Nine Class I and 30 Class II beta-quartz glass-ceramic insert restorations were placed in 16 patients who were seen regularly by personnel at Umeå University Dental School. The California Dental Association criteria were used to evaluate the restorations at baseline, 6 months, and 1, 2, and 3 years after luting. The occurrence of postoperative sensitivity, the time taken to manufacture each restoration, and certain periodontal conditions were also evaluated., Results: Sixty-nine percent of the restorations were rated satisfactory at the 3-year examination. During the follow-up period, 4 became loose and 7 were fractured or had flaking surfaces. Caries was registered in connection with 1 restoration. Excellent ratings were obtained for marginal integrity, anatomic form, surface, and color in 62%, 84%, 32%, and 44% of the restorations, respectively. There was no statistically significant difference in the occurrence of plaque and bleeding on probing in comparison with the controls. The mean overall time for placement was 38 minutes. The estimated survival rate (Kaplan-Meier) was 59% after 3.5 years., Conclusion: The quality of the beta-quartz glass-ceramic restorations in the present study was inferior to that presented in most earlier studies of ceramic or resin composite posterior restorations placed in patients treated at university clinics. Both the technique and the beta-quartz glass-ceramic inserts have to be evaluated in more long-term studies to assess the possibility of their serving as an alternative restorative technique.

Statement of Problem: Several in vitro studies have been published showing the incapability of the chemical cure of dual-cured resin composite luting agents to compensate for absence of visible light activation., Purpose: This study evaluated and compared pairs of Empress ceramic inlays luted with 2 chemical-cured luting agents: a resin-modified glass ionomer cement and a resin composite within individual patients., Material and Methods: Seventy-nine ceramic inlays were placed in class II cavities in 29 patients. In each patient half of the inlays were luted with a resin-modified glass ionomer cement and the other half with a chemical-cured resin composite cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months, and 1 and 2 years., Results: No failed inlays were observed during the 2-year follow-up. A slight ditching of the cement margins was observed in both luting groups. No significant difference was seen between the 2 luting techniques., Conclusion: IPS Empress inlays luted with both chemical-cured luting agents functioned satisfactorily in the short-term follow-up. Longer observation periods are necessary to evaluate the long-term clinical behavior of both luting techniques.

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.

The aim of this retrospective clinical study was to evaluate the clinical performance of indirect composite resin inlays and onlays. Patients among the dental school clientele in need of posterior approximal filings and preferring esthetic restorations were included. Clinical teachers or trained students under supervision carried out the preparations, made impressions and prepared stone casts. Inlays made from either Tetric, Z100 or Maxxim were light-cured and placed in a light oven for secondary curing, before being luted with a dual cure cement. At recall, the inlays were evaluated using slightly modified US Public Health Service (USPHS) criteria. Twenty-two patients with 50 fillings presented for the assessment. The right censored observation periods ranged from 12 to 34 months, with a mean of 20. With the only exception of an early fracture of one onlay, all restorations were classified as successful. This was based on 15 "A" (optimal) and 34 "B" (acceptable) ratings, each of which representing the lowest rating for the individual restoration. The major reason for the "B" ratings was imperfect gingival marginal adaptation due to a small surplus of bonding material and/or luting cement.

Objective: This preliminary study aimed to find out whether it is possible to produce a well fitting Class II inlay from an extracted tooth using a copy-milling technique., Methods: Two pairs of matching sound extracted permanent molar teeth were used. The molars were matched for mesio-distal size of the tooth crown and the convexity of the approximal surfaces. One tooth of each pair was assigned to be the 'donor' tooth, the other tooth being the 'host'. MO inlay preparations were made in the host teeth. These were restored with the milled 'Natural Inlays' produced from the donor teeth using the CELAY system. The restored host teeth were sliced and examined using light-microscopy., Results: The specimens showed the desired location of enamel and dentine, and a clinically acceptable fit., Conclusion: This study has shown that by using the CELAY milling machine it is possible to 'recycle' extracted teeth for the production of dental restorations.

This study evaluated the in vitro marginal quality at the interproximal cervical margin of class II Cerec restorations. Marginal quality was evaluated separately by (1) SEM analysis before and after simultaneous thermocycling and mechanical loading for the integrity of the restoration surface and (2) dye penetration after thermocycling and mechanical loading to evaluate the strength of the bond within the depth of the cavity. The results reveal that marginal integrity is influenced by the width of the luting space and the luting composite. With a luting space of 100 microns, marginal quality with as little as 3% to 14% loss of adhesion can be obtained. Luting spaces greater than 100 microns can partially be compensated by the luting composite. For Cerec inlays, highly filled luting composites with a high viscosity are recommended.

The purpose of this in vivo study was to evaluate the microleakage of indirect composite resin inlays and to determine the thickness of composite resin luting material. Twenty periodontally involved posterior teeth scheduled for extraction were selected and Class II cavities were prepared. Ten cavities had gingival margins placed in enamel above the cementoenamel junction, and the other 10 were placed in dentin below the cementoenamel junction. Six months after cementation, the teeth were extracted and analyzed. The leakage was higher in inlays with gingival margins in dentin than in inlays with gingival margins in enamel. The cement thickness was between 15 and 40 microm, a clinically acceptable range.

With the arrival of the new dentin-enamel adhesives, the dentist is able to bond many different materials to the tooth. The esthetic inlays or onlays may thus be made out of various materials such as composite or ceramics with long term success. This article is an attempt to detail all the clinical procedures necessary to succeed such restorations.

Time registrations for indirect class II resin composite inlays are given. They are compared with treatment times for direct resin composite restorations.

The length of service and the clinical performance of two groups of functioning class-II cast gold inlays in patients attending a private practice were assessed by conventional clinical and radiographic examination. In one group all inlays were older than 25 years (median age, 34 years), and they had an extended outline form. The impression technique was based on a thermoplastic material in a copper ring. In the other group, comprising inlays inserted during the past 25 years (median age, 16.5 years), the outline form was minimal and an elastic impression material in a copper ring was used. The inlays in the older group appeared to perform better than those in the younger group. In both groups recurrent caries appeared to be the predominant reason for repair.

This article indicates that the gingival opening of a two-surface cast restoration after cementation is minimized by the use of a preparation with proximal grooves.

Today's dental patient concerned about attractive restorations is looking for a dentist who incorporates the newest and best techniques into practice. This article discusses a newer concept that pleases both the patient and dentist: restorations that are bonded into acid-etched tooth preparations with composite resin cement--tooth-colored inlays and onlays. Basic questions asked by practitioners about these esthetic restorations are addressed; characteristics, performance expectations, comparisons with cast gold inlays and onlays, and comparisons with amalgam are presented, in addition to other relevant information for today's dental practitioner.