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Aesthetic Inlays

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 ISSN 0975-8437
REVIEW ARTICLE
Aesthetic Inlays
Sathish Abraham, Kailash Attur, Santosh Kumar Singh, N.Lisa Chacko
Abstract
Aesthetic Inlays has an important role in conserving sound tooth structure with more esthetic results.
Composite resins and Ceramic restorations can be used to restore a tooth which needs an inlay. This review
discusses the details of various aesthetic inlays systems.
Key Words: Inlays; Composite resins; Ceramics; CAD/CAM Restorations
In recent times the field of aesthetic dentistry
has picked up speed and has turned as one of the
most important branch in dentistry. There are
different aesthetic materials and techniques used to
prepare inlays, an important restorative procedure.
Inlays were earlier prepared with different alloys
including Cast gold alloys. With the introduction of
newer materials and techniques in the field of
aesthetic dentistry, the role of restoring a tooth with
an aesthetic inlay has become more desirable for the
patients and the dentists alike. Newer Composite
resins and Ceramics can be used for inlay
restorations in the field of aesthetic dentistry.(1)
This review discusses the details of various
aesthetic inlays systems.
Composite resins can be used to restore a
tooth which needs an inlay. With the introduction of
newer posterior composite resins with better
material properties, this treatment modality benefits
the patients immensely. Inlays can be prepared after
the shade selection, both with direct or indirect
technique.(2, 3)
The direct technique includes, chair side
preparation, good aesthetic properties and cost
effectiveness. The indirect technique gives accurate
fit with pulse curing and secondary pulse curing.
The chair side repair possible with less shrinkage(4)
and better strength as it is oven cured.(5, 6)
Ceramic Inlay Restorations
Recent advances in porcelain have given
better overall advantage for aesthetic dentistry.
Porcelain is the most natural appearing synthetic
replacement material for the missing tooth structure.
The developments of new all-ceramic systems have
better strength and precision fit which was lacking
in conventional porcelain. These can also be bonded
to the tooth with newer dentinal adhesives and resin
cements. With the introduction of upgraded
materials and machineries, a variety of treatment
options have opened up including aesthetic inlays.
All the materials and techniques in ceramic inlay
preparation are discussed below.(7)
Single-visit Direct Ceramic restorations:
Cerana Restorations: This system uses matched
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drills with pre-etched and silanated Lucite inserts
cemented with a conventional composite resin
material. The technique is based on a ceramic insert
with the optional use of a size-matched bur for
cavity preparation.(8-10)
I. Conventional Power-slurry ceramics
The powder is available in a variety of shades
including stains and glazes. Optec HSP has good
flexural strength (146 Mpa) and produces uniform
translucency and shade throughout. It can be etched
to bond to the tooth structure with an accurate fit.
Duceram LFC has good flexural strength and
greater density with greater fracture resistance, as its
hardness close to that of tooth.(11)
II. Castable ceramics
It is supplied in solid ceramic ingots. These
are used to fabricate cores and full contour
restorations using the lost wax technique. Dicor
(DENTSPLY) and Dicor plus has good flexural
strength (152 Mpa) and good fracture resistance. It
can be etched to bond to the tooth. But it need
special investment and casting equipment.
III. Machinable ceramics
It is available as ingots in different shades and
sizes. These are used in CAD CAM and CAD CIM
technologies. These ingots are placed at the cutting
end of the Machinable apparatus to produce
required contour. In this technology an image
(Optical impression) is taken after the tooth is
prepared and is transferred to the computer.(12) It is
then assessed for the right dimension and contour.
This information is then passed on to proceed with
machining the ingot at the cutting end. It is then
placed on the prepared tooth to check the fit.
Occlusal adjustment is done followed by polishing
and etching the fitting surface. It is then bonded to
the prepared tooth.(13, 14).
Cerec Vita Block 1 and Cerec Vita Block 2:
The latter has finer grains and produces less
abrasive wear of opposing tooth with an increased
strength (152Mpa).
Celay is fine grain size feldspathic porcelain
similar to Cerec Vita Block 2.
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 ISSN 0975-8437
Dicor MGC has greater flexural strength
(216Mpa) with less wear of opposing tooth.
Copy milling Technique: In this technique, a
provisional inlay restoration is prepared with a
composite resin. This is kept on the reading end of
the CAD CAM machine, with an ingot of the
selected shade on the cutting end. When activated,
the machine reads the details of the provisional
restoration on the reading end and cuts the ingot on
the cutting end with exact details to obtain the final
product.(15, 16) It gives excellent fit with a single
sitting treatment option. Here the disadvantage of
marginal gap is minimized.(17)
Double Inlay Technique: In This technique
two different materials are used in restoring an inlay
preparation. Here, gold is used to restore the body
of the restoration and the occlusal half is restored
with ceramic inlay restoration.(18) This use the
advantage of biocompatibility of gold and good
aesthetics of ceramic, as occlusal half is of
ceramics. Its disadvantage could be the factor that it
is a multiple cemented or bonded restoration.
IV. Pressable ceramics
IPS Empress: This Feldspathic porcelain is
supplied in ceramic ingots. Here, a pattern is
prepared, invested and is placed in a mold that has
alumina plunger. The ceramic ingot is placed under
the plunger. The entire unit is heated to a
temperature of 11500C and the plunger is released
which presses the ceramic into the mold. This
pressed ceramic is then baked for good translucency
and good flexural strength (182Mpa) after heat
treatment.(19)
V. Infiltrated ceramics: This has two components,
which are aluminum oxide and magnesium oxide
spinel powder and glass infiltrate. It has high
flexural strength (450Mpa) and gives accurate fit. It
is sand blasted, as it is difficult to etch.
Advance in material science.
Recent advances in the field of ceramic
material have improved the quality of different
techniques used for restorations. Development of
shrink free ceramics and hybrid ceramics has helped
tremendously. Shrink free ceramics provides an
option for optimal marginal fit and longevity as the
shrinkage of material is minimized. Hybrid
ceramics helps in prevention of crack propagation in
the material thereby reducing the chances of
fracture of restorations.
Zir Cad: All-ceramic restorations have flexural
strength of 900Mpa, fracture toughness of 6Mpa,
good biocompatibility and low heat conduction.
Zirconia: Zirconia is the oxidized form of
zirconium and can exist in several phases,
depending on the temperature. In dental ceramics,
zirconia can inhibit crack growth and prevent
©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 4 ISSUE 3 JULY- SEPTEMBER
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catastrophic failure. The following case report
demonstrates the use of zirconia as a framework
material. Overall, zirconia has proven to be a strong
and reliable framework material. In combination
with CAD/CAM, this material allows for the
fabrication of esthetic all-ceramic restorations in all
areas of the mouth.(20)
Conclusion
Clinicians should provide a treatment option
which is most conservative and at the same time
suitable functionally as well as aesthetically with
predictable longevity. They are always faced with
the problem of deciding what restoration and
material they should use when restoring deficient
tooth structure.(21) Composite resin material
selection as well as the technique followed for tooth
cavity preparation is equally important for the
success of the restoration in terms of longevity.(22)
Ceramic inlay restorations, especially in
defects of posterior teeth requires proper care both
in tooth/cavity preparation and material selection.
Placement of ceramic inlay materials in high-stress
areas may result in less predictable long-term
performance. Ceramic inlays are advantageous for
restoring moderately sized defects when proper
restoration contours and esthetics is desired.
Successful clinical use of ceramic inlay materials is
absolutely dependent on the creation of an
uncompromised adhesive tooth/ceramic interface.
Ceramic inlay restorations perform well in terms of
long-term retention, color match, and anatomic
contour stability. Ceramic inlays fail predominantly
as a result of crack propagation from material flaws
leading to bulk fracture. Superficial ceramic defects
can be repaired with composite resin. Internal
material flaws are minimized by industrial
production of indirect pressable glass-ceramic
materials or ceramic blocks designed for computer-
aided design / computer-assisted manufacturing
(CAD/CAM). External surface flaws are limited by
careful polishing techniques. Strategic placement of
ceramic inlays in teeth that are not subject to heavy
occlusal loading will result in more predictable
long-term performance.(23)
Authors Affiliations: 1. Dr. Sathish Abraham, MDS,
Professor, 2. Dr. Kailash Attur, MDS, Senior Lecturer, 3.
Dr. Santosh Kumar Singh, MDS, Senior Lecturer, 4. Dr.
N. Lisa Chacko, MDS, Reader, Department of
Periodontics, RKDF Dental College and Research Centre,
Bhopal, India.
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Source of Support: Nil, Conflict of Interest: None Declared
©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 4 ISSUE 3 JULY- SEPTEMBER
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Address for Correspondence
Dr. Sathish Abraham, MDS,
Professor,
Department of Conservative
Dentistry & Endodontics,
RKDF Dental College & Research Centre,
Bhopal -462026, India.
Email: abrahamsathish@yahoo.in
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