Giuseppe Marchetti Shadeguides Composite inlays and onlays 10 Jul 2017 The choice of the restorative procedures is quite often a cause of doubt, perplexity, and indecision for the dentist. There's a lot of confusion among the colleagues about what to do and when. We, as Style Italiano, strongly believe that, whenever possible, a direct approach must be taken, when talking about restorative procedures in posteriors; but in all those clinical situations in which there's the need of a cusp coverage and when there are a lot of cavities to restore, such as a quadrant or more, an indirect approach can avoid spending a lot of chairside time for modeling and creating good shapes, as all the contact areas can be perfectly managed on a plaster model too, thus helping the clinician with one of the big challenges in restoring multiple cavities. This clinical case shows how to treat a quadrant with composite inlays and onlays, in a modern and easy way. Page 1 of 25
1 Img. 1 Preoperative picture of the old restorations that have to be removed due to the occurrence of secondary caries Page 2 of 25
2 Img. 2 Isolation of the field with the rubber dam Page 3 of 25
3 Img. 3 Cleaning of decays and preliminary preparations Page 4 of 25
4 Img. 4 After cleaning and disinfection of the dentin the etching of the enamel for 20 secs is performed Page 5 of 25
5 Img. 5 Adhesion is performed with a Universal (8th generation) adhesive system thanks to its brilliant performance and its semplification of the operative procedures. It's used in a self etching mode Page 6 of 25
6 Img. 6 The adhesive's brushed on the cavities for 20 seconds for each tooth Page 7 of 25
7 Img. 7 It's then lightcured for 40 seconds for each tooth Page 8 of 25
8 Img. 8 The build-ups are done with a bulk flowable composite Page 9 of 25
9 Img. 9 The final preps are done with finishing burs Page 10 of 25
10 Img. 10 Impression is taken with a polyvinylsiloxane (Imprint 4) Page 11 of 25
11 Img. 11 The restorations are first tried without the dam, then we put back in place the rubber dam and sandblast the build-ups with aluminum oxide particles. Page 12 of 25
12 Img. 12 We then try the restorations again with the rubber dam in place Page 13 of 25
13 Img. 13 Details of the sandblasting of the inner surface of restorations which needs to be done too Page 14 of 25
14 Img. 14 The selective etching procedure's done for 20 seconds over the enamel only Page 15 of 25
15 Img. 15 The Universal adhesive is applied both on the build up and on the enamel Page 16 of 25
16 Img. 16 Application of the adhesive on the inner surface of the restorations Page 17 of 25
17 Img. 17 The indirects are bonded with a dual curing cement, two by two Page 18 of 25
18 Img. 18 Details of the bonding procedures on the other two teeth Page 19 of 25
19 Img. 19 The application of the spiral system for polishing, after the finishing procedures Page 20 of 25
20 Img. 20 Details of the anatomies at the end of the work Page 21 of 25
21 Img. 21 Details after finishing and polishing Page 22 of 25
22 Img. 22 After removal of the rubber dam Page 23 of 25
23 Img. 23 Occlusal check (cross bite) Page 24 of 25
24 Img. 24 Two years follow-up The usage of modern materials can be applied also in old techniques, such as partial indirect estethic posterior restorations. Nowadays we can afford these workflows as faster and precise at the same time, keeping in mind the health of our patients as supreme and most important goal. Thanks to Mr. Sebastiano Nardo for the lab. work. Page 25 of 25