CAST METAL

RESTORATIONS-
INLAY
PREPARATION
• DEFINITION OF INLAY
• Inlay is defined as a fixed intracoronal
restoration, a dental restoration made outside
of a tooth to correspond to the form of
prepared cavity, which is then luted into the
tooth (Rosensteil)

• Class II inlay involves occlusal surfaces and

proximal surfaces of a posterior tooth and may
cap one or more but not all of the cusps
(John R.Sturdevant, Clifford M. Sturdevant)
INDICATIONS:
• Extensive lesion
• Low plaque / caries index
• Adjunct to successful periodontal therapy.
• Correction of occlusion.
• Restoration of stress bearing areas.
• Partially subgingival restoration.

OTHER INDICATIONS:
• Restoration of endodontically treated
teeth.
• Cracked teeth.
• Retainer for fixed prosthesis.
 An inlay is a pure intracoronal restoration can be used only
when:
• A cavity’s width does not exceed one third of the
intercuspal distance.
• Strong self retentive cusps remain.
• When indicated teeth have minimal or no occlusal facets.
• The tooth is not to be an abutment for removable or fixed
prosthesis.
• Occlusion or occluding surfaces are not to be changed by
restorative procedure.
Contraindications

• High caries rate

• Young patients
• Esthetic concerns
• Small restorations
• They rely on intracoronal wedging,
therefore unless sufficient bulk of
tooth is there to provide retention
and resistance, it is contraindicated
 ADVANTAGES:

• Strength of the material.

• Biocompatible
• Less tarnish and corrosion.
• Abrasion resistance and low wear rate.
• Reproduction of precise form and minute details.
• Long lasting restoration.
• Produces surface with maximum biologic
acceptance.
• Maintains proximal contact for considerable period
of time.
• Configuration of contact and contours can also be
modified.
DISADVANTAGES:

• Lack of close adaptability to the cavity walls

because of interface of luting cement.
• Microleakage.
• Cost
• Time consuming.
• Extensive tooth involvement.
• Recurrent caries.
• Galvanism in case of dissimilar in metal.
• MATERIALS FOR CAST
RESTORATIONS:
• Four distinct groups alloys are used
for cast restorations.
• Traditional high-gold alloys
• Low gold alloys
• Palladium – silver alloys
• Base metal alloys
Basic concepts of cavity
design for cast
restoration
Basic concepts of cavity
design for cast restoration
• Preparation path
• Inlay taper
• Preparation features of
circumferential tie
• Occlusal & gingival Bevels
• Types
• Functions
• Facial & lingual Flares
• Primary
• Secondary
Preparation path

• Single insertion path

• All reductions
oriented towards one
path
• The “line of draw” –
path of removal & re-
insertion should be
perpendicular to plane
across cusp tips or
parallel to long axis
of tooth crown
 Inlay taper
• Apico-occlusal taper
• Cavity walls must diverge
from floor outwards
• To permit unobstructed
removal & placement of wax
pattern & casting
• Developed by preparing
occlusal walls so that they
form obtuse angle with pulpal
floor
 Inlay taper

• Described by :
• Convergent angle formed
by projecting the line of
the walls to a point of
intersection
• Angle formed by taper &
line of draw of the
preparation
• According to Sturdevant :
• 2 ° – 5 ° from line of draw
• Short vertical walls : 2 °
• Long vertical walls : > 2 °

• According to Charbeneau :
• 10 ° – 16 ° of convergent
angle
• 5 ° – 8 ° on each wall

• According to Marzouk :
• 2 ° – 5 ° from path of
preparation
• Taper may be increased or decreased according
to following factors :

1. Wall length Taper required (< 10°)

2. Surface involvement in preparation Taper

required (< 10°)

3. Need for retention taper

BEVELS

• “Flexible extentions”
of a cavity preparation,
allowing the inclusion
of surface defects,
supplementary grooves,
or other areas on tooth
surface.
• To provide “lap joint”
• Establishes closure at
the interface of gold &
enamel or cementum
 Types & design features
of occlusal & gingival
bevels
• According to their shapes & types
of tissue involvement there are 6
types of bevels :
• Partial bevel
• Short bevel
• Long bevel
• Full bevel
• Counter bevel
• Hollow ground (concave) bevel
 Partial bevel

• Involves : part of
enamel wall ; not
exceeding 2/3 of
its dimension
• Use : to trim
weak enamel rods
from margin
peripheries
Short bevel

• Involves : entire
enamel wall ;
but not dentin
• Use : mostly
with Class I
alloys specially
type 1 & 2
 Long bevel

• Involves : all enamel

wall & up to ½ of
dentinal wall
• Use : most frequently
used for Class I,II &
III alloys
• Advantage : preserves
internal “boxed-up”
shape. Providing
resistance & retention
features to the
preparation
Full bevel

• Involves : all the

dentinal & enamel
walls of cavity wall or
floor
• Use : only if other
bevels cannot be used
• Disadvantage :
deprives the
preparation of its
internal resistance &
retention features
Counter bevel
• Use : when
capping cusps ;
to protect &
support them
• Used opposite
to an axial
cavity wall on
facial or lingual
surface of tooth
• It will have
gingival
inclination
facially &
lingually
Hollow ground
(concave) bevel
• Any bevel prepared
in concave form
• Allows space for
cast material bulk ;
improves retention
& resistance
• Ideal for Class IV &
V cast materials
(ceramic
restorations)
 Types and design feature of facial &
lingual flare:

• Primary flare.
• Secondary flare.
• Primary flare:
• Conventional and basic part
of circumferential tie.
• Similar to Long bevel.
• 45° to inner dentinal wall
proper.
• Function:
• Same as bevel.
• Brings facial and lingual margins of the
cavity preparation to cleansable –
finishable areas.

• Indications:
• Any facial and lingual proximal wall of
intracoronal cavity preparation.
• Secondary Flare:
• Flat plane superimposed peripherally to
primary flare.
• Some times prepared in a hollow ground
form to accommodate materials with low
castability.(non gold alloys)
• Prepared solely in enamel or some times
may involve dentin.
• Have different angulation, involvement
and extent depending upon their
functions.
 Functions
 Same as bevels.

 In wide extended lesions buccolingually a

secondary flare superimposed at correct
angulation can create the obtuse angulation of the
marginal tooth structure.

 In very broad contact area or malposed contact

area a secondary flare superimposed peripherally
on the primary flare will bring facial and lingual
margins to finishable cleansable area.
 Principles of cavity
design
• Outline form
• External outline form
• Internal outline form
• Resistance & retention form
• Removing carious dentin
• Convenience form
• Finishing enamel walls & margins
• Cleansing the critical appraisal of the
cavity
External outline form

• Smooth flowing curves

• Avoid sharp angles
• Proximal margins
extended till all caries
removed & convenient
for finishing
• No unsupported
enamel
• Stabilized gingival
health prior to
initiation
Internal outline form
• Pulpal floor & axial wall based
in dentin
• Gingival floor in sound tooth
structure
• Additional loss of dentin
replaced by cement base
• Appropriate taper given
• Well defined line angles
• Rounded axiopulpal &
axioproximal line angles
Marginal ridge integrity
enhanced by the above
factors.
 Resistance & retention
form
Resistance form
That shape & placement of preparation walls
that best enable both restoration & tooth to
withstand, without fracture masticatory forces
delivered principally in the long axis of tooth
Retention form
That shape or form of conventional preparation
that resists displacement or removal of
restoration from tipping or lifting forces
 Resistance & retention
form
• Preparation should be
designed to resist
dislodging forces of
compression & tension
• Should take into
consideration occlusal
forces that may cause
fracture of the tooth
• Strength of cement
bond alone will not
provide sufficient
retention
Resistance & retention form

• Correct taper of cavity walls

• Pulpal & gingival floors designed
perpendicular to lines of force
• Dovetail
• Special features like :
• Pinholes/potholes
• Tapered grooves
A Gingival marginal trimmer is
used to provide
V-shaped groove at the
junction of axial wall & gingival
floor of box
This groove is referred to as
“Minnesota ditch”
Placed to enhance resistance
to displacement by occlusal
forces
Convenience form
That shape or form of preparation that
provides for adequate observation,
accessibility and ease of operation in
preparing and restoring the tooth.

• Provides accessibility
& visibility
• Includes :
• Extension
• Taper
• Flare
• Bevel placement
 Removing carious dentin
• After the initial
cavity
preparation,
• Internal walls of
preparation are
explored
• Any remaining
soft dentin
removed using
slow revolving
round bur or
spoon excavator
Tooth preparation for
class II-- cast metal
inlays according to
STURDEVANT
 Armamentarium
• Tapered , round &
cylindrical carbide burs
• Finishing stones
• Mirror
• Explorer & periodontal
probe
• Chisels
• Hatchet
• Gingival marginal trimmer
• Excavators
• High & low speed
handpiece
• Articulating film
 Tooth preparation for class
II cast metal inlays
• Class II inlay involves occlusal
surfaces and proximal surfaces
of a posterior tooth and may
cap one or more but not all of
the cusps

• Steps :
• Initial preparation
• Occlusal step
• Proximal box
• Final preparation
• Removal of infected carious
dentin & pulp protection
• Preparation of bevels & flares
 Initial preparation

Plane cut tapered fissure carbide

burs are used to prepare vertical
internal walls of the preparation

Throughout the
preparation, the cutting
instrument used are
oriented to a single
“draw” path
Gingival to occlusal
divergence of walls : 2 ° –
5 ° from line of draw
 Occlusal step

With No. 271 bur General rule : In mandibular

enter the fossa / long axis of bur molar &
pit to an initial parallel to long premolar -5 °
depth of 1.5mm axis of tooth to 10 °
crown lingually tilted
Extend to uninvolved fossa/pit keeping faciolingual
width minimum & marginal ridge strong
If a fissure extends on the
mesial marginal ridge, it is
treated by :

Enameloplasty Bevel
 Extension to Slender No. This provides
include faulty 169L bur is the desired
facial & lingual used so “Dovetail
fissures that tooth retention form”
radiating from structure which resists
mesial pit can be distal
conserved displacement of
inlay
The occlusal step is As the preparation is
extended distally into extended distally, the
distal marginal ridge faciolingual width is
sufficiently to expose progressively widened
junction of proximal – till proximal
enamel & dentin surfaces clear
adjacent teeth by 0.2
– 0.5 mm
 Proximal box

Continuing
with 271 Mesiodistal Facio &
While
bur the width of linguoaxial
penetrating
distal ditch : line angles
gingivally,
enamel is 0.8mm should
the
isolated by 2/3 at proximal clear
cutting a expense of ditch is adjacent
proximal dentin & extended tooth by
ditch 1/3 at facially & 0.2-0.5mm
expense of lingually
enamel
Make 2 cuts at Until the bur If the wall
facial & lingual is nearly of enamel
limit of through the is still
proximal ditch marginal present, it
ridge enamel is broken
away using
a spoon
excavator
 Proximal & gingival walls are planed using hand
instruments to remove all remaining enamel

Modified palm & No. 15 Gingival wall is

thumb grasp used Straight planed using a hoe
in chisel like chisel / in lingual to facial
motion in occluso – Binangle scraping direction ;
gingival direction chisel/ Axial wall may be
Enamel planed with
hatchet may secondary edge of
be used blade
Shallow (0.3mm)
retention
grooves may be
cut on the
facioaxial &
linguoaxial line
angles with
No.169L bur
Final preparation

• Removal of infected carious

dentin & pulp protection

• Preparation of bevels & flares

 Removing carious dentin
• After the initial
cavity
preparation,
• Internal walls of
preparation are
explored
• Any remaining
soft dentin
removed using
slow revolving
round bur or
spoon excavator
 Removal of infected carious dentin & pulp
protection

If infected shallow / moderate

carious dentin (>= 1mm RDT)
-Satisfactory isolation
-Small round bur(No. 2 or 4) / spoon
excavator used
-Light cure GIC placed as base &
excess trimmed with No. 271 bur
If carious lesion closely approaching the pulp :
Pulp space therapy / direct pulp capping

Pulp exposure on removal of soft dentin – Pulp space

therapy
Mechanical exposure – Direct pulp capping

Place calcium No. ¼ bur can be used to For Glass

hydroxide using place retention coves in Ionomer
flow technique peripheral dentin to Base
provide mechanical
Preparation of Bevels &
Flares
 Preparation of Bevels

Gingival retraction
cord – widens
Slender sulcus to 0.5mm –
flame results in open
shaped sulcus – improves
fine grit visibility & prevents
diamond is injury to gingival
used to tissue
bevel
 The cavosurface design
The bevel should result
helps seal & protect
in 30° – 40°marginal
margins & results in
metal on inlay
strong enamel margin with
an angle on 140° - 150°
To place gingival bevel - The instrument is held
parallel to gingival third of proximal surface of
adjacent tooth
If the bur is tilted lingually / buccally,
undercut will be created at corners of the
box (commonly seen fault)
Preparation of Flares
Distolingual wall No. 169L or paper disc
extends into Secondary
lingual embrasure
Slender flame shaped flare are
fine grit diamond directed
in 2 planes :
to result
1st termed – in 40°
lingual primary marginal
flare metal &
2nd termed – 140°
lingual secondary marginal
can be used to prepare
flare enamel
secondary flare
The lingual secondary flare is prepared
approaching from lingual embrasure moving
the instrument mesiofacially
Gingival bevel
Should result in 30°-
40° marginal metal
Instrument is tilted
slightly mesially
0.5-1mm wide
Should blend with
lingual secondary flare
 Preparation of facial secondary flare

40° marginal
metal should
Long axis of To prevent result
instrument is along abrasion to
the line of draw adjacent
with only small tooth the
tilting mesially & instrument
facially may be raised
occlusally Completed
facial
secondary flare
Finishing enamel walls
& margins
At low speed Vertical box Isthmus
paper disc walls walls
creates long
vertical bevel

Higher speed is
Box walls necessary to Only now is
smooth all the disc
residual corners used
Broken point of A new one
an arkansas Beautifully
flattens cavity
improves
stone is floors smoothening
smoothened by on corners
rotating it on a
diamond disc

A rubber
point used at
Boxes , and Occlusal low speed,
.. margins completes the
smoothening
 Summary chart
Indications Contraindications Advantages Disadvantages

Small carious High caries index Superior material Less conservative

lesion in Poor plaque properties than amalgam
otherwise sound control Longevity May display
tooth Small teeth No discoloration metal
Adequate Adolescents from corrosion Gingival
dentinal support Less complex extension beyond
MOD
Low caries rate cast restoration ideal
Poor dentinal
Patients request support requiring “Wedge”
for gold wide preparation retention
Preparation steps Recommended Criteria
armamentarium
Occlusal outline Tapered carbide Includes central groove;
avoids centric contact;
includes dovetail or pin
hole for resistance;
approx. 1.8mm deep

Proximal box Tapered carbide Follows curvature of

original tooth surface

Caries removal Excavator or round bur Tissue replaced with base

Axiogingival groove Gingival marginal trimmer Detectable with explorer

tip (0.2mm deep)

Gingival & proximal bevels Thin tapered carbide or 30° approx. 0.8mm wide
diamond (0.5-1mm)

Occlusal bevels Round carbide or stone 30° - 40°

Hollow ground, avoid
centric contacts
Difference between tooth preparation for porcelain &
cast gold inlay
Porcelain

• All margins should have a 90° butt joint cavosurface angle

• Carbide or diamond bur used – tapering instrument
• Occlusal step should be 1.5-2mm
• Axial reduction – 1-1.5mm
• Clearance – Atleast 0.5mm
• If facial & lingual surfaces affected, gingival shoulder is
necessary
If cusp capping required – reduced 1.5-2mm & 90° cavosurface
angle should extend beyond contact with opposing tooth
Stains on external surfaces should be removed
Difference between tooth preparation
for cast gold inlay & amalgam
 INLAY PREPARATION AMALGAM PREPARATION

May Support tooth Preparation supported by tooth

Retention achieved by nearly parallel From parallel walls & undercuts

opposing walls ; close adaptation of
casting ; cementing medium
Good Resistance to occlusal forces Poor resistance to occlusal
forces
Narrower Isthmus width

All Margins beveled Requires right angle margins

No Reverse Curve Present

More extensive Proximal outline (0.5- 0.5mm clearance

1mm) [access for disking, finishing, home [access for finishing, home care
care ] ]
Rounded Gingival cavosurface point Definite angle [for ease of
angles [for ease of finishing gold] condensing amalgam]
Proximal outline diverges occlusally Converges
 INLAY PREPARATION AMALGAM PREPARATION

Preparation must draw ; Preparation must not

no undercuts draw ; retentive
undercuts placed
Gingival wall in 2 planes Flat gingival wall
Axiopulpal line angle is Axiopulpal line angle is
rounded to prevent voids rounded to prevent
in the working die stress on amalgam
All margins are beveled No cavosurface bevels
Difference between tooth preparation for
cast gold inlay & direct gold restorations
• Class II indication – reduced occlusal forces on marginal ridge
• Burs used – pear shaped No. 330 or No. 329 bur is used
• - small hoe used to flatten pulpal floor
• - no. 33½ bur or angle former chisel used to place
undercuts
• - white stone or angle former or finishing bur used to place
bevel

• Sharp internal line angles

• To resist movement
• To allow convenient “starting” gold foil compaction
• Rounded form permitted when E-Z gold is used
• Initial depth – 0.5mm from DEJ
• Parallel external walls
• Mesial & distal walls diverge slightly occlusally
• Small undercuts may be placed in dentin
• Cavosurface bevel – 30° – 40° (for ease of finishing & remove rough
enamel)
• 0.2mm width of bevel
 DOUBLE INLAY TECHNIQUE

• 2 treatment options :
• 1 – piece inlay : containing ceramic fused to
inlay in laboratory
• 2-piece inlay : cemented metal base overlaid by
bonded porcelain inlay
• Major problem with this technique
• Amount of tooth reduction needed to avoid
ceramic fracture
• A cavity preparation of 2.5mm is mandatory
because of volume required for 2 inlay
components
 Procedure of modification of double
inlay technique
• Prepare occlusal cavity as a classic ceramic inlay box-shaped
preparation with an appropriate bur (835-016, Komet)
• Minimal occlusal depth of 1.5mm – because floor of inlay will
not be covered by metal substructure
• Proximal box prepared for receiving the metal base
substructure
• Cavity preparation is extended until the proximal contact with
adjacent tooth is completely open by 1 mm on all sides
• Bevel only the gingival margin to ensure the best fit of the metal
casting portion at this critical area
• 1.5 – 2 mm dentinal pit is prepared at the floor of the proximal
cavity. Parallel to the pulp chamber & to the long axis of the root
(aids in retention of the metal base)
• Horizontal part of the metal base covering the cavity floor
& the vertical grooves are replaced with “vertical parallel
pin system” (Whaledent)
FUTURE STUDIES
Esthetics is important in today's society. Dentists
and researchers share this concern, and they have
even more demands:
They insist on good mechanical and physical properties of
materials as well as on reasonable longevity of the
restoration.
They also require that the technique of preparing such a
restoration be relatively easy and that the cost not
exceed that of existing materials designed for the
same purpose.
Full-ceramic restorations need more research to
develop materials to fulfill these requirements.
 INSTRUMENTSFOR USE IN
BEAUTIFUL WOOD and IVORY
INLAYS
 DEFINITION:
• INLAY + CAPPING OF ALL CUSPS.
• Definition: Onlay
• The class II onlay involves the proximal
surface(s) of a posterior tooth and caps all of
the cusps

• Thus it is intermediate restoration between

inlays that is primarily an intracoronal
restoration and full crown, which is totally
extracoronal restoration.
INDICATIONS:
• IF THE LESION WIDTH IS MORE THAN
1/3rd OF THE INTERCUSPAL DISTANCE.

• IF THE LENGTH:WIDTH RATIO OF CUSP

IS:
UPTO 1:1 NO CUSP CAPPING
B/W 1:1-2:1 CONSIDER CUSP CAPPING
≥ 2:1 CUSP CAPPING IS MANDATORY
• IF CHANGE IN DIMENSION, SHAPE AND
INTERRELATIONSHIP OF OCCLUDING
SURFACES IS REQUIRED.

• IF THE TOOTH IS GOING TO SERVE AS AN

ABUTMENT FOR RPD/FPD.

• WHEN IT IS NECESSARY TO INCLUDE WEAR

FACETS THAT EXCEED THE CUSP TIPS AND
TRIANGULAR RIDGE CRESTS FACIALLY OR
LINGUALLY.
TOOTH PREPARATION FOR
CAST METAL ONLAYS:
ARMAMENTS REQUIRED:

• SAME AS FOR
INLAYS
• ALL STEPS (OCCLUSAL AND
PROXIMAL) ARE SAME AS IN
INLAY EXCEPT FOR CUSP
CAPPING.
• General shape:
• Onlays are dovetailed internally
and follow cuspal anatomy
externally.
• Proximally they appear as box
(or) cone shaped.
• The main feature is capping of
the functional and the shoeing
non-functional cusps.
Location of margin:
1. Occluso-facio-lingual portion.
1.On the functional side cusps are capped for the additional
retention and protection.
2.They must be located far enough gingivally away from
contact with the opposing tooth surface.
Internal anatomy: All the features of
inlay except .The table is the
transitional area between the intra-
coronal and extra-coronal parts of
the preparation. It is partly in
dentin and in enamel. It is relived
form opposing cusps by at least
1.5mm in both static and functional
contacts. At any location the table
should be flat, following cuspal
direction in mesio-distal direction.
The table is one of the major
Four hollow ground bevels
-In addition to the advantages of those features mentioned with the
occlusal bevel, the counterbevel will embrace the cuspal elements for
retention and/or support.
COUNTERBEVEL
ANGULATION OF
COUNTERBEVEL DEPENDS
ON:
• AMOUNT OF DESIRED
INVOLVEMENT ON FACIAL &
LINGUAL SURFACE.

• AMOUNT OF NEEDED RETENTION.

• TYPE OF CAST ALLOY.

CUSP CAPPING
• TOOTH PREPARATION FOR CAST
RESTORATION WITH SURFACE
EXTENSIONS
REVERSE SECONDARY
FLARE:
 IT IS A PARTIAL BEVEL INVOLVING THE ENAMEL ONLY,
WITH ITS MAXIMUM DEPTH AT ITS JUNCTION WITH THE
MAIN CAVITY PREPARATION.

 IT ENDS ON THE FACIAL OR LINGUAL SURFACE WITH A

KNIFE EDGE FINISH LINE, AND ITS EXTENT SHOULD NOT
EXCEED THE HEIGHT OF CONTOUR ON THE FACIAL OR
LINGUAL SURFACE IN A M-D DIRECTION.

 IT MAY NOT INCLUDE THE ENTIRE PERIPHERY OF

PREPARATION OCCLUSO-APICALLY AND CAN BE GIVEN
IN ONLY MIDDLE OR UPPER AND LOWER PART OF
PREPARATION.
INDICATIONS:
• TO INCLUDE THE SURFACE DEFECTS ON
THE FACIAL AND LINGUAL SURFACE.

• TO ENCOMPASS AN AXIAL ANGLE FOR

REINFORCING AND SUPPORTING REASONS.

• TO ADD TO THE RETENTIVE CAPABLITY OF

THE RESTORATION PROXIMALLY.

SUCH EXTENSION IS CONTRAINDICATED IN

CASE OF CLASS IV AND V CAST MATERIALS.
SKIRT
• IT IS MORE EXTENSIVE VERSION OF
REVERSE SECONDARY FLARE.

• FLAME SHAPED DIAMOND IS USED.

• IF LINGUAL AXIAL WALL IS MISSING OR

SHORT, PREPARE SKIRT ON FACIAL
SURFACE AND VICE VERSA.

• HOWEVER, UNNECESSARY DISPLAY OF

METAL AT FACIAL SURFACE IS A DEMERIT.
INDICATIONS:
• TO INVOLVE DEFECTS ON FACIAL OR
LINGUAL SURFACE, THAT CANNOT BE
COVERED BY REVERSE SECONDARY FLARE.

• TO IMPART RESISTANCE AND RETENTION ON

A CAST RESTORATION IN LIEU OF MISSING
OR SHORTENED OPPOSING FACIAL OR
LINGUAL WALLS.

• WHEN CONTACT AREAS OR CONTOUR OF

PROXIMAL SURFACE IS TO BE CHANGED.

• REQUIRED TO RESTORE FACIALLY OR

LINGUALLY TILTED TEETH IN ORDER TO
RESTORE THE OCCLUSAL PLANE.
COLLAR
• AXIAL DEPTH IS 1.5-2.0 mm.

• OCCLUSOGINGIVAL HEIGHT IS 2-3

mm.

• FINISH LINE IS BEVELLED

SHOULDER. FOR CAST CERAMICS IT
MAY OR MAY NOT BE BEVELLED.
Composite inlays
• Indications
• Contraindications
• Advantages
• Disadvantages
• Treatment planning
• Design of the preparation
• Fabrication
• Try in
• Finishing and polishing
• Indications
1. restoration of conservative cavity preparation
that have an isthmus of les than one third the
cuspal distance
2. replacement of composite restorations
3. replacement of existing metallic restorations
due to esthetics

• Contraindications
1. patients with Para functional habits
2. if Occlusal forces are high
• Advantages
high esthetics
better control of contacts and contours
good marginal adaptation
reduced lab fees
ready reparability of material intraorally
reduced polymerization shrinkage
good strength
• Disadvantages
needs special equipment
needs indirect composite materials
Composite resin inlay
systems
Newer generation of indirects resin materials that
has been termed ceromers or ceramic optimized
polymers.

Currently, four ceromer products are widely used:

• Artglass (Heraeus Kulzer),
• BelleGlass HP (Kerr),
• Targis (Ivoclar), and
• Skulptur FibreKor (Jeneric/Pentron).

These materials are reported to have greater

durability, fracture toughness, wear resistance,
esthetics, and repairability.
 Design of the preparation
• Same as inlay cavity
• Single path of insertion
• Slight flaring of the proximal margins
• No occlusal bevel
• Gingival cavosurface bevel
• Cavosurface margins should not be placed in the centric
holding areas
• Walls should be smooth, no irregularities and undercuts.
• Divergence of the walls – 15/200
• Preparation should be 0.5mm into dentin
• If the remaining dentin is less than 1mm over the pulp –
base protection to be given
Fabrication

• Two types of fabrication

- indirect technique
- combined direct-indirect
technique
direct-indirect technique

• For this technique composite resin inlay

is fabricated directly in the tooth
preparation in the mouth and then inlay
is removed and cured in the oven
• Rubber dam application mandatory
• Materials used
brilliant direct inlay system
true vitality system
PROXIMAL CURING

REMOVAL OF INLAY

CURED OUTSIDE
• Composite resin inlay material placement
- first in the proximal box then occlusally
placed
- light cured for 60 seconds

Inlay removal
- removed with a scaler or by use of an
dental floss from the inter proximal region
Oven tempering
- first inlay is cured again for 60 seconds
- then heat cured in a DI-500 oven for 7
minutes at 1100c
OVENS
• Advantages of direct-indirect technique
- no need to take impression
- single visit

COMPLETED INLAY RESTORATION

Indirect technique
• In this technique inlay fabrication is done by
taking an impression and fabricated on a die
-Systems used – clearfil cr inlay system
-Can be done in one visit or two visits

• One visit method – taking rubber base

Impression, cast is made and fabricated by help of
trained personal - 30 minutes
• Two visit method -- impression is made send to
lab for fabrication of the inlay
Steps in fabrication of inlay by -indirect technique
• Cavity prepared
• Impression is made
• Using die stone cast is made
• Cast is sectioned and mounted
• Inlay fabricated
- margins marked with the pencil
- separating medium to be applied and gently air dried
- composite placed , light cured for 40 seconds (each surface)
- inlay is removed from the die
• Heat treatment
- in oven for 15 minutes at 1000c
• Finishing and polishing
• Characterization
-cleaned in ultrasonic bath
- if staining of the pits and fissures are needed, stain is applied
and cured for 40 seconds
Try in

• Evaluation for irregularities

• Throat pack is placed
• Inlay is gently seated
• Check for occlusal interferences
• Proximal surface is verified for margins if nay
can be disked with soflex discs
• Cavosurface- nay excesses can be trimmed
with – os-2/et 4 finishing bur
• For indirect inlay – occlusion is checked and
adjusted on the die
Try in
Finishing and polishing

• 9/16/30 bladed E T finishing bur

• Occlusal grooves or fissures -
OS3/OS4/16-30 fluted carbide burs
• Restoration is finished with aluminum
oxide polymer disk
• Final polish - polishing paste on a cup
Completed composite inlay restoration
Posterior Bonded Porcelain Restoratiions
Ceramic inlays were introduced in 1913 but
did not become popular
• Difficulties in fabrication
• High failure rate

In 1980s Development of compatible

refractory
materials made fabrication easier
Development of abrasive resin cements
greatly
improved clinical success rates
 INDICATIONS
 Small to moderate carious lesions

 Large carious or traumatic lesions with undermined

enamel to the extent that a cast-metal restoration or a
full crown normally becomes necessary.

 Endodontically compromised tooth.

 Where metal allergy is a factor

 The restoration of teeth in an arch opposed by already

present porcelain restorations.

 Teeth where it is difficult to develop retention form.

CONTRAINDICATIONS

 Heavy occlusal forces

Inability to maintain a dry field.

Deep sub gingival preparations.

 ADVANTAGES
• Improved physical properties.

• Improved wear resistance.

• Radiodensity

• Ability to strengthen remaining tooth structure.

• More precise control of contours & contacts.

• Biocompatibility & good tissue response.

DISADVANTAGES
• INCREASED COST & TIME

• TECHNIQUE-SENSITIVITY

• BRITTLENESS OF CERAMICS

• WEAR OF OPPOSING DENTITION & RESTORATIONS

• RESIN TO RESIN BONDING DIFFICULTIES

• LOW POTENTIAL FOR REPAIR

• DIFFICULT INTRAORAL POLISHING

Difference between tooth preparation for porcelain & cast gold inlay
Porcelain

• All margins should have a 90° butt joint cavosurface angle

• Carbide or diamond bur used – tapering instrument
• Occlusal step should be 1.5-2mm
• Axial reduction – 1-1.5mm
• Clearance – Atleast 0.5mm
• If facial & lingual surfaces affected, gingival shoulder is necessary
If cusp capping required – reduced 1.5-2mm & 90° cavosurface
angle should extend beyond contact with opposing tooth
Stains on external surfaces should be removed
PRINCIPLES OF CAVITY
PREPARATION FOR INLAY
TWO ALTERNATE FORMS FOR PULPAL FLOOR OF CAVITY
PREPARATION;FORM IS DEPENDENT ON CAVITY DEPTH
PRINCIPLES OF CAVITY
PREPARATION FOR ONLAY
ARMAMENTARIUM

C.I.P two-grit diamond Round micro-fine diamond C.I.P no.4

PROCEDURE FOR PORCELAIN INLAY
 Materials
Feldspathic porcelain
Hot pressed ceramics
Machinable ceramics
for CAD/CAM
system
Ceramics can be designed by CAD-CAM

technology.The restorations can be made

to fit the teeth accurately with excellent

esthetics for better function.

Cerec 1 -1987

Cerec 2-1994

Cerec 3-2000

Cerec in lab-2001
THE STEPS REQUIRED FOR MAKING
A CAD-CAM RESTORATION ARE--

OPTICAL IMPRESSION WITH AN INTRA

ORAL SENSOR

MILLING PROCESS

CEMENTATION OF THE
RESTORATION
 ADVANTAGES OF CAD/ CAM TECHNIQUE

• COMPLETE CONTROL

• SINGLE APPOINTMENT

• NO IMPRESSION

• NO PROVISIONAL RESTORATION REQUIRED

• COST CONTROL

• HIGH BONDABLE QUALITY RESTORATION

• BETTER FIT
 • REDUCED MARGINAL GAP.

• LESS FRACTURE OF THE INLAY, BECAUSE IT IS MILLED

FROM A SOLID,HOMOGENEOUS BLOCK.

• IMPROVED ESTHETICS.

• EXCELLENT POLISHING CHARACTERISTICS.

• LESS REDUCTION OF TOOTH STRUCTURE, HENCE

BETTER PERIODONTAL HEALTH.
THE FUTURE OF ESTHETIC RESTORATIVE
DENTISTRY WILL NO DOUBT SEE
CONSIDERABLE IMPROVEMENT IN
LONGER-LASTING CEMENTING
MATERIALS, EASE OF CONSTRUCTION,
AND IN THE PORCELAIN MATERIALS
THEMSELVES.

FINALLY, FUTURE DEVELOPMENTS IN CAD-

CAM CAPABILITY WILL NO DOUBT HAVE A
POSITIVE EFFECT ON ALL ASPECTS OF
BOTH ANTERIOR AND POSTERIOR
RESTORATIONS…
THANK U