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This document provides information about class II inlays, including definitions, history, materials, indications, contraindications, advantages, disadvantages, and the tooth preparation and fabrication process. Class II inlays involve the occlusal and proximal surfaces of posterior teeth. Key steps in tooth preparation include creating an occlusal box, proximal boxes, bevels, flares, and tapers for resistance and retention forms. Impressions can be made directly or indirectly using addition or carving techniques with inlay wax. The finished casting is then cemented into the prepared tooth.

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CLASS-II INLAY B.Sai Madhuri 1st year MDS
CONTENTS  Definition  History  Material for cast restoration  Indication  Contraindications  Advantages  Disadvantages  Steps of tooth preparation  Bevels and flares  Modifications  Inlay wax  Impression techniques  References
 Class II inlay involves the occlusal and proximal surfaces of a posterior tooth and may cap one or more, but not all of the cusps -Studevant, 7th ed  A fixed intracoronal restoration; a dental restoration made outside of a tooth to correspond to the form of the prepared cavity, which is then luted into the tooth. - GPT 9  Inlays are entirely intracoronal restorations, most commonly with occlusal and proximal extensions - summit 4th ed  Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions -Shillingburg Definitions
History  Metal casting : Lost wax/ “Cire perdue” method  Agiulhon de Saran in 1844: Inlay in investment mold with molten Gold  B.F. Philbrook: simplified version of casting process in 1897  Porcelain inlays : 1857 later replaced by the cast gold inlays  William Taggart in 1907: Technique of fabrication of gold castings  Centrifugal casting machine : Jamieson in 1907  1985: first ceramic inlay CAD/CAM Schluein TM. Significant events in the history of Operative dentistry. Journal of History of Dentistry. Vol 53. No 2.2005.63-72
Material for cast restoration  ADA Speciication No. 5  Requires a minimum total gold plus-platinum-metals content of 75 weight percent (wt%). Acc to sturdevant four distinct groups of alloys are in use for cast restorations: (1) Traditional high-gold alloys, (2) Low-gold alloys, (3) Palladium–silver alloys, and (4) Base metal alloy . Studevant’s Art and science of operative dentistry – 7th edition
Acc to marzouk Class I – Gold and Platinum based alloys Class II- low gold alloys <50% Class III- non Gold, Palladium based alloys Class IV- Nickel-Chromium based alloys Class V – Castable and moldable ceramics Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
 Type-I (Soft): For restorations subject to very slight stress such as inlays.  Type-II (Medium): For restorations subject to moderate stress such as onlays.  Type-III (Hard): For high-stress situations, including onlays, crowns, thick veneer crowns and short-span fixed partial dentures.  Type-IV (Extra hard): For extremely high stress states, such as endodontic posts and cores, thin veneer crowns, long span fixed partial dentures and removable partial dentures Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
Indication  Large Restoration  Endodontically Treated Teeth  Teeth at risk for Fracture  Removable Prosthodontic Abutment  Dental rehabilitation with cast metal alloys  Diastema closure and occlusal plane correction . Studevant’s Art and science of operative dentistry – 7th edition
Contraindications  High caries rate  Young patients  Esthetics  Small restorations . Studevant’s Art and science of operative dentistry – 7th edition
Advantages  Strength  Biocompatibility  Low wear  Control of contours and contacts . Studevant’s Art and science of operative dentistry – 7th edition
Disadvantages  Number of Appointment and Higher Chair Time  Temporary Restoration  Cost  Technique Sensitivity  Splitting Force . Studevant’s Art and science of operative dentistry – 7th edition
Basic concepts of cavity design  Inlay taper  Bevels and Flares  Variation in proximal design Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Initial Procedure  Occlusion  Anesthesia  Consideration for Temporary Restoration . Studevant’s Art and science of operative dentistry – 7th edition
Tooth Preparation for Class  II Cast- Metal Restoration  Initial Preparation . Studevant’s Art and science of operative dentistry – 7th edition
Occlusal Step . Studevant’s Art and science of operative dentistry – 7th edition
. Studevant’s Art and science of operative dentistry – 7th edition
Proximal box . Studevant’s Art and science of operative dentistry – 7th edition
. Studevant’s Art and science of operative dentistry – 7th edition
. Studevant’s Art and science of operative dentistry – 7th edition
Inlay taper  In extracoronal preparation walls must converge from the cervical to the occlusal surface. This is the concept Of taper.  Taper permits an unobstructed removal of the wax pattern & seating of the subsequent casting.  The taper is 2-5 degree from the path of preparation  Each wall should make a right angle or slightly obtuse angle with the pulpal floor.  Longer preparations require taper in higher range, short preparations in the lower range . Studevant’s Art and science of operative dentistry – 7th edition
 Extension of opposing walls, which diverge toward the occlusal form a convergent angle ‘b’.  A bisection of this angle positions the “line of draw” which is perpendicular to the pulpal floor. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Final Preparation Removal of Soft Dentin and Pulp Protection . Studevant’s Art and science of operative dentistry – 7th edition
. Studevant’s Art and science of operative dentistry – 7th edition
 Bevels are the flexible extensions of a cavity preparation, allowing the inclusion of surface defects, supplementary grooves, or other areas on the tooth surface.  Beveling of enamel margins serve the following purposes 1. Obtuse -angled tooth structure i.e. the strongest configuration and acute-angled marginal alloy i.e. burnishable. Thus makes it possible to decrease the cement line. 2. A lap, sliding fit is produced at gingival margin. 3. It results in 30- degree metal that is burnishable. 4. Weak enamel is removed. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
 Properly directed gingival bevel resulting in 30 degree marginal metal  Failing to bevel gingival margin resulting in undermined rods and difficulty in burnishing A cavosurface enamel angle of more than 150 degrees is incorrect because it results in a less defined enamel margin (finish line), and the marginal cast-metal alloy is too thin and weak if its angle is less than 30 degrees. Conversely, if the enamel margin is 140 degrees or less, the metal is too bulky and difficult to burnish when its angle is greater than 40 degrees Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
 Noy’s requirements 1. If preparation ends on enamel, the enamel must be supported by sound dentin 2. Enamel rods forming the cavosurface margin should be continuous with sound dentin & covered with restorative material Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Types of bevel  Partial bevel  Short bevel  Long bevel  Full bevel  Hollow ground bevel  Counter bevel Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
 Partial bevel Involves the part of the enamel wall, not exceeding 2/3rd of its dimensions.  Not used in cast restorations  Used to trim weak enamel rods from margin peripheries Short bevel Includes the entire enamel wall but not dentin  Long bevel Includes all of the enamel wall & up to one half of the dentinal wall.  Advantage: preserves the internal boxed up resistance & retention features of the preparation  Counter bevel Given opposite to an axial wall, on the facial or lingual surface with the gingival inclination facially or lingually.  Used for the capping of cusps to protect & support them `  Full bevel Includes all of the dentinal & enamel walls .  Disadvantag e: deprives the preparations internal resistance & retention form Hollow ground (concave) bevel Prepared in concave form. It allows more space for cast material bulk Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Flares  Primary flare  Secondary flare Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
. Studevant’s Art and science of operative dentistry – 7th edition
. Studevant’s Art and science of operative dentistry – 7th edition
Summit JB, Robbins JW, Schwartz RS. Fundamentals of Operative Dentistry. A Contemporary Approach. 2nd edition
. Studevant’s Art and science of operative dentistry – 7th edition
Modifications of proximal box preparation  Box preparation  Slice preparation  Auxiliary slice preparation  Modified flare Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Box preparation  Introduced by Dr.G.V.Black  Proximal cavities are box shaped.  Advantages • Resistence and retention form • The outline form can be made on all types of teeth. • Minimum display of metal.  Disadvantages • Involves removal of lot of tooth structure. • Time consuming clinically. • Narrow bevels leave a sharp edge and an undercut gingivally, which cannot be reproduced satisfactorily. • While taking impressions, distortions and breaking of wax pattern occurs Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Slice preparations  This form of cavity is modified so that the proximal surface is flat without definite side walls.  Retention mainly depends upon occlusal key, locks cut in the axial wall.  Indications  As abutment in bridge work.  Teeth with proximal undercuts can be eliminated which facilitates taking impression.  For indirect wax pattern technique. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
 Advantages : • Less tooth structure is sacrificed. • Quicker and easier. • Well protected enamel margins. • Increase resistence and retention by exposing larger amount of tooth structure.  Disadvantages : • It displays more amount of gold. • Direct wax pattern cannot be made as distinguishing between margins become difficult. • Metal margins are likely to distort due to less thickness Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
CONTENTS  Definition  History  Material for cast restoration  Indication  Contraindications  Advantages  Disadvantages  Steps of tooth preparation  Bevels and flares  Modifications  Inlay wax  Wax pattern  Sprue  References
Auxiliary slice preparations  Wraps partially around the proximal line angles, thus providing additional support.  Resistance form is enhanced  Provide external retention form. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Modified flare preparation  Modified flare is a combination of box preparation and slice preparation.  Minimum disking of proximal walls is done for better finishing and polishing. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Modifications in Inlay Tooth Preparations  Mesioocclusodistal Preparation  Modifications of Class II Preparation for Esthetics . Studevant’s Art and science of operative dentistry – 7th edition
 Facial or Lingual Surface Groove Extension . Studevant’s Art and science of operative dentistry – 7th edition
 Class  II Preparation for Abutment Teeth and Extension Gingivally to Include Root-Surface Lesion . Studevant’s Art and science of operative dentistry – 7th edition
 Maxillary First Molar With Unaffected, Strong Oblique Ridge – also called as Tucker Technique
Auxillary retention forms  Luting cement  Reverse bevel  Internal box  Pins  Collars  Skirts  Roughening of pulpal floor  Electrolytic etching of inlay Proximal & occlusal surface protected with wax Kept in electrolyte solution of 0.5 normal nitric acid Inlay-anode & metal with greater EMF cathode Current causes microporosities and enables flow of luting cement for better retention Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
Textbook of operative dentistry –Vimal K Sikiri - 4nd edition
Textbook of operative dentistry –Vimal K Sikiri - 4nd edition
Inlay wax  ADA SP. NO. 4  Types 1. Type I – medium wax – direct technique 2. Type II – soft wax – indirect technique Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Composition  Paraffin wax  Ceresin  Gum dammar  Carnuaba wax  Candelilla Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Properties  When softened, the wax should be uniform.  Color should contrast with the die or tooth.  No flakiness.  No chipping.  Completely vaporize during burnout.  Completely rigid & dimensionally stable at all time Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Flow:  lacks rigidity, flows at room temperature • type I – 1% at 37°C • type I & II- 70-90% at 45°C Coefficient of thermal expansion : The rate of expansion of type 1 inlay wax is greatest from just below mouth temp. to above 45 C Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Impression techniques Impression technique Direct technique Open method- with matrix band Closed method- without matrix Indirect technique Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
PKT instruments  No. 1 and no. 2 are wax addition instruments  No. 3 is a burnisher for refining occlusal anatomy  Nos. 4 and 5 are wax carvers. Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209.
Direct technique Tissue compatible lubricant is placed in the internal surface of the prepared tooth and adjacent tooth Piece of wax is placed on band and is flamed to achieve hanging drop and band is immediately place on tooth and pushed 2-3mm cervically The wax is added PKT no1 or no 2. Whenever subsequent layers of wax are added the previous layer which was applied should be remelted or else creases or folds would form on fitting surface Adequate bulk should be provided at proximal and axial surface in order to prevent distortion while removal Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209. Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Finger pressure is maintained while the wax is cooled and hardened The bulk of excess wax is then trimmed using PKT 3,4 & 5. A moistened cotton is firmly placed on occlusal surface to stabilize the pattern during carving Matrix Retainer is loosened and removed Wax is held firmly in place and band is removed A narrow strip of copper ribbon is bent into a ‘V’ or ‘U’ shape, heated over the flame and quickly inserted as a staple into the marginal ridge areas of the wax pattern THE PATTERN IS CAREFULLY INSPECTED FOR: Sharp internal details Good reproduction of the cavosurface and gingival margins Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
The pattern is again seated in the cavity. A heated instrument is held lightly against the copper staple, thus facilitating its removal Pattern is then carved. Prepared tooth & opposing tooth is isolated and dried with cotton rolls. With camel hair brush, talcum powder is dusted on the occlusal surface of the wax and the patient is instructed to close the teeth lightly Cuspal contact with the wax pattern is indicated by a shiny burnished spot on the pattern. The spots of hyperocclusion are carved away using warm carvers Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Direct technique – without matrix band  Simple conservative preparation of class 2 Contraindicated- no adjacent teeth preparation with deep cervical floor most of class 3,4 &5 Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Disadvantages  Great skill & patience is required  Greater tendency for wax pattern to get distorted.  Indirect vision is required.  Discrepancies at the gingival margin is difficult to detect  If the casting fails patient has to be recalled Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
Indirect method  Wax pattern is made on the die.  Type -2 inlay wax.  More commonly used technique Disadvantages  The model may not be the exact replica of the tooth.  Time consuming procedure. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
The double-inlay technique Use of both materials ( gold + ceramics) to add the strength of metal to the esthetics of ceramic.
Sprue Sprue former, or sprue pin, is to provide a channel through which molten alloy can reach the mold in an invested ring after the wax has been eliminated. A sprue former can be made up of Wax Plastic Metal Diameter and length depend  Type and size of the pattern  Type of casting machine and  Dimensions of the flask or ring Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Wax pattern removal Sprue former attached to the wax pattern on the master die provided that the pattern can be removed directly in line with its path of withdrawal from the die. Sprue diameter Same size as the thickest area of the wax pattern  large sprue former to a thin, delicate pattern could cause distortion  Small sprue former solidify before the casting itself localized shrinkage porosity (“suck-back” porosity) Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Sprue position  Proximal wall or just below a nonfunctional cusp to minimize subsequent grinding of occlusal anatomy and contact areas  Ideal area for the sprue former is the point of greatest bulk in the pattern to avoid distorting thin areas of wax during attachment to the pattern Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Sprue attachment The sprue former connection to the wax pattern is generally flared for high-density gold alloys but often restricted for lower-density alloys  Function – same as reservoir Direct spruing - The sprue former provides a direct connection between the pattern area and the sprue base. Indirect spruing - A connector or reservoir bar is positioned between the pattern and the crucible former Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Sprue direction –  Should be directed away from any thin or delicate parts of the pattern  Sprued at a 45° angle to the proximal area  Should not be attached to a broad flat surface at a right angle – causes turbulence within the mold cavity and severe porosity Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Sprue length Depends on the length of the casting ring Sprue length should be adjusted so that the top of the wax pattern is within 6 mm of the open end of the ring for gypsum-bonded investments 3mm - higher-strength phosphatebonded investments too short, the wax pattern – incomplete elimination of gases - porosities Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
Causes of gold inlay failures are (1) recurrent caries, (2) periodontal breakdown, (3) sensitive teeth, (4) tooth fracture, (5) poor esthetics, and (6) loss of retention. Fayle, H. E. (1973). Gold inlay failures and some causes. The Journal of Prosthetic Dentistry, 29(4), 439–441.
Conclusion Cast restorations form an integral link in the dental restorative chain. They are an excellent choice in many demanding situations. Understanding the principles of tooth preparations and the intricacies of cast restorations will enable the dentist to optimally utilize this excellent option when the clinical situation demands.
 Studevant’s Art and science of operative dentistry – 7th edition  Schluein TM. Significant events in the history of Operative dentistry. Journal of History of Dentistry. Vol 53. No 2.2005.63-72  Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition  Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition  Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition  Summit JB, Robbins JW, Schwartz RS. Fundamentals of Operative Dentistry. A Contemporary Approach. 2nd edition  Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209.  Textbook of operative dentistry –Vimal K Sikiri - 4nd edition  GPT-9
class 2 inlay 1.pptx

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class 2 inlay 1.pptx

  • 2.
  • 3.
    CONTENTS  Definition  History Material for cast restoration  Indication  Contraindications  Advantages  Disadvantages  Steps of tooth preparation  Bevels and flares  Modifications  Inlay wax  Impression techniques  References
  • 4.
     Class IIinlay involves the occlusal and proximal surfaces of a posterior tooth and may cap one or more, but not all of the cusps -Studevant, 7th ed  A fixed intracoronal restoration; a dental restoration made outside of a tooth to correspond to the form of the prepared cavity, which is then luted into the tooth. - GPT 9  Inlays are entirely intracoronal restorations, most commonly with occlusal and proximal extensions - summit 4th ed  Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions -Shillingburg Definitions
  • 5.
    History  Metal casting: Lost wax/ “Cire perdue” method  Agiulhon de Saran in 1844: Inlay in investment mold with molten Gold  B.F. Philbrook: simplified version of casting process in 1897  Porcelain inlays : 1857 later replaced by the cast gold inlays  William Taggart in 1907: Technique of fabrication of gold castings  Centrifugal casting machine : Jamieson in 1907  1985: first ceramic inlay CAD/CAM Schluein TM. Significant events in the history of Operative dentistry. Journal of History of Dentistry. Vol 53. No 2.2005.63-72
  • 6.
    Material for castrestoration  ADA Speciication No. 5  Requires a minimum total gold plus-platinum-metals content of 75 weight percent (wt%). Acc to sturdevant four distinct groups of alloys are in use for cast restorations: (1) Traditional high-gold alloys, (2) Low-gold alloys, (3) Palladium–silver alloys, and (4) Base metal alloy . Studevant’s Art and science of operative dentistry – 7th edition
  • 7.
    Acc to marzouk ClassI – Gold and Platinum based alloys Class II- low gold alloys <50% Class III- non Gold, Palladium based alloys Class IV- Nickel-Chromium based alloys Class V – Castable and moldable ceramics Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
  • 8.
     Type-I (Soft):For restorations subject to very slight stress such as inlays.  Type-II (Medium): For restorations subject to moderate stress such as onlays.  Type-III (Hard): For high-stress situations, including onlays, crowns, thick veneer crowns and short-span fixed partial dentures.  Type-IV (Extra hard): For extremely high stress states, such as endodontic posts and cores, thin veneer crowns, long span fixed partial dentures and removable partial dentures Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
  • 9.
    Indication  Large Restoration Endodontically Treated Teeth  Teeth at risk for Fracture  Removable Prosthodontic Abutment  Dental rehabilitation with cast metal alloys  Diastema closure and occlusal plane correction . Studevant’s Art and science of operative dentistry – 7th edition
  • 10.
    Contraindications  High cariesrate  Young patients  Esthetics  Small restorations . Studevant’s Art and science of operative dentistry – 7th edition
  • 11.
    Advantages  Strength  Biocompatibility Low wear  Control of contours and contacts . Studevant’s Art and science of operative dentistry – 7th edition
  • 12.
    Disadvantages  Number ofAppointment and Higher Chair Time  Temporary Restoration  Cost  Technique Sensitivity  Splitting Force . Studevant’s Art and science of operative dentistry – 7th edition
  • 13.
    Basic concepts ofcavity design  Inlay taper  Bevels and Flares  Variation in proximal design Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 14.
    Initial Procedure  Occlusion Anesthesia  Consideration for Temporary Restoration . Studevant’s Art and science of operative dentistry – 7th edition
  • 15.
    Tooth Preparation forClass  II Cast- Metal Restoration  Initial Preparation . Studevant’s Art and science of operative dentistry – 7th edition
  • 16.
    Occlusal Step . Studevant’sArt and science of operative dentistry – 7th edition
  • 17.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 18.
    Proximal box . Studevant’sArt and science of operative dentistry – 7th edition
  • 19.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 20.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 21.
    Inlay taper  Inextracoronal preparation walls must converge from the cervical to the occlusal surface. This is the concept Of taper.  Taper permits an unobstructed removal of the wax pattern & seating of the subsequent casting.  The taper is 2-5 degree from the path of preparation  Each wall should make a right angle or slightly obtuse angle with the pulpal floor.  Longer preparations require taper in higher range, short preparations in the lower range . Studevant’s Art and science of operative dentistry – 7th edition
  • 22.
     Extension ofopposing walls, which diverge toward the occlusal form a convergent angle ‘b’.  A bisection of this angle positions the “line of draw” which is perpendicular to the pulpal floor. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 23.
    Final Preparation Removal ofSoft Dentin and Pulp Protection . Studevant’s Art and science of operative dentistry – 7th edition
  • 24.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 25.
     Bevels arethe flexible extensions of a cavity preparation, allowing the inclusion of surface defects, supplementary grooves, or other areas on the tooth surface.  Beveling of enamel margins serve the following purposes 1. Obtuse -angled tooth structure i.e. the strongest configuration and acute-angled marginal alloy i.e. burnishable. Thus makes it possible to decrease the cement line. 2. A lap, sliding fit is produced at gingival margin. 3. It results in 30- degree metal that is burnishable. 4. Weak enamel is removed. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 26.
     Properly directedgingival bevel resulting in 30 degree marginal metal  Failing to bevel gingival margin resulting in undermined rods and difficulty in burnishing A cavosurface enamel angle of more than 150 degrees is incorrect because it results in a less defined enamel margin (finish line), and the marginal cast-metal alloy is too thin and weak if its angle is less than 30 degrees. Conversely, if the enamel margin is 140 degrees or less, the metal is too bulky and difficult to burnish when its angle is greater than 40 degrees Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 27.
     Noy’s requirements 1.If preparation ends on enamel, the enamel must be supported by sound dentin 2. Enamel rods forming the cavosurface margin should be continuous with sound dentin & covered with restorative material Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 28.
    Types of bevel Partial bevel  Short bevel  Long bevel  Full bevel  Hollow ground bevel  Counter bevel Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 29.
     Partial bevel Involvesthe part of the enamel wall, not exceeding 2/3rd of its dimensions.  Not used in cast restorations  Used to trim weak enamel rods from margin peripheries Short bevel Includes the entire enamel wall but not dentin  Long bevel Includes all of the enamel wall & up to one half of the dentinal wall.  Advantage: preserves the internal boxed up resistance & retention features of the preparation  Counter bevel Given opposite to an axial wall, on the facial or lingual surface with the gingival inclination facially or lingually.  Used for the capping of cusps to protect & support them `  Full bevel Includes all of the dentinal & enamel walls .  Disadvantag e: deprives the preparations internal resistance & retention form Hollow ground (concave) bevel Prepared in concave form. It allows more space for cast material bulk Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 30.
    Flares  Primary flare Secondary flare Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 31.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 32.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 33.
    Summit JB, RobbinsJW, Schwartz RS. Fundamentals of Operative Dentistry. A Contemporary Approach. 2nd edition
  • 34.
    . Studevant’s Artand science of operative dentistry – 7th edition
  • 35.
    Modifications of proximalbox preparation  Box preparation  Slice preparation  Auxiliary slice preparation  Modified flare Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 36.
    Box preparation  Introducedby Dr.G.V.Black  Proximal cavities are box shaped.  Advantages • Resistence and retention form • The outline form can be made on all types of teeth. • Minimum display of metal.  Disadvantages • Involves removal of lot of tooth structure. • Time consuming clinically. • Narrow bevels leave a sharp edge and an undercut gingivally, which cannot be reproduced satisfactorily. • While taking impressions, distortions and breaking of wax pattern occurs Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 37.
    Slice preparations  Thisform of cavity is modified so that the proximal surface is flat without definite side walls.  Retention mainly depends upon occlusal key, locks cut in the axial wall.  Indications  As abutment in bridge work.  Teeth with proximal undercuts can be eliminated which facilitates taking impression.  For indirect wax pattern technique. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 38.
     Advantages : •Less tooth structure is sacrificed. • Quicker and easier. • Well protected enamel margins. • Increase resistence and retention by exposing larger amount of tooth structure.  Disadvantages : • It displays more amount of gold. • Direct wax pattern cannot be made as distinguishing between margins become difficult. • Metal margins are likely to distort due to less thickness Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 40.
    CONTENTS  Definition  History Material for cast restoration  Indication  Contraindications  Advantages  Disadvantages  Steps of tooth preparation  Bevels and flares  Modifications  Inlay wax  Wax pattern  Sprue  References
  • 41.
    Auxiliary slice preparations Wraps partially around the proximal line angles, thus providing additional support.  Resistance form is enhanced  Provide external retention form. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 42.
    Modified flare preparation Modified flare is a combination of box preparation and slice preparation.  Minimum disking of proximal walls is done for better finishing and polishing. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 43.
    Modifications in InlayTooth Preparations  Mesioocclusodistal Preparation  Modifications of Class II Preparation for Esthetics . Studevant’s Art and science of operative dentistry – 7th edition
  • 44.
     Facial orLingual Surface Groove Extension . Studevant’s Art and science of operative dentistry – 7th edition
  • 45.
     Class  IIPreparation for Abutment Teeth and Extension Gingivally to Include Root-Surface Lesion . Studevant’s Art and science of operative dentistry – 7th edition
  • 46.
     Maxillary FirstMolar With Unaffected, Strong Oblique Ridge – also called as Tucker Technique
  • 47.
    Auxillary retention forms Luting cement  Reverse bevel  Internal box  Pins  Collars  Skirts  Roughening of pulpal floor  Electrolytic etching of inlay Proximal & occlusal surface protected with wax Kept in electrolyte solution of 0.5 normal nitric acid Inlay-anode & metal with greater EMF cathode Current causes microporosities and enables flow of luting cement for better retention Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition
  • 48.
    Textbook of operativedentistry –Vimal K Sikiri - 4nd edition
  • 49.
    Textbook of operativedentistry –Vimal K Sikiri - 4nd edition
  • 50.
    Inlay wax  ADASP. NO. 4  Types 1. Type I – medium wax – direct technique 2. Type II – soft wax – indirect technique Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 51.
    Composition  Paraffin wax Ceresin  Gum dammar  Carnuaba wax  Candelilla Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 52.
    Properties  When softened,the wax should be uniform.  Color should contrast with the die or tooth.  No flakiness.  No chipping.  Completely vaporize during burnout.  Completely rigid & dimensionally stable at all time Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 53.
    Flow:  lacks rigidity,flows at room temperature • type I – 1% at 37°C • type I & II- 70-90% at 45°C Coefficient of thermal expansion : The rate of expansion of type 1 inlay wax is greatest from just below mouth temp. to above 45 C Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 54.
    Impression techniques Impression technique Direct technique Open method- withmatrix band Closed method- without matrix Indirect technique Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 55.
    PKT instruments  No.1 and no. 2 are wax addition instruments  No. 3 is a burnisher for refining occlusal anatomy  Nos. 4 and 5 are wax carvers. Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209.
  • 56.
    Direct technique Tissue compatiblelubricant is placed in the internal surface of the prepared tooth and adjacent tooth Piece of wax is placed on band and is flamed to achieve hanging drop and band is immediately place on tooth and pushed 2-3mm cervically The wax is added PKT no1 or no 2. Whenever subsequent layers of wax are added the previous layer which was applied should be remelted or else creases or folds would form on fitting surface Adequate bulk should be provided at proximal and axial surface in order to prevent distortion while removal Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209. Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 57.
    Finger pressure ismaintained while the wax is cooled and hardened The bulk of excess wax is then trimmed using PKT 3,4 & 5. A moistened cotton is firmly placed on occlusal surface to stabilize the pattern during carving Matrix Retainer is loosened and removed Wax is held firmly in place and band is removed A narrow strip of copper ribbon is bent into a ‘V’ or ‘U’ shape, heated over the flame and quickly inserted as a staple into the marginal ridge areas of the wax pattern THE PATTERN IS CAREFULLY INSPECTED FOR: Sharp internal details Good reproduction of the cavosurface and gingival margins Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 58.
    The pattern isagain seated in the cavity. A heated instrument is held lightly against the copper staple, thus facilitating its removal Pattern is then carved. Prepared tooth & opposing tooth is isolated and dried with cotton rolls. With camel hair brush, talcum powder is dusted on the occlusal surface of the wax and the patient is instructed to close the teeth lightly Cuspal contact with the wax pattern is indicated by a shiny burnished spot on the pattern. The spots of hyperocclusion are carved away using warm carvers Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 59.
    Direct technique –without matrix band  Simple conservative preparation of class 2 Contraindicated- no adjacent teeth preparation with deep cervical floor most of class 3,4 &5 Textbook of operative dentistry –Vimal K Sikiri - 4nd edition Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 60.
    Disadvantages  Great skill& patience is required  Greater tendency for wax pattern to get distorted.  Indirect vision is required.  Discrepancies at the gingival margin is difficult to detect  If the casting fails patient has to be recalled Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 61.
    Indirect method  Waxpattern is made on the die.  Type -2 inlay wax.  More commonly used technique Disadvantages  The model may not be the exact replica of the tooth.  Time consuming procedure. Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition
  • 62.
    The double-inlay technique Useof both materials ( gold + ceramics) to add the strength of metal to the esthetics of ceramic.
  • 63.
    Sprue Sprue former, orsprue pin, is to provide a channel through which molten alloy can reach the mold in an invested ring after the wax has been eliminated. A sprue former can be made up of Wax Plastic Metal Diameter and length depend  Type and size of the pattern  Type of casting machine and  Dimensions of the flask or ring Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 64.
    Wax pattern removal Sprueformer attached to the wax pattern on the master die provided that the pattern can be removed directly in line with its path of withdrawal from the die. Sprue diameter Same size as the thickest area of the wax pattern  large sprue former to a thin, delicate pattern could cause distortion  Small sprue former solidify before the casting itself localized shrinkage porosity (“suck-back” porosity) Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 65.
    Sprue position  Proximalwall or just below a nonfunctional cusp to minimize subsequent grinding of occlusal anatomy and contact areas  Ideal area for the sprue former is the point of greatest bulk in the pattern to avoid distorting thin areas of wax during attachment to the pattern Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 66.
    Sprue attachment The sprueformer connection to the wax pattern is generally flared for high-density gold alloys but often restricted for lower-density alloys  Function – same as reservoir Direct spruing - The sprue former provides a direct connection between the pattern area and the sprue base. Indirect spruing - A connector or reservoir bar is positioned between the pattern and the crucible former Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 67.
    Sprue direction – Should be directed away from any thin or delicate parts of the pattern  Sprued at a 45° angle to the proximal area  Should not be attached to a broad flat surface at a right angle – causes turbulence within the mold cavity and severe porosity Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 68.
    Sprue length Depends onthe length of the casting ring Sprue length should be adjusted so that the top of the wax pattern is within 6 mm of the open end of the ring for gypsum-bonded investments 3mm - higher-strength phosphatebonded investments too short, the wax pattern – incomplete elimination of gases - porosities Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition
  • 69.
    Causes of goldinlay failures are (1) recurrent caries, (2) periodontal breakdown, (3) sensitive teeth, (4) tooth fracture, (5) poor esthetics, and (6) loss of retention. Fayle, H. E. (1973). Gold inlay failures and some causes. The Journal of Prosthetic Dentistry, 29(4), 439–441.
  • 70.
    Conclusion Cast restorations forman integral link in the dental restorative chain. They are an excellent choice in many demanding situations. Understanding the principles of tooth preparations and the intricacies of cast restorations will enable the dentist to optimally utilize this excellent option when the clinical situation demands.
  • 71.
     Studevant’s Artand science of operative dentistry – 7th edition  Schluein TM. Significant events in the history of Operative dentistry. Journal of History of Dentistry. Vol 53. No 2.2005.63-72  Marzouk MA, Simonton AL, Gross RD. Operative Dentistry- Modern Theory & Practice, 1st Edition  Principles and practice of operative dentistry – Gearld T. Charbeneau – 3rd edition  Anusavice, Shen, Rawls. Phillips’ Science of Dental Materials, 12th Edition  Summit JB, Robbins JW, Schwartz RS. Fundamentals of Operative Dentistry. A Contemporary Approach. 2nd edition  Waxing Techniques to Develop Proper Occlusal Morphology in Different Occlusal Schemes J Indian Prosthodont Soc (Oct-Dec 2011) 11(4):205–209.  Textbook of operative dentistry –Vimal K Sikiri - 4nd edition  GPT-9