Indirect resins / certified fixed orthodontic courses by Indian dental academy

INDIRECT RESINS
www.indiandentalacademy.com

CONTENTS
 Introduction
 Comparison With Direct Resin
 Indirect resin systems
 Indirect resin inlays
 Onlay Modifications
 Intracoronal Restorations
 Crown And Bridgework
 Laminate Veneers
 Restorations Of Endodontically Treated Teeth
 Indirect Resin in Adhesive Bridgework
 Application In Implant Dentistry
 Conclusion
 Bibliography

INTRODUCTION
 Indirect resins is a homogeneous microfilled
material developed to enhance the performance
of light cured resins.
 Offer excellent aesthetics combined with a
superior strength that gives a more durable
restoration.

 The resin material is a urethane dimethacrylate
with a loaded filler of
56% volume.
 Utilizes a two-stage technique
 Cured by: chemical catalyst , by light , heat or a
combination of heat and pressure
 Can be re-polished to the same lustre
 Better wear resistance

Direct (composite)
Resin
Indirect Resin
Polymerization shrinkage,
danger of porosity
Dimensionally stable, no
porosity
Variable rates of Wear leading
to restrictive use.
Wear rate comparable to
natural teeth
Microleakage around margins Much Reduced microleakage
Curing may produce
Undesirable stresses
Minimal adverse effects

Direct Resin Indirect resin
Plucking of filler
particles causes a rough
surface
Homogeneous
microfilled material
Difficulty in producing the
desired contour “freehand”
Any required design can be
fabricated in the lab
Changes in colour on
polymerization-difficulty
in colour matching
Colour stable

Physical properties
Properties Indirect resins Direct resins
Tensile strength 90-120 N/mm² 70-80 N/mm²
Deformation at 200
MPa
3.5-4.5% 8-9%
Vickers hardness 500-600 N/mm² 360-410 N/mm²
E-modulus N/mm² 7000-10000 4000-5500

Clinical wear of indirect resins
 Study by David James- ISOSIT indirect resin has
the lowest wear
 Wear rate diminishes over a long period
 University of Alabama –resin bonded crowns
wore at 7µ per year

Indirect composite resins
Name MANUFACTURER
Composite
type
Curing
method
Use
Artglass Heraeus
Kulzer
Polyglass Light Crowns, inlays,
onlays,laminate
veneers, veneers
on metal
sustructures
Belleglass
HP
Kerr ,
Sybron
dental
Polymer-
ceramic
Light,
heat and
pressure
Crowns,inlays
,onlays,laminate
veneers,veneers
on metal
sustructures,mul
tiple-unit metal
free fiber-
reinfored
restorations
sculpture Jeneric/p
entron
Polymer-
ceramic
Light,heat
and
vaccum
Crowns,inlays,
onlays,laminat
-e veneerswww.indiandentalacademy.com

Targis Ivoclar Ceramic-
optimized
polymer(cer
-omer)
Light,vaccu
-m and
pressure
Veneers on metal
substructures,multiple-
unit metal-free
fiber(Fibrekor)-
reinforced restorations
Crowns,inlays,onlays,l
a-minate
veneers,multiple-unit
metal free
fiber(Vectris)-
reinforced restoration
veneers
Clearfil
CR Inlay
Kuraray Hybrid Light
and
heat
Inlays and
onlays
Cristobal Dentsply bioglass light Crowns,inlays,onlay
-s,laminate
veneers,veneers on
metal
substructure,multipl
-e unit metal free
restorationswww.indiandentalacademy.com

Visio-Gem ESPE
Premier
Microfill Light
and
vaccum
Inlays and
onlays.lamina-
te veneers on
metal
substructures
True
vitality
Den-Mat Hybrid Heat,light,
self
Crowns,inlays,
onlays,
laminate
veneers,multi-
ple-unit metal
free
restorations
Coltene
inlay/
onlay
Coltene Hybrid Light
and heat
Inlays and
onlays,
laminate
veneers

Concept (Ivoclar/Williams)
 Heat and pressure cured
 Indirect resin inlay / onlay system
 Degree of conversion- 85%
 High compressive strength, enhanced color
stability
 Microfill , enamel–like wear
 Radiopaque , contains ytterbiumtrifluoride
 Highly polishable
 Occlusion can be adjusted after
cementation

 Easy to repair
 Greater control of ideal proximal and
anatomic contours
 Study in University of Manitoba-97%
no clinical wear
 Class 1 or 11 inlays

Artglass(1995)
 Composition
 70 wt% filler –barium-aluminosilicate
glass (0.7µm) + colloidal silica(20%)
 30 wt% organic resin- methacrylate
monomers
 Degree of conversion-54%
 Cured with high intensity, xenon
strobe light (UniXS)

 Bonded to the metal – Kevloc system
 Application
 acrylonitrile copolymer primer and a
urethane resin applied to sandblasted
metal surface
 Place and cure Artglass
 16 Vita shades
 Can be repaired intraorally
 Flexural strength-132±14MPa

BelleGlass HP(1996)
 Composition
 Resin matrix-urethane and aliphatic
dimethacrylates
 78wt%-barium glass(0.6µm)
 Degree of conversion-98.5%
 Curing with a fiber-optic light, a heat
level of 140°c , under pressure
(5 bars/ 80-85psi)

 Curing in nitrogen environment
 Flexural strength-150±16MPa
 University of Alabama-wear rate less
than 1.5µm/year

Sculpture /FibreKor
 Composition-PCDMA resin , glass filler
reinforced with glass fiber
 Hilly filled , stain resistant - low water
sorption( 9-12mg/mm³)
 FibreKor-structural integrity,
transluscency
 Biocompatible,noncytotoxic
 Easily polished and repaired intraollay

 Shock absorbing used in conjunction with
oseointegrated implants
 Polymerized in the Cure-Lite Plus / hands-
free Spectra Lite
 Surface glazed –curing in nitrogen
atmosphere
 Final curing-in heat curing unit under
vaccum
 Color stable, resistant to plaque retention
 Restorations are fluorescent

 Single-pontic implant bridges
 Incorporated in FibreKor system
 FibreKor frameworks-high flexure
strength, excellent cohesive bond
 visible light, heat curable
 5 transluscent shades, 2 sizes
 Little memory before
polymerization

Targis/Vectris
 Ceromer composition
 77wt% filler- barium glass(1µm)
,silica
 23wt% organic resin
 Final curing-Targis Power light curing
unit at approx 97°c for 25min
 Targis Link –forms bond to metal
substructures

 Durable,abrasion resistant,stable
 Excellent polishability, ease of
adjustment
 Enamel like transluscency,
fluorescence
 Low degree of brittleness, fracture
 Vectris(FRC)- metal free restoratons

Clearfil CR Inlay
 Hybrid
composite( 86.5wt%)
 6 shades, formulated
with extra body
 Processed in CRC-100
curing oven
 Bonded with-CR Inlay
cement
 Light irradiation for
40sec per surface
 Intraoral repairs-Clearfil
Photoposterior light-
cured resin

Results of a 1 year follow-up
Characteristic 60 crowns of each of Targis,
Artglass, BelleGlass
Wear Targis,Artglass,BelleGlass
Debonded from restoration Artglass 42%
Debonded from substructure Targis 28%
Post-op sensitivity High for all
Occlusal pitting Higher than 1st
generation
materials
Wear of antagonists none

Coltene Inlay system FibreKor
Visio-Gem

Indirect Inlays
 Fabrication
 Choose a shade of composite
 Remove restoration/ or caries , make a
preparation with 8-10° occlusal divergence.
 Record and pour the impression
 Remove the cast and lubricate with a seperating
media
 Place composite in the preparation , shape and
contour

Broken cusp Amalgam restoration may
require pinning
Outline of an indirect resin restoration.www.indiandentalacademy.com

 Light cure for 60seconds
 Saw die from master cast and remove the resin inlay
 Finish resin margins and contours on the die
 Postcure inlay
INSERTION
 Place the rubber dam
 Place inlay in the preparation and check for complete
seating
 Check interproximal contacts

 Air abrade the inner surface of the resin inlay
with 50µm aluminium oxide and wash.
 Place strips to protect the proximal surfaces of
adjacent teeth
 Etch for 20seconds , rinse
 Place dentin primer on the prepared tooth
 Place silane on the inner surface of the inlay
and air dry.
 Mix dual-cured adhesive resin and place a thin
coat on the inlay and the preparation

 Mix dual-cured resin cement and place into the preparation
 Place inlay in the preparation, remove excess resin
cement and light cure for 90 sec from the occlusal aspect and
30 seconds (interproximal).
FINISHING
 12-fluted pear-shaped finishing bur for occlusal margins
 12-fluted flame-shaped finishing bur for interproximal
margins and no.12 /12b scalpel blade
 Smoothen and polish with composite-finishing kit.
 Etch with phosphoric acid for 5-10 seconds and rebond .

Preparation of the maxillary first premolar for an indirect resin inlay
Impression of the inlay
preparation
Fabrication on a
silicon die
Air abrasion Preparation for
cementation of the
inlay

After
cementation
Impression
recorded
Painting the
separator prior to
fabrication
Fabrication of
inlay on the
stone die
Stone die of the
inlay preparation www.indiandentalacademy.com

Stone die sawed
and separated for
finishing of the
inlay margins
Try-in of the
indirect inlay in
the maxillary 2nd
premolar
After cementation

Carious tooth requiring
restoration
Preparation and
lining
Inlay ready to try-in On completion

Minimal occlusal lining Deep occlusal lining
Lining for a
non-vital tooth

ONLAY MODIFICATIONS
 To restore teeth
requiring cuspal
protection
 Remove 1.5-2mm of
tooth structure
 Non- bevelled margin

Red ink shows reduction of
the buccal cusp
Cusps which are
reducedwww.indiandentalacademy.com

Onlay ready for insertion Onlay attached with dual curing cement
Completed restoration

Non vital molar requiring
restoration of the access cavity

INRA-CORONAL MODIFICATIONS
 Esthetic and functional restoration
 Crown and bridgework
 Larger restorations
 Incisal repairs
 Minimal wear requirement
 Diastemas , altering tooth contour
 Should not be used in thin sections
 Avoid feather margins

Fractured lower incisors After placement of two incisor onlays
Onlay preparation for
vital lower incisor

 Splinting – with linked indirect resin inlays
 MOD channels prepared
 Impression recorded, temporized
 Separate indirect inlays fabricated
 Cut an occlusal channel
 Inlays tried for proper fit

Separate inlays and a
fitted cast metal bar
Metal bar is covered
with a ceramic opaque

Crown and bridgework
 Can be supported by precious, non-precious alloys
 Used as entire pontic or crown exterior
 For buccal facing on posterior crowns
 A chamfer – shoulder margin design
 No firing shrinkage unlike porcelain
 Gold casting margins eliminated
 Tooth margin primed with dentin bonding Agent
 Additions and repairs can be made

Occlusal designs for full coverage
restorations

first premolar requiring a full
coverage crown
Metal design before indirect resin is
applied
Occlusal view of
the fitted crown

LAMINATE VENEERS
 Indications
• Stained and discolored teeth
• Repairing chipped teeth
• Mild irregularities
• Alteration of contour
• Diastema closure
• Conservation of the tooth structure

 Can be repolished in situ
 Polished surface is comparable to that of glazed
porcelain
 Material of choice for covering non –vital teeth
( subgingival margins)
 Capable of achieving a fine margin
 Excellent marginal tissue health

Clinical procedure
 Clean the tooth and neighbouring teeth with pumice
 Select the shade of composite
 Remove 0.25-0.50mm of enamel facially, 1-1.5mm
incisally
 Full arch impression(vinyl polysiloxane)
 Place provisional restoration if needed
 Pour stone models, after set, soak in water -10min,
make an irreversible hydrocolloid impression of the
model

 Inject vinyl polysiloxane into the irreversible
hydrocolloid impression
 Fabricate composite resin veneer on the
flexible model
 Remove the veneers
 Contour and polish-12 and 30 fluted
finishing carbide bur
 Check the fit and margins on the stone
model
 Heat treat the veneers in boiling water
/heat device-10min

 Acid etch the lingual side with 10%
hydrofluoric acid gel-30 sec/lightly
sandblast, rinse
 Evaluate the internal surface
 Clean with no 4 fine pumice in a
prophylaxis cup, rinse, dry
 Etch enamel with 37%phosphoric
acid for 15sec, rinse
 Surface Left Slightly moist
 Apply silane coupling agent

 Coat the etched surface with primer
 Dry primer till glossy
 Paint internal surface with thin layer of
bonding resin
 Apply luting composite resin to the
internal surface of the veneer
 Place on the tooth, remove excess
 Light cure-40 sec
 Remove excess with a 12 surgical
blade /scaler

 Polishing interdental areas with
graded strips, the gingival areas
with polishing cones
Cross section and side view of tooth preparation for an indirect resin
veneerwww.indiandentalacademy.com

Vinyl polysiloxane injected
into an alginate impression
of a stone model
Composite resin applied to the
flexible model
Composite resin veneer
is light cured
8 indirect composite
resin veneers

Hydrofluoric acid gel(10%)
applied for 30sec
Etched internal surface the
resin veneer
Enamel surface etched with
37%phosphoric acid
Bonding resin applied
to the etched enamel

Excess luting composite
resin removed with a brush Luting resin Light cured
Excess removed

Preoperative view of
tetracyclined-stained teeth
Post-operative view

RESTORATION OF
ENDODONTICALLY TREATED TEETH
 Resin bonded post crown –loss of natural
buccal enamel wall
 Use of indirect resin negates metal and
porcelain shrinkage
 Retains maximum of the remaining tooth
 Resin cement produces a strong bond
 Laminate veneers –non vital teeth

Pre-formed post inserted in the
palatal root canal
Lining placed
Restoration completed Onlay preparation

Non vital tooth requiring a post crown Cast post and
core on model
Completed casewww.indiandentalacademy.com

ADHESIVE BRIDGEWORK
 Alternative to fused porcelain pontic
 Indirect resin inlay
 Self-curing or dual-curing resin cement used
 Good retention for the cured cement-abutment
teeth are etched and the metal undersurface of
the bridge primed

Lower missing tooth
Adhesive bridge with single
pontic of indirect resin
Matched veneers and pontic
of indirect resin
Veneers and
bridgework attachedwww.indiandentalacademy.com

IMPLANT DENTISTRY
 In areas of occlusal stress-permit
articulation to be finalised
 Wears at a rate comparable to other teeth
 Multiple implant replacement
 Can be used when implant position is less
than ideal
 Indirect resin anterior teeth should be
backed and supported with metal
substructure

 Indirect resins are resilient-shock
absorption
 Wears at approx 7µ/ year- advantage
in cases of differential wear between
natural and artificial teeth
 Posterior teeth replacement
 Detachable prosthesis- formed to
resemble natural teeth

Canine requiring
extraction
Implant shortly after placement
Treatment crown of
indirect resin

CONCLUSION
New materials carve a niche for themselves and offer a
different way of achieving treatment objectives.
Indirect resin can enhance the clinical performance of
light cured resins, offer longer durability, strength and
better aesthetics.

BIBLIOGRAPHY
 Esthetic dentistry-2nd
edition , Aschhein Dale
 Fundamentals of operative dentistry, a contemporary
approach- Richard S. Schwartz ,James B. Summitt ,
J. William Robbins
 Aesthetic dentistry with indirect resins- Howard Stean
 Change your smile-Ronald E.Goldstein
 Journal of operative dentistry ,supplement
6,2001,153-176
 Adhesive metal free restorations- Dioer Dietschi

Indirect resins / certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Indirect resins / certified fixed orthodontic courses by Indian dental academy

Similar to Indirect resins / certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Indirect resins / certified fixed orthodontic courses by Indian dental academy