Indirect restorations are fabricated outside of the mouth using laboratory processed composites or ceramics. They are indicated for large defects or esthetic areas and provide better physical properties than direct composites. However, they have increased costs and time. Tooth preparation for indirect restorations requires rounded line angles, occlusal convergence, and extension to sound tooth structure. Impressions are needed to fabricate the restoration on a working cast.

1. GOOD MORNING

2. TOOTH COLOURED -INDIRECT
RESTORATIONS
R PRANEETH

3. What is indirect restoration????
◦ Indirect restoration – restorations are fabricated outside of the mouth.
◦ Tooth colored indirect system include laboratory processed composites and
ceramics.
◦ In addition chairside Computer-aided design/ Computer-assisted
manufacturing (CAD/CAM) systems are currently available for fabrication of
ceramic restoration.
Sturdevant’s ED 5

4. INDICATIONS
◦ The indications for Class I and II indirect tooth-colored restorations are
◦
◦ 1]Esthetics-Indicated for Class I and II restorations located in areas of esthetic
importance for the patient.
◦ 2] Large defects or previous restorations—They are considered for
restoration of large Class I and II defects or replacement of large
compromised existing restorations, especially those that are wide facio-
lingually and require cusp coverage.
Sturdevant’s ED 5

5. INDICATIONS
◦ Indirect tooth-colored restorative materials are more durable than direct
composites when placed in large occlusal posterior restorations, especially in
regard to maintaining occlusal surfaces and occlusal contacts.[Söderholm etal]
◦ The wear resistance provided by indirect materials is especially important in
large posterior restorations that involve most or all of the occlusal contacts
[Sturdevant etal]
◦ Economic factors—Some patients desire the most esthetic dental treatment
available, regardless of cost
Sturdevant’s ED 5

7. Contraindications
◦ 1] Heavy occlusal forces—Ceramic restorations can fracture when they lack
sufficient bulk or are subject to excessive occlusal stress, as in patients who
have bruxing or clenching habits
◦ 2] Inability to maintain a dry field.
◦ 3] Deep subgingival preparation.
◦ These margins are difficult to record with an impression and are difficult
to finish.
Sturdevant’s ED 5

8. TAKE HOME MESSAGE
◦ Indirect tooth- colored restorations should be considered for restoration of large Class II defects or
replacement of large compromised existing restorations.
◦ Indirect tooth- colored restorations contraindicated where tooth is subject to excessive occlusal stress.
◦ Indirect tooth- colored restorations avoided in patients with high plaque and caries index
◦ Indirect tooth- colored restorations contraindicated in deep gingival preperations.

9. PROS
◦ Improved physical properties: Indirect restorations have better physical properties than direct composite
restorations because they are fabricated under relatively ideal laboratory conditions
◦ Variety of materials and techniques
◦ Wear resistance—Ceramic restorations are more wear resistant than direct composite restorations, an
especially critical factor when restoring large occlusal areas of posterior teeth
◦ Reduced polymerization shrinkage
◦ Ability to strengthen remaining tooth structure—Tooth structure weakened by caries, trauma, or preparation
can be strengthened by adhesively bonding indirect tooth-colored restorations
Sturdevant’s ED 5

10. PROS
◦ More precise control of contours and contacts
◦ Biocompatibility and good tissue response
Sturdevant’s ED 5

11. CONS
◦ Increased cost and time—Most indirect techniques, excluding chairside CAD/CAM methods, require two
patient appointments, plus fabrication of a temporary restoration
◦ Technique sensitivity—Restorations made using indirect techniques require a high level of operator skill
Sturdevant’s ED 5

12. CONS
◦ Brittleness of ceramics—A ceramic restoration can fracture if the preparation
does not provide adequate thickness to resist occlusal forces.
◦ Wear of opposing dentition and restorations—Ceramic materials can cause
excessive wear of opposing enamel or restorations
Sturdevant’s ED 5

13. CONS
◦ Resin-to-resin bonding difficulties—Laboratory-processed resins are highly cross-linked, so few double
bonds remain available for chemical adhesion of the composite cement
◦ Low potential for repair—Indirect restorations, particularly ceramic inlays/onlays, are difficult to repair in
the event of a partial fracture.
Sturdevant’s ED 5

14. TAKE HOME MESSAGE
◦ Indirect restorations have better physical properties than direct composite restorations.
◦ Tooth structure weakened by caries, trauma, or preparation can be strengthened by adhesively bonding
indirect tooth-colored restorations.
◦ A ceramic restoration can fracture if the preparation does not provide adequate thickness to resist occlusal
forces.
◦ Ceramic materials can cause excessive wear of opposing enamel or restorations.

15. A schematic representation of the types of restorative
materials, based
on the materials used and based on the
manufacturing technique

16. Laboratory-Processed Composite Inlays and
Onlays
Processed composite restorations are indicated when
1] Maximum wear resistance is desired from a composite restoration,
2]Achievement of proper contours and contacts would be difficult otherwise,
3] The indirect composite likely would cause less wear of the opposing dentition than a similar ceramic
restoration
Sturdevant’s ED 5

17. Laboratory making of Inlays
and onlays
◦ 1. The indirect composite restoration is initially formed on a
replica of the prepared tooth
◦ 2. The composite is built up in layers, polymerizing each
layer with a brief exposure to a visible lightcuring unit
◦
◦ 3. After it is built to full contour, the restoration is coated
with a special gel to block out air and prevent formation of
an oxygen-inhibited surface layer.
Sturdevant’s ED 5

18. Processing cont…….
◦ 4. Final curing is accomplished by inserting the inlay into an oven-like
device that exposes the composite to additional light and heat and, in some
cases, pressure
◦ 5. The cured composite inlay is trimmed, finished, and polished in the
laboratory
Sturdevant’s ED 5

19. Ceramic Inlays and Onlays
◦ Among the ceramic materials used are feldspathic porcelain, hot
pressed ceramics, and machinable ceramics designed for use with
CAD/ CAM systems
The physical and mechanical properties of ceramics come closer to
matching those of enamel than do composites.
◦ They have excellent wear resistance and a coefficient of thermal
expansion close to that of tooth structure.
Sturdevant’s ED 5

20. Feldspathic Porcelain
◦ Feldspathic Porcelain Inlays and Onlays. Dental porcelains are partially
crystalline minerals (feldspar, silica, alumina) dispersed in a glass matrix.
◦ Currently, some ceramic inlays and onlays are fabricated in the dental
laboratory by firing dental porcelains on refractory dies, but more are
fabricated by pressing or milling methods .
Sturdevant’s ED 5

21. The fabrication steps for fired ceramic inlays
and onlays are summarized as follows
• After tooth preparation, an impression is made, and a die- stone master working cast is poured.
• The die is duplicated and poured with a refractory investment capable of withstanding porcelain firing
temperatures.
• Porcelain is added into the preparation area of the refractory die and fired in an oven. Multiple increments and
firings are necessary to compensate for sintering shrinkage
• The ceramic restoration is recovered from the refractory die, cleaned of all investment, and seated on the master
die and working cast for final adjustments and finishing
Sturdevant’s ED 5

23. DISADVANTAGES
◦ The major disadvantage is its technique sensitivity, both for the technician and
the dentist.
◦ Inlays and onlays fabricated with this technique must be handled gently during
try-in and bonding to avoid fracture.
◦ Feldspathic porcelains are weak, so even after bonding, the incidence of fracture
can be relatively high.
Sturdevant’s ED 5

25. Pressed Glass-Ceramics
◦ Dicor (DENTSPLY International, York, PA) a popular ceramic for dental restorations.
◦ A major disadvantage of Dicor was its translucency, which necessitated external application of all shading.
◦ Newer leucite-reinforced glass-ceramic systems (e.g., IPS Empress, Ivoclar Vivadent, Amherst, NY) also use
the lost-wax method, but the material is heated to a high temperature and pneumatically pressed, rather than
centrifuged, into a mold .
Sturdevant’s ED 5

26. The fabrication of leucite-reinforced pressed
ceramic restoration is summarized as follows
• After tooth preparation, an impression is made, and a working cast is poured in die-
stone. A wax pattern of the restoration is made using conventional techniques.
• After spruing, investing, and wax pattern burnout, a shaded ceramic ingot and
aluminum oxide plunger are placed into a special furnace .
• At approximately 2012°F (1100°C), the ceramic ingot becomes plastic and is slowly
pressed into the mold by an automated mechanism
Sturdevant’s ED 5

27. FABRICATION CONT….
• After being separated from the mold, the restoration is seated on the master die
and working cast for final adjustments and finishing.
• To reproduce the tooth shade accurately, a heavily pigmented surface stain is
typically applied. The ceramic ingots are relatively translucent and available in a
variety of shades, so staining for hot pressed ceramic inlay and onlay restorations
is typically minimal.
Sturdevant’s ED 5

28. ADVANTAGES
o The advantages of leucite-reinforced pressed ceramics are their
• (1) similarity to traditional “wax-up” processes,
• (2) excellent marginal fit,
• (3) moderately high strength, and
• (4) surface hardness similar to that of enamel.
Sturdevant’s ED 5

29. TAKE HOME MESSAGE
◦ The major disadvantage in Feldspathic porcelains is technique sensitivity.
◦ Feldspathic porcelains are weak, so even after bonding, the incidence of fracture can be relatively high.
◦ IPS Empress inlays and onlays have performed well in clinical trials ranging up to 12 years in duration.
◦ Lithium disilicate is a moderately high-strength glass ceramic that also can be used for full crowns or ultra-
thin veneers.

31. CAD/CAM
◦ CAD/CAM systems are expensive laboratory-based units requiring the
submission of an elastomeric or digital impression of the prepared
tooth.
◦ The CEREC system was the first commercially available CAD/CAM
system developed for the rapid chairside design and fabrication of
ceramic restorations.
Sturdevant’s ED 5

32. CAD/CAM
◦ CAD/CAM restoration begins after the dentist prepares the tooth and
uses a scanning device to collect information about the shape of the
preparation and its relationship with the surrounding structures .
◦ This step is termed optical impression
Sturdevant’s ED 5

33. CAD/CAM
◦ The system projects an image of the preparation and surrounding structures
on a monitor, allowing the dentist or the auxiliary personnel to use the CAD
portion of the system to design the restoration
◦ The operator must input or confirm some of the restoration design such as
the position of the gingival margins.
Sturdevant’s ED 5

34. CAD/CAM
◦ After the restoration has been designed, the computer directs a milling device (CAM portion of the system) that mills
the restoration out of a block of high-quality ceramic or composite in minutes.
◦ The restoration is removed from the milling device and is ready for try-in, any needed adjustment, bonding, and
polishing.
Sturdevant’s ED 5

35. CAD/CAM
◦ Different types of ceramics are available for chairside
CAD/CAM restoration fabrication.
◦ These include the feldspathic glass ceramics Vitablocs
Mark II (Vident, Brea, CA) and CEREC Blocs (Sirona,
manufactured by Vita Zahnfabrik, Bad Säckingen,
Germany).
◦ The ceramic blocks are available in various shades and
opacities, and some are even layered to mimic the
relative opacity or translucency in different areas of a
tooth.
Sturdevant’s ED 5

36. CAD/CAM
◦ The major disadvantages of chairside CAD/CAM systems are the high initial cost and the need for special
training.
◦ CAD/CAM technology is changing rapidly, however, with each new generation of devices having more
capability, accuracy, and ease of use
◦ Clinical studies have reported good results on the longevity of CAD/CAM ceramic restorations.
Sturdevant’s ED 5

38. TAKE HOME MESSAGE
◦ Ceramic blocks are available in various shades and opacities, and some are even layered to mimic the relative
opacity or translucency in different areas of a tooth.
◦ The major disadvantages of chairside CAD/CAM systems are the high initial cost and the need for special
training.
◦ Clinical studies have reported good results on the longevity of CAD/CAM ceramic restorations.
Sturdevant’s ED 5

39. Tooth Preparation of inlays and onlays
◦ First clinical step, the patient is anesthetized and the area is isolated,
preferably using a rubber dam.
◦ The compromised restoration is completely removed and all caries is
excavated.
◦ All margins should have a 90-degree butt-joint cavosurface angle to
ensure marginal strength of the restoration.
◦ All line and point angles, internal and external, should be rounded to
avoid stress concentrations in the restoration and tooth, reducing the
potential for fractures.
Sturdevant’s ED 5

40. Tooth Preparation of inlays and onlays
◦ The carbide bur or diamond used for tooth preparation should be
a tapered instrument creates occlusally divergent facial and lingual
walls, which allows for passive insertion and removal of the
restoration.
◦ It should be greater than the 2 to 5 degrees taper per wall
recommended for cast gold inlays and onlays.
◦ Resistance and retention form are required to help preserve the
adhesive interface, so excessive divergence must be avoided.
Sturdevant’s ED 5

41. Tooth Preparation if inlays and onlays
◦ The occlusal portion of the preparation should be 2 mm deep.
◦ Most ceramic systems require that any isthmus be at least 2 mm wide to
decrease the possibility of fracture of the restoration.
◦ The facial and lingual walls should be extended to sound tooth structure
and should go around the cusps in smooth curves.
Sturdevant’s ED 5

42. Tooth Preparation
◦ Ideally, there should be no undercuts that would prevent the insertion or removal
of the restoration.
◦ Small undercuts, if present, can be blocked out using a resin-modified glass
ionomer (RMGI) liner.
◦ The pulpal floor should be smooth and relatively flat.
Sturdevant’s ED 5

43. Tooth Preparation
◦ After removal of extensive caries or previous restorative
material from any internal wall, the floor is restored to more
nearly ideal form with a material that has a reasonably high
compressive strength such as an RMGI liner or base.
◦ The facial, lingual, and gingival margins of the proximal
boxes should be extended to clear the adjacent tooth by at
least 0.5 mm.
Sturdevant’s ED 5

44. Tooth Preparation
◦ The gingival margin should be extended as minimally as possible
because margins in enamel are greatly preferred for bonding.
◦ Deep gingival margins are difficult to impress and to isolate properly
during bonding.
◦ Facial or lingual surface is affected by caries or other defect, it might be
necessary to extend the preparation (with a gingival shoulder) around
the transitional line angle to include the defect.
◦ Axial wall of the shouldered extension should be prepared to allow for
adequate restoration thickness (i.e., 1–1.5 mm).
Sturdevant’s ED 5

45. Tooth Preparation
◦ When extending through or along the cuspal inclines to reach sound tooth
structure, a cusp usually should be capped if the extension is two-thirds or
greater than the distance from any primary groove to the cusp tip.
Sturdevant’s ED 5

46. Tooth Preparation
◦ If the cusps must be capped, they should be reduced by 2 mm and
should have a 90-degree cavosurface angle.
◦ When capping cusps, especially centric holding cusps, shoulder is
prepared to move the facial or lingual cavosurface margin away from
contact with the opposing tooth, either in maximum intercuspal
position or during functional movements.
Sturdevant’s ED 5

47. summit

48. Impression
◦ Gingival retraction cord can be used to reflect the gingival tissues away
from the tooth structure thus providing access to the impression material
to reach the subgingival margins.
◦ Tooth-colored inlay or onlay systems require an elastomeric or optical
impression of the prepared tooth and the adjacent teeth and interocclusal
records, which allow the restoration to be fabricated on a working cast in
the laboratory.
◦ With chairside CAD/CAM systems, no working cast is necessary.
Sturdevant’s ED 5

49. TAKE HOME MESSAGE
◦ 90-degree butt-joint cavosurface angle to ensure marginal strength of the restoration.
◦ The occlusal portion of the preparation should be 2 mm deep and isthmus 2 mm wide.
◦ More than 2 to 5 degrees taper per wall recommended for cast gold inlays and onlays.
◦ Gingival margin should be extended as minimally as possible because margins in enamel are greatly preferred for
bonding.
◦ Gingival retraction cord can be used to reflect the gingival tissues away from the tooth structure thus providing
access to the impression material to reach the subgingival margins.

50. Provisional Restoration
◦ Provisional restoration protects the pulp–dentin complex in vital teeth, maintains the position of the
prepared tooth in the arch.
◦ The provisional can be made using conventional techniques and bis-acryl composite materials.
◦ Temporary restorations for PFM and cast gold restorations typically are cemented with eugenol-based
temporary cements
Sturdevant’s ED 5

51. Provisional Restoration
◦ Eugenol reacts with free radicals, thereby inhibiting the polymerization of methacrylate monomers, however,
and potentially could reduce the adhesion of the permanent composite cement to tooth structure.
◦ Because of the nonretentive design of the onlay preparation, the more retentive polycarboxylate cement is
the temporary luting cement of choice.
Sturdevant’s ED 5

52. CAD/CAM Techniques
◦ Tooth preparations for CAD/CAM inlays must reflect the capabilities of the CAD software and hardware
and the CAM milling devices that fabricate the restorations.
◦ CEREC system automatically “blocks out” any undercuts during the optical impression, large undercuts
should be avoided.
◦ This system eliminates the need for a conventional impression, provisional restoration, and multiple patient
appointments
Sturdevant’s ED 5

54. Try-in and Bonding
◦ Try-in and bonding of tooth-colored inlays or onlays are more demanding than those for cast gold
restorations because of
1.the relatively fragile nature of some ceramic materials,
2.the requirement of near-perfect moisture control, and
3.the use of resin cements.
◦ Occlusal evaluation and adjustment generally are delayed until after the restoration is bonded, to avoid
fracture of the ceramic material.
Sturdevant’s ED 5

55. Preliminary Steps
◦ The use of a rubber dam is strongly recommended to prevent
moisture contamination of the conditioned tooth or
restoration surfaces during cementation and to improve
access and visibility during delivery of the restoration.
◦ After removing the provisional restoration, all of the
temporary cement is cleaned from the preparation walls.
Sturdevant’s ED 5

56. Restoration Try-in and Proximal Contact
Adjustment
◦ Inlay or onlay is placed into the preparation using light pressure to evaluate its
fit.
◦ If the restoration does not seat completely, the most likely cause is an over-
contoured proximal surface
◦ Using the mouth mirror the embrasures should be viewed from the facial,
lingual, and occlusal aspects to determine where the proximal contour needs
adjustment to allow final seating of the restoration.
◦ Abrasive disks or points are used to adjust the proximal contour and contact
relationship.
Sturdevant’s ED 5

57. Restoration Try-in and Proximal Contact
Adjustment …………
◦ If the proximal contours are not over-contoured and the restoration still does not fit completely, the
preparation should be checked again for residual temporary materials or debris.
◦ If the preparation is clean, internal or marginal interferences also might prevent the restoration from seating
completely.
◦ When these interferences have been identified through careful visual inspection of the margins or using “fit-
checker” materials, they can be adjusted on the restoration, in the preparation.
Sturdevant’s ED 5

58. Restoration Try-in and Proximal Contact
Adjustment………………………………..
◦ Marginal fit is verified after the restoration is completely seated.
◦ Ceramic inlays and onlays typically have slightly larger marginal gaps than gold restorations.
◦ Slight excesses of contour can be removed, if access allows, using fine-grit diamond instruments or 30-fluted
carbide finishing burs.
◦ These adjustments are done preferably after the restoration is bonded so that marginal fractures are avoided.
Sturdevant’s ED 5

59. Bonding
◦ For proper adhesive bonding, the internal surface of the inlay or onlay
must be treated appropriately.
◦ HF acid or a similar acid usually is used to etch the internal surfaces of
the restoration for 60 sec
Sturdevant’s ED 5

60. BONDING……………..
◦ Chairside ceramic etching can be done with a brief application of 5% to 10% HF acid on the internal surfaces of
the inlay or onlay.
◦ Application time depends on the type of ceramic material being used.
◦ After etching, the ceramic is treated with a silane coupling agent to facilitate chemical bonding of the resin cement.
Sturdevant’s ED 5

61. BONDING…………
◦ The inlay or onlay is tried-in again and checked for fit.
◦ The preparation surfaces are etched with phosphoric acid and treated
with the components of an appropriate adhesive system.
◦ A dual-cure resin cement is mixed and inserted into the preparation
with a paddle-shaped instrument or a syringe
Sturdevant’s ED 5

62. BONDING
◦ The internal surfaces of the restoration also are coated with the resin cement and using light pressure, the
restoration is immediately inserted into the prepared tooth.
◦ A ball burnisher or similar instrument applied with a slight vibrating motion is usually sufficient to seat the
restoration.
Sturdevant’s ED 5

63. BONDING
◦ Excess resin cement is removed with thin-bladed composite instruments, brushes, micro- brush, or an
explorer.
◦ Light-activated with multiple exposures from occlusal, facial, and lingual directions, according to the
manufacturer’s recommendations for the specific cement and light-curing device.
Sturdevant’s ED 5

66. TAKE HOME MESSAGE
◦ CAD/CAM eliminates the need for a conventional impression, provisional restoration, and multiple patient
appointments.
◦ Proximal contours are not over-contoured and the restoration still does not fit completely, the preparation should
be checked again for residual temporary materials or debris.
◦ HF acid usually is used to etch the internal surfaces of the restoration for 60sec.
◦ Chairside ceramic etching can be done with a brief application of 5% to 10% HF acid on the internal surfaces of
the inlay or onlay.

67. Finishing and Polishing Procedures
◦ After light-curing the cement, all marginal areas are checked with an
explorer tine.
◦ Medium-grit or fine-grit diamond rotary instruments are used initially to
remove any excess resin cement at the margins.
◦ Slender flame shapes are used interproximally, whereas larger oval or
cylindrical shapes are used on the occlusal surface.
Sturdevant’s ED 5

68. Finishing and Polishing Procedures
◦ Interproximally, a No. 12 scalpel blade can be used to remove
excess resin cement when access permits.
◦ Abrasive strips of successively finer grits also can be used to
remove slight interproximal excesses.
Sturdevant’s ED 5

69. Finishing and Polishing Procedures
◦ With care and appropriate instrumentation, ceramic restorations can be polished to a surface as smooth as
glazed porcelain using the abrasive sequence
Sturdevant’s ED 5

71. Finishing and Polishing Procedures
◦ The rubber dam is removed after all of the excess resin cement has been removed, marginal integrity has
been verified.
◦ The occlusion is now checked and adjusted, if necessary.
◦ Premature occlusal contacts can be adjusted using fine-grit diamond instruments, followed by 30-fluted
carbide finishing burs and appropriate polishing steps.
◦ In selected cases, the occlusion can be adjusted on the opposing dentition.
Sturdevant’s ED 5

72. Common Problems and Solutions
◦ The most common cause of failure of tooth-colored inlays or onlays is fracture .
◦ Fractures can result from placing the restoration in a tooth where it was not indicated, from lack of
appropriate restoration thickness resulting from insufficient tooth preparation or from restoration contours
that introduce excursive interferences in occlusal function.
◦ If fracture occurs, replacement of the restoration is almost always indicated.
Sturdevant’s ED 5

73. Repair of Ceramic Inlays and Onlays
◦ Minor defects in ceramic restorations can be repaired, but before initiating any repair procedure, the operator
should determine whether replacement, rather than repair, is the appropriate treatment.
◦ A small fracture resulting from occlusal trauma might indicate that some adjustment of the opposing
occlusion is required.
Sturdevant’s ED 5

74. Repair of Ceramic Inlays and Onlays
◦ The repair procedure is initiated by mechanical roughening of the involved surface.
◦ A better result is obtained with the use of airborne particle abrasion using aluminum oxide particles and a
special intraoral device.
◦ Initial mechanical roughening is followed by brief (typically 2 minutes) application of 5% to 10% HF acid
gel.
Sturdevant’s ED 5

75. Repair of Ceramic Inlays and Onlays
◦ The next step in the repair procedure is application of a silane coupling agent.
◦ Silanes mediate chemical bonding between ceramics and resins and may improve the predictability of resin–
resin repairs
Sturdevant’s ED 5

76. Cast gold CERAMIC composite
Cast gold usually made of 10 to 22
carats gold , copper, silver ,
palladium, platinum, nickel, zinc.
INDICATIONS
1. Extensive tooth loss, Correction of
occlusion
2. Restoration of endodontically treated
teeth
3. Preexisting cast metal restorations
CONTRAINDICATIONS
1. Occlusal disharmony
2. Dissimilar metals
Ceramic restorations, also known
as porcelain restorations, are made
of dental-grade ceramic materials.
1.ESTHETICS
2.PRESERVATION OF TOOTH
STRUCTURE
1]Heavy occlusal forces
2] Inability to maintain a dry field.
3] Deep subgingival preparation.
Resin composite restorations are
made of a mixture of plastic
(composite resin) and fine glass
particles
1. .ESTHETICS
2.WORN OUT TOOTH
3]BRUXISM
4]ALLERGY

77. Cast gold CERAMIC composite
ADVANTAGES
1.Greater tensile strength
2.Precise reproduction of the form and
minute details
3.Metal alloys used are tarnish and
corrosion resistant
4. Finishing and polishing can be done
outside the oral cavity, thus preventing
damage to the pulp
DISADVANTAGES
1. Leakage around and under the
restorations through the cement-
restoration - tooth junction
2.It involves extensive tooth preparation
3.Technique sensitive
4. Galvanic deterioration
1]Wear resistance—Ceramic restorations
are more wear resistant than direct
composite restorations.
Ability to strengthen remaining tooth
structure
3]More precise control of contours and
contacts
4]Biocompatibility and good tissue
response
1]Brittleness of ceramics.
2]Wear of opposing dentition and
restorations
3]Resin-to-resin bonding difficulties
4]Low potential for repair
1]Bonding and reinforcement
2]Reduced sensitivity
3]Repairability
4]Conservative tooth preparation
5]Biocompatibility
1]Durability
2]Staining and discolouration
3]less lifespan
4]technique sensitive
5]limited strength in large restorations

78. Cast gold usually made of
copper, silver, platinum, nickel,
zinc
Gold offers high strength and
durability.
They are more suitable for
posterior teeth where esthetics
are not a primary concern
Ceramic restorations, also
known as porcelain restorations,
are made of dental-grade
ceramic materials.
They are generally not as strong
as metal restorations.
They are highly esthetic and are
commonly used in the front
teeth.
Resin composite restorations
are made of a mixture of plastic
(composite resin) and fine glass
particles
They are generally not as strong
as ceramics or metals.
They offer excellent esthetics
and are commonly used in both
front and back teeth.
Cast gold CERAMIC composite
LUTING CEMENT:
Zinc phosphate cement provides good
retention and is particularly useful for
cast gold restorations due to its ability
to bond to both metal and tooth
structure[Donovan and Cho, 1999]
TOOTH PREPERATION:
Bevel is needed
Cast gold inlays, a slight divergence or
taper of 2 to 5 degrees is required
Occlusal Reduction:1.5-2 mm
Resin cements are widely used for
luting ceramic restorations due to their
excellent adhesive properties and
esthetics
Bevel is usually not recommended
The divergence angle of more than[ 2 to
5]. helps ensure a secure fit and stability
of the restoration within the tooth
preparation
1.5 to 2mm.
Resin cements used for composite inlays
are typically dual-cured or light-cured
[el-Mowafy et al. ]
Bevel not needed.
The divergence angle of [more than 2 to
5 degrees] same as ceramic
1.5 to 2mm

79. Cast gold CERAMIC composite
Isthmus width is to be 1 to 1.5 mm Ceramic systems require that any
isthmus be at least 2 mm wide to
decrease the possibility of fracture of
the restoration.
Composite also require 2mm
isthmus width

80. Cast gold CERAMIC composite
Biocompatibility is good
ADAPTABILITY
Gold restorations are more
adaptable
LONGEVITY
Gold restorations known for their
durability [Leempoel et al. ]
TYPE OF TOOTH PREP
Gold restorations usually require
less tooth removal
Dental ceramics are generally
biocompatible
Ceramics are difficult to adapt
Ceramic restorations are known
for their excellent long-term
durability[Wendt SL etal]
Ceramic restorations may require
more tooth structure removal
They are also biocompatible
Composites are also difficult to
adapt
They tend to have a shorter
lifespan compared to ceramic
restorations. [Taylor DF, et al]
Resin composite restorations
require less tooth structure
removal

81. "Every tooth in a man's head is more
valuable than a diamond." - Miguel de
Cervantes

82. Aparnna Sreeprakash

83. Judith

84. M.ASMA

85. Sanjna

86. Direct resin composite restorations versus indirect
composite inlays: one-year results
Juliano Sartori Mendonça et al. J Contemp Dent Pract. 2010
◦ Methods and materials: Seventy-six Class I and II restorations (44 direct and 32 indirect) were inserted in premolars and molars with carious lesions or deficient
restorations in 30 healthy patients according to the manufacturer's instructions. Each restoration was evaluated at baseline and after 12 months according to the modified
USPHS criteria for color match (CM), marginal discoloration (MD), secondary caries (SC), anatomic form (AF), surface texture (ST), marginal integrity (MI), and pulp
sensitivity (PS). Data were analyzed by Fisher and McNemar Chi-square tests.
◦ Results: No secondary caries and no pulpal sensitivity were observed after 12 months. However, significant changes in marginal discoloration (MD) criteria could be
detected between baseline and one-year results for both materials (p<0.05). For marginal integrity (MI) criteria, the differences between baseline and one-year recall were
statistically significant (p<0.05). For marginal integrity (MI) criteria, Tetric Ceram (TC) showed results statistically superior to Targis (TG) in both observation periods
(p<0.05). No statistically significant changes in color match (CM), anatomic form (AF), or surface texture (ST) appeared during the observation periods (p>0.05).
◦ Conclusions: BDirect resin composite restorations performed better than indirect composite inlays for marginal integrity, but all restorations were judged to be clinically
acceptable.
Shaik Imran
3rd Yr Pg

87. ABHIRAJ G

88. Kirtana
II MDS

89. Loyola

90. S.MURALIDAR
AN
CONCLUSION:
◦ Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin prior
to impression making is recommended.
◦ The IDS technique helps achieve improved bond strength, fewer gap formations, decreased bacterial
leakage and reduced dentin sensitivity.
◦ This concept should stimulate both the researchers and clinicians in the study and development of
new protocols for the rationalization and standardization of adhesive techniques and materials leading
to maximum tooth structure preservation, improved patient comfort, and long term survival of
indirect bonded restorations

91. Sai Saranya
2nd PG

92. Aishwarya.B 1st PG

93. ASHOK

94. Pooja Gomase

98. Comparison between metal and ceramic
indirect restorations
Metal
◦ Metal Restorations: These restorations are
typically made of various metal alloys, such
as gold, silver, or base metal alloys like
cobalt-chromium or nickel-chromium.
◦ These metals offer high strength and
durability.
◦ They are more suitable for posterior teeth
where esthetics are not a primary concern
CERAMIC
◦ Ceramic restorations, also known as
porcelain restorations, are made of dental-
grade ceramic materials.
◦ They are generally not as strong as metal
restorations.
◦ They are highly esthetic and are commonly
used in the front teeth.

99. Comparison between metal and ceramic
indirect resrorations
METAL
◦ Biocompatibility varies depending on the
specific metal used.
◦ Metal restorations are more adaptable
CERAMIC
◦ Dental ceramics are generally
biocompatible
◦ Ceramics are difficult to adapt

100. Comparison between resin composite and
ceramic
composite
◦ Resin composite restorations are made of
a mixture of plastic (composite resin) and
fine glass particles
◦ They offer excellent esthetics and are
commonly used in both front and back
teeth.
◦ While resin composites have improved in
terms of strength, they are generally not as
strong as ceramics or metals.
ceramic
◦ Ceramic restorations, also known as
porcelain restorations, are made of dental-
grade ceramic materials
◦ they provide a lifelike appearance and are
commonly used for front teeth where
esthetics are a primary concern.
◦ Ceramic restorations are known for their
excellent strength and durability. They can
withstand heavy biting forces and are less
prone to fracture or wear

101. Comparison between resin composite and
ceramic
composite
◦ Resin composite restorations require less
tooth structure removal
◦ They tend to have a shorter lifespan
compared to ceramic restorations.
ceramic
◦ Ceramic restorations may require more
tooth structure removal
◦ Ceramic restorations are known for their
excellent long-term durability.