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PubMed1995

Effects of gold and bonded ceramic inlays on the ability to perceive occlusal thickness.

Any crown or inlay preparation will be accompanied with pulpal involvement and possible altered biomechanical and/or viscoelastic properties concerning the treated tooth. This study was aimed to assess this influence in terms of differences in interocclusal discrimination threshold value, before and after rehabilitation with gold inlays and by composite resin bonded ceramic inlays. Twenty patients were included and treated with one gold and three ceramic inlays each. For purposes of determining the discrimination threshold between the inlays and antagonizing teeth, plastic foils of different thicknesses were used. Each inlay position, as well as a pair of control teeth, were tested before and after treatment. Before rehabilitation an interocclusal and discrimination threshold of 24 microns at the level of 80% right answers were determined. Treatment with inlays, however, resulted in a significantly different and increased threshold for every tooth/inlays combination. No significant differences between the sessions were recorded for the control teeth. It could be concluded that, in the short term, an oral rehabilitation with inlays and in particular bonded inlays will influence mechanosensitive afferents.

Adult↗

PubMed2005

The clinical performance of CAD/CAM-generated composite inlays.

BACKGROUND: The authors conducted a study to evaluate the longitudinal clinical performance of a resin-based composite (Paradigm, 3M ESPE, St. Paul, Minn.) for computer-aided design/computer-aided manufacturing (CAD/CAM)-generated adhesive inlays. METHODS: The researchers used a CAD/CAM unit (CEREC 2, Sirona Dental Systems, Bensheim Germany) to fabricate 40 porcelain (Vita Mark II, Vita Zahnfabrik, Bad Säckingen, Germany) and 40 resin-based composite (Paradigm, 3M ESPE) inlays. Both restorative materials were cemented with a total-etch technique using Single Bond dental adhesive (3M ESPE) and a dual-cured resin cement (RelyX ARC Adhesive Resin Cement, 3M ESPE). Two examiners evaluated the inlays using modified U.S. Public Health Service (PHS) criteria at six months, one year, two years and three years. RESULTS: No sensitivity was reported for either material at any recall period. There was no significant difference between the two materials relative to margin adaptation at three years. Margin adaptation initially was very good for both materials, with an increase in margin detection due to apparent wear of the resin-based composite luting agent. There was a significant difference in color match between the two materials at three years, with 91.4 percent of the resin-based composite inlays and 58.8 percent of the porcelain inlays rated Alfa. CONCLUSIONS AND CLINICAL IMPLICATIONS: The resin-based composite inlays had a significantly better color match at three years than did the porcelain inlays. Resin-based composite CAD/CAM inlays performed as well as porcelain CAD/CAM inlays after three years of clinical service.

Bicuspid↗

PubMed2001

A clinical evaluation of ceramic inlays bonded with different luting agents.

PURPOSE: The purpose of this study was to evaluate the clinical performance of a fired ceramic inlay system bonded with three different luting agents. MATERIALS AND METHODS: A total of 45 Ducera LFC ceramic inlays (12 in premolars, 33 in molars) were placed in 26 patients. Fifteen of the inlays were inserted with one of three different luting agents: (1) Variolink High Viscosity, (2) Enforce, and (3) Geristore. The restorations were evaluated for a period of 3 to 46 months, with a mean of 26.3 months after insertion using modified USPHS criteria. The evaluation period ended when the restoration had to be replaced due to fracture or secondary caries. Postoperative sensitivity was determined by direct questioning. Kaplan-Meier statistical analysis was used to calculate the survival rate of the inlays. Selected restorations were further evaluated indirectly with SEM. RESULTS: The fracture rates observed for Variolink, Enforce, and Geristore were 13%, 13%, and 33%, respectively. There was a high rate of early bulk fracture, seen mainly within 12 months, for inlays luted with Geristore. For all groups, secondary caries was found to be relatively low. The inlays in all luting agent groups showed acceptable color match and surface roughness scores during the whole evaluation period. SEM observation revealed that the deterioration of marginal adaptation was found to be more severe for inlays luted with Geristore, and that the rate of submargination was also higher for Geristore-luted inlays in comparison to those luted with Variolink and Enforce. CONCLUSION: The use of a polyacrylic acid modified glass ionomer, Geristore, resulted in a higher fracture rate and loss of marginal adaptation in fired ceramic inlays. The marginal adaptation of the luting agent was more durable at the enamel interface than that at ceramic interface.

Adult↗

PubMed1990

[Marginal fit of ceramic and composite inlays in vitro].

Direct and indirect composite and ceramic inlays exhibit a space between inlay and tooth, which is filled with a luting composite resin. The aim of the present study was to evaluate the influence of the width of this space upon the quality of the marginal seal of the inlay system. The marginal quality of class II-inlays with small (0.2 mm) and large (0.4 mm) spaces was examined using quantitative SEM analysis and dye penetration. Regular class-II composite fillings served as controls. After thermal and mechanical loading the composite inlays with the wider composite layer showed more marginal gaps than both groups of ceramic inlays. The ceramic inlays did not show a significant deterioration of the margins. The least amount of dye penetration was observed in ceramic inlays with a wider composite layer at the interproximal cavity wall. Composite fillings showed more dye penetration than inlays.

Ceramics↗

PubMedDate not supplied

Tensile bond strength of gold and porcelain inlays to extracted teeth using three cements.

This in vitro study compared the tensile bond strength of gold and porcelain inlays to extracted molars in standardized cavities. Three cements were used: zinc phosphate, glass-ionomer, and a resin composite cement. The gold inlays were cemented using zinc phosphate or glass-ionomer cement, and the porcelain inlays were luted using resin composite or glass-ionomer cement. Surface treatments included, for gold inlays, either no treatment (zinc phosphate cement) or airborne particle abraded and tinplated (glass-ionomer cement); and for porcelain inlays, either no treatment (glass-ionomer cement) or etched and silane-treated (resin composite cement). Statistical analysis was performed using the Weibull distribution. Results showed no significant differences between gold inlays cemented using zinc phosphate or glass-ionomer cements and porcelain inlays luted using glass-ionomer cements. The bonded porcelain inlays (resin composite cement) showed tensile bond strengths two to three times higher than those obtained for cemented gold inlays.

Composite Resins↗

PubMed1993

Marginal fit and microleakage of indirect inlay systems.

Three different indirect adhesive inlay systems were investigated for marginal fit and microleakage. MOD cavities were prepared in 67 extracted sound premolar teeth initially with parallel cavity walls. Thirty-four of the premolars had the cavity walls modified to a 10 degrees and 33 to a 15 degrees occlusal divergence. EOS, Isosit and Hi-Ceram porcelain inlays did not fit cavities prepared with parallel walls. All inlays in the Isosit and porcelain groups were able to be seated without modifications in cavities prepared with either a 10 degrees or 15 degrees occlusal divergence. Inlays made by the EOS system required considerable modification of the fitting surface in order for them to fit. Results showed the EOS system to have the largest marginal gaps before cementation (P < 0.001). There was no significant difference in leakage between the three inlay systems after cementation (P < 0.05). The cementum margins leaked more than margins finished on enamel for all inlay systems (P < 0.05). It is concluded from this study that inlay cavities for Isosit and porcelain require at least a 10 degrees occlusal divergence of cavity walls to permit the fitting of inlays without unacceptable modification. The EOS inlays required considerable trimming even when a 15 degrees occlusal divergence of the cavity walls was used.

Acrylic Resins↗

PubMed2002

Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods.

BACKGROUND: The optimal method of replacement of the posterior cruciate ligament with a bone-patellar tendon-bone graft is not known. The purpose of this study was to compare the mechanical responses to cyclic loading tests of bone-patellar tendon-bone allograft replacements fixed to the tibia with one of two methods: a tibial tunnel or a tibial inlay technique. METHODS: The proximal ends of sixty-two posterior cruciate graft replacements, thirty-one fixed with the tibial tunnel technique and thirty-one fixed with the tibial inlay technique in cadaver knees, were subjected to 2000 cycles of tensile force of 50 to 300 N with the angle of pull at 45 to the tibial plateau. The central 10 mm of the medial and lateral halves of previously fresh-frozen bone-patellar tendon-bone preparations from cadaver knees were used as the grafts. Two pairs of tibiae were used for testing; the two types of fixation and the medial and lateral halves of the patellar tendons were distributed between the tibial pairs. Graft thickness was measured at the point of highest anticipated tissue deformation and at two additional locations at distances from these points. The total change in graft length after cyclic loading at an applied force level of 200 N was recorded. Elongation of the graft during loading cycles between 20 and 200 N of applied tensile force was also measured. A repeated-measures analysis of variance was used to compare all measurements between the inlay and tunnel techniques, and between the medial and lateral halves of the graft used for the inlay method. RESULTS: Ten of the thirty-one grafts that had been passed through a tibial tunnel failed at the acute angle before 2000 cycles of testing could be completed; all thirty-one grafts that had been fixed to the tibia with use of the inlay method survived the testing intact. Evaluation of the twenty-one graft pairs that survived testing after both fixation techniques revealed that the grafts that had been fixed with the inlay method had significantly less thinning at all three measurement sites at the completion of testing; the mean reduction of thickness was 40.6% (at the acute angle) in the grafts fixed with the tunnel method and 12.5% (adjacent to the bone block) in those fixed with the inlay method. After 2000 cycles, the mean lengths of the grafts fixed with the inlay and tunnel methods increased 5.9 and 9.8 mm, respectively; 38% of this increase occurred during the first six loading cycles. After both methods of fixation, the mean graft elongation during a loading cycle decreased approximately 50% from cycle 1 to cycle 2000, resulting in an effectively stiffer graft construct. There was no significant difference in any measured parameter between medial and lateral graft halves. CONCLUSIONS: These tests showed that the inlay technique of posterior cruciate ligament replacement was superior to the tunnel technique with respect to graft failure, graft thinning, and permanent increase in graft length.

Adult↗

PubMed2001

Long-term survival of cast-gold inlays in a specialized dental practice.

At a dental office in Münster, Germany, the majority of gold inlays incorporated between July 1969 and August 1999 (n=2,071) in 531 patients were checked with reference to the dental records and assessed retrospectively to determine their longevity. One hundred seventy-five gold inlays were rated as failures (no longer in situ); 10 abutment teeth were extracted. The 20-year Kaplan-Meier survival rate for restoration-bearing teeth was 98.9%, and the 25-year rate for all gold inlays 73.4% (+/- 4.0%; 95% confidence interval respectively in brackets). Gold inlays inserted in maxillary teeth had significantly better probabilities of survival after this period than those inserted in lower teeth (P=0.0002). Based on the number of surfaces involved, 52.0% (+/- 45.3) of one-surface inlays, 64.3 (+/- 7.5) of two-surface inlays, 75.8% (+/- 7.6) of three-surface inlays, and 84.8% (+/- 5.4) of inlays with more than three surfaces were still in situ after 25 years.

Adolescent↗

PubMed1993

Marginal adaptation and fit of adhesive ceramic inlays.

This in vitro study compared the marginal adaptation of CAD/CAM and laboratory-made ceramic inlays before, during and after loading. Six MOD inlay preparations of standardized design with one cervical margin in dentine and the other in enamel were prepared for each inlay type: CAD/CAM fabricated MGC-glass ceramic inlays, CAD/CAM fabricated feldspathic porcelain inlays, laboratory-made glass ceramic inlays and laboratory-made feldspathic porcelain inlays. Appropriate luting composite materials were used. The restored teeth were subjected to occlusal loading, thermal cycling, toothbrush-toothpaste abrasion and chemical degradation in vitro. Marginal adaptation was quantitated along the entire length of the cavosurface margin and along selected sections of the margin using SEM, following in vitro testing corresponding to 0, 0.5, 1.0, 2.7 and 5.0 years of clinical service. In addition, marginal fit of the cemented inlays was evaluated in the SEM. The initial marginal adaptation in enamel was excellent in all groups. After in vitro testing, significant marginal discrepancies were found in all groups. A high percentage of marginal openings was recorded, notably in the cervical portions of the margins in both enamel and dentine.

Ceramics↗

PubMed1994

Comparison of marginal fit and microleakage of ceramic and composite inlays: an in vitro study.

The purpose of this in vitro study was to evaluate the marginal fit and microleakage of four types of ceramic or resin composite inlays. Sixty extracted human third molar teeth were randomly assigned into four groups. MOD cavities without bevels were prepared. The mesiogingival margin was cut in enamel, whereas the distogingival margin was placed below the amelocemental junction. The preparations and inlays were made according to the manufacturers' instructions. After acid-etching and treatment with a dentine bonding agent the inlays were cemented with dual curing CEREC resin composite luting material. After placement and polishing 10 teeth of each group were thermocycled 2500 times between 14 degrees C and 62 degrees C. Each tooth was bisectioned and from each part, one occlusal and three proximal sections of 75-100 microns thickness were cut and ground (EXAKT Cutting and Grinding system). The marginal discrepancy and the thickness of the luting cement were measured microscopically at each section and an average for each tooth was calculated. Considerable variation of marginal fit was seen, within inlays, and among different types of inlays. In general, the Vita Dur N inlays showed the best fit, e.g. the thickness of the luting cement for Vita Dur N was 114 microns occlusally and 119 microns mesiogingivally compared to 199 microns occlusally for CEREC and 219 microns mesiogingivally for Estilux. At enamel margins, a tendency of less microleakage was seen for ceramic inlays compared to composite inlays.

Aluminum Oxide↗

PubMed1995

Clinical and semiquantitative marginal analysis of four tooth-coloured inlay systems at 3 years.

OBJECTIVES: The marginal quality of four tooth-coloured inlay systems was clinically investigated and subjected to computer-aided semiquantitative marginal analysis under scanning electron microscopy (SEM) after 3 years of clinical service. METHODS: Three of the restoration types were made using the Cerec CAD-CAM apparatus: one was milled from preformed glass ceramic blocks, and the two other inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect resin composite inlay system. Each inlay type was luted with a different luting resin composite. The clinical evaluation was performed with a mirror and explorer by two clinicians separately, and the marginal analysis was conducted microscopically on replicas (SEM x 200). RESULTS: After 3 years in situ, all the restorations were clinically acceptable. No recurrent caries was observed. Marginal analysis under SEM detected a high percentage of submargination for all four systems, which suggests that their respective resin composite luting agents were all subject to wear. The percentage of marginal fractures on the enamel side as well as on the inlay side did not increase dramatically compared to the 6-month results. CONCLUSION: The first recall after 6 months of clinical service indicated how tooth-coloured inlays behave at their margins. The 3-year results confirmed the early findings, indicating that wear of resin composite lutes is important and present in all systems. The two ceramic materials showed a similar behaviour at the margins. The resin composite inlay performed better at the inlay site than at the enamel site.

Adult↗

PubMed2004

Stress distributions in adhesively cemented ceramic and resin-composite Class II inlay restorations: a 3D-FEA study.

OBJECTIVES: The purpose of this study was to investigate the effect of differences in the resin-cement elastic modulus on stress-transmission to ceramic or resin-based composite inlay-restored Class II MOD cavities during vertical occlusal loading. METHODS: Three finite-element (FE) models of Class II MOD cavity restorations in an upper premolar were produced. Model A represented a glass-ceramic inlay in combination with an adhesive and a high Young's modulus resin-cement. Model B represented the same glass-ceramic inlay in combination with the same adhesive and a low Young's modulus resin-cement. Model C represented a heat-cured resin-composite inlay in combination with the same adhesive and the same low Young's modulus resin cement. Occlusal vertical loading of 400 N was simulated on the FE models of the restored teeth. Ansys FE software was used to compute the local von Mises stresses for each of the models and to compare the observed maximum intensities and distributions. Experimental validation of the FE models was conducted. RESULTS: Complex biomechanical behavior of the restored teeth became apparent, arising from the effects of the axial and lateral components of the constant occlusal vertical loading. In the ceramic-inlay models, the greatest von Mises stress was observed on the lateral walls, vestibular and lingual, of the cavity. Indirect resin-composite inlays performed better in terms of stress dissipation. Glass-ceramic inlays transferred stresses to the dental walls and, depending on its rigidity, to the resin-cement and the adhesive layers. For high cement layer modulus values, the ceramic restorations were not able to redistribute the stresses properly into the cavity. However, stress-redistribution did occur with the resin-composite inlays. SIGNIFICANCE: Application of low modulus luting and restorative materials do partially absorb deformations under loading and limit the stress intensity, transmitted to the remaining tooth structures.

Bicuspid↗

PubMed2005

Inlay shading effect on the photopolymerization kinetic of a dental composite material used as bonding system in an indirect restoration technique.

OBJECTIVES: To define the inlay shading effect on the polymerization levels and kinetics of a light activated bonding system for an indirect restoration technique. MATERIALS AND METHODS: For the bonding system, an adhesive: Excite (Ivoclar-vivadent) and a composite: Z250 (3M-ESPE, St Paul Minnesota, USA) were investigated. A Demetron (Kerr USA) light curing unit was used. The composite inlay blocks of 2 mm thick were used for the experiment (Artglass A2 Heraeus, Kulzer, Dormagen, Germany). The bonding composite was photocured using a 2 mm composite inlay block as a shielding system while the adhesive was shielded by a 2.3 mm thick wafer, composed of the inlay material and the previously cured bonding composite. The kinetics and levels of polymerization were measured by a differential scanning calorimeter technique (DSC 25, Mettler, Orange, CA, Toledoh, küsnacht, switzerland). RESULTS: The inlay shielded dental composite reaches a significantly lower level of polymerization compared to the unshielded composite. Inlay shielded composite, has a slower polymerization kinetic compared to unshielded composite. The resin adhesive shielded by the inlay-composite wafer reaches polymerization values not significantly different from those of the unshielded adhesive. SIGNIFICANCES: The degree of cure of the light-cured composite resins for use as a base for indirect composite restorations, may be severely reduced as a result of inlay shielding.

Calorimetry, Differential Scanning↗

PubMed1998

Fired ceramic inlays: a 6-year follow up.

OBJECTIVES: The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up. METHODS: One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period. RESULTS: Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity. CONCLUSION: A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group.

Adult↗

PubMed2005

Technology assessment in dentistry: a comparison of the longevity and cost-effectiveness of inlays.

OBJECTIVES: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges. RESULTS: Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40-8.85), 8.65 (8.58-8.73), and 8.76 (8.72-8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive. CONCLUSIONS: While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.

Cost-Benefit Analysis↗

PubMed2006

In vivo and in vitro evaluation of marginal fit of class II ceromer inlays.

The aim of this study was to evaluate the marginal adaptation of class II ceromer (Targis, Vivadent) indirect inlay restorations under both in vivo and in vitro conditions. Twenty Targis inlays were produced for class II inlay cavities (13 mandibular and seven maxillary teeth) in 20 patients. The in vivo adaptation of the inlay to the tooth cavity was evaluated by means of silicone replica technique. For in vitro evaluation, 20 mesio-occluso-distal (MOD) Targis inlays were made in extracted upper molars. Half of the inlays were cemented with Variolink high-viscosity resin cement while the other half was cemented with Variolink Ultra. The replica specimens and in vitro samples were sectioned buccolingually and mesiodistally, and marginal adaptation was evaluated at both proximal and occlusal margins at 200x magnification under a light microscope. The data was analyzed with anova (P < 0.05). The in vivo mean film thickness values for occlusal and proximal locations were recorded as 73 and 132 microm respectively. In vitro mean marginal fit values were observed as 48 and 67 microm for occlusal and proximal margins of inlays luted with Variolink II high viscosity. The marginal fit values recorded under in vivo conditions were higher in magnitude than the measurements obtained under in vitro conditions. The use of a highly filled resin luting agent with an ultrasonic insertion technique did not cause an increase in marginal gap width of the inlay.

Acrylic Resins↗

PubMed1994

Effect of the ultrasonic insertion technique on the seating of composite inlays.

The seating of MOD composite inlays was determined before and after cementation with one of three cements of different viscosities. The seating was determined by measuring the axial discrepancy. Inlays were seated by strong finger pressure or by the ultrasonic insertion (USI) technique. The axial discrepancy of luted inlays varied between 115 microns and 472 microns. The axial discrepancy of inlays luted with finger pressure increased with the viscosity of the cement (Duo Cement < Twinlook < Sono-Cem). Inlays luted with the cement of lowest viscosity (Duo Cement) had seating values of similar magnitude irrespective of seating procedure. As compared with luting by finger pressure, use of the USI technique improved the seating of inlays luted with Twinlook and Sono-Cem (the cement of highest viscosity) to such an extent that the values of seating were of the same magnitude as those of inlays luted with Duo Cement. Consequently, the seating of inlays cemented with the USI technique did not depend on the viscosity of the cement.

Analysis of Variance↗

PubMed1996

A 3-year clinical follow-up study of a ceramic (Optec) inlay system.

To evaluate the clinical quality of ceramic (Optec) inlays, the inlay production of 10 dentists, served by 3 dental laboratories, was examined independently by 2 calibrated examiners. Of the 57 patients with 205 inlays participating in the first examination, 47 patients with 145 remaining inlays participated in the 3-year follow-up reexamination. For 14 of the participants in the reexamination, altogether 21 inlays had fractured. The mean time in service before fracture was 26.4 months (range, 12-53 months). The inlays were rated using the California Dental Association (CDA) quality evaluation system. This examination showed that the mismatch of color had increased from the first examination to the reexamination and registered slightly roughened surfaces. As to anatomic form, a reduced number of inlays did not receive an excellent CDA rating at the reexamination. Visible evidence of ditching along the margin had increased by almost 50%, and an apparent discoloration of the margin between the restoration and the tooth structure was seen in 73% of the reexamined inlays, compared with 7% at the first examination.

Adolescent↗