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PubMedDate not supplied

In vitro evaluation of fit of adhesively luted ceramic inlays.

PURPOSE: The purpose of this study was to evaluate both marginal and overall adaptation of 4 adhesively luted ceramic inlay systems. MATERIALS AND METHODS: A total of 40 extracted teeth were restored with mesio-occlusodistal ceramic inlays using 4 different techniques: Colorlogic, IPS Empress, Celay direct, and Celay indirect. After cementation with a resin luting agent, the samples were sectioned along a mesiodistal line passing through the center of the restoration. The thickness of the cement was measured at the margins and at several points along the inside of the restorations by means of a stereomicroscope fitted with a measuring grid. RESULTS: The results were analyzed by one-way analysis of variance. The marginal precision of IPS Empress and Colorlogic inlays averaged below 50 microns. Marginal precision of Celay inlays averaged between 110 and 130 microns. IPS Empress and Celay inlays showed a uniform distribution of the cement along the entire prepared surface. Colorlogic inlays showed an uneven distribution of the cement film. CONCLUSION: IPS Empress inlays showed the best clinical features compared to Colorlogic and Celay inlays.

Aluminum Silicates↗

PubMed1992

[Clinical results and material behavior of composite, ceramic and gold inlays].

Laboratory-manufactured gold, ceramic and composite inlays were compared with the CAD/CAM produced CEREC inlay experimentally and clinically. The following systems were examined: Dicor, Optec, Hi-Ceram, Du-Ceram, Cerec, Kulzer, Coltene, SR-Isosit composite inlays, and gold inlays (Degulor C) with adhesive fixation (group I) and with zinc oxide phosphate cement (group II). In the clinical trial inlays in 270 teeth were re-evaluated in a total of 73 patients after 2.3 to 5 years. After 3 years the results obtained with Optec, Hi-Ceram and the Coltene composite inlay were less favorable than those of other systems--statistically however, this difference was of rather low significance (p less than 0.05). Fractures of ceramic inlays occurred in 6 cases within 8 months. 10 failures of ceramic and composite inlays were due to secondary caries.

Composite Resins↗

PubMed1991

Tooth-colored inlays.

There is an increasing need for conservative treatment with tooth-colored inlay restorations due to esthetic concerns and the decreasing acceptance of amalgam. The use of ceramic materials has become possible by using adhesive luting techniques, in which enamel and ceramic inlays are etched and luted with composite resins. The weakest point is still the poor tensile strength of brittle inlay materials, so most efforts are concentrated on strengthening porcelains by ion exchange, tempering, or improving the composition. Despite the fact that adhesively luted inlays show good marginal adaptation, the luting composite layer is worn out because of the low filler fraction of the resins. For composite inlays, the same resins are used as for direct placement. Despite more effective curing techniques, the wear behavior of composite inlays may have been improved, but it is still less than ideal. In clinically orientated studies, it is clearly demonstrated that the luting procedure is technically sensitive with all systems. The clinical experience is limited to only a few years, so to assess the longevity of adhesively luted inlays, more clinical studies must be done. However, tooth-colored inlays are the most esthetic, conservative restorations dentistry has ever offered its patients.

Composite Resins↗

PubMed1991

A 1-year clinical examination of indirect composite resin inlays: a preliminary report.

Twenty-three patients received 45 heat- and pressure-cured composite resin inlays. Approximately 6 months after placement of the inlays, 34 of the inlays (in 19 patients) were examined according to the criteria of the California Dental Association and also for bleeding upon probing. At least 12 months later, 30 inlays (in 16 patients) were reexamined. At the first examination, 28 inlays were rated excellent, three were rated acceptable, and three were rated unsatisfactory. At the second examination, 21 were found to be excellent, eight were acceptable, and one was unsatisfactory. One inlay had been fractured before the first examination, but no other fractured inlays were observed. Except for slightly discolored margins in six inlays, excellent color match and smooth, glossy surfaces were found in most of the restorations.

Acrylic Resins↗

PubMed1996

In vivo and in vitro evaluation of marginal integrity in ceramic inlays.

The marginal integrity is an important factor for the long-term success of ceramic inlays. The long term clinical performance of porcelain inlays depends on a number of factors of which the marginal adaptation is of significant interest. The aim of this study was to determine the margin quality of adhesively luted sintered porcelain inlays both in vivo and in vitro. MOD cavities without bevels were prepared on 10 extracted human mandibular molar teeth. Using the Ducera inlay system, inlays were fired on refractory dies and luted with a dual-curing composite resin. After polishing, each, tooth was sectioned in buccal/lingual and mesial/distal directions and marginal adaptation was assessed microscopically. The mean marginal gap of 78.77 +/- 14.85 microns recorded for occlusal margins was significantly smaller than that of 128.85 +/- 34.34 microns seen at the approximal margins. For in vivo evaluation, 25 fired porcelain inlays, including 7 onlays, were placed in Class II cavities. The assessment of the marginal adaptation of inlays was made according to the scaling system used by Aberg et al. (Acta Odontol Scand 1994; 52:140-149). In 19 of the clinical cases, the restoration was contiguous with the existing anatomic form. Both in vivo and in vitro evaluations showed the margin quality of porcelain inlays to be high.

Adult↗

PubMed2005

Effect of hybrid layer on stress distribution in a premolar tooth restored with composite or ceramic inlay: an FEM study.

The aim of this finite elemental stress analysis study was to evaluate the effect of hybrid layer on distribution and amount of stress formed under occlusal loading in a premolar tooth restored with composite or ceramic inlay. The mandibular premolar tooth was selected as the model based on the anatomical measurements suggested by Wheeler. The analysis is performed by using a Pentium II IBM compatible computer with the SAP 2000 structural analysis program. Four different mathematical models including the following structures were evaluated: 1) composite inlay, adhesive resin, and tooth structure; 2) composite inlay, adhesive resin, hybrid layer, and tooth structure; 3) ceramic inlay, adhesive resin, and tooth structure; 4) ceramic inlay, adhesive resin, hybrid layer, and tooth structure. Loading was applied from the occlusal surface of the restoration, and shear stresses under loading were evaluated. The findings were drawn by the Saplot program, and the results were analyzed by graphical comparison method. The output indicated that the hybrid layer acts as a stress absorber in models 2 and 4. The hybrid layer has also changed mathematical values of stress on cavity floors in both restoration types. Ceramic inlay collected the stress inside the body of the material, but the composite inlay directly transferred the stress through dental tissues. As a result, it was concluded that the hybrid layer has an effect on stress distribution under loading in a premolar tooth model restored with composite or ceramic inlay.

Acrylic Resins↗

PubMed2004

In vitro fracture resistance of posterior metal-ceramic and all-ceramic inlay-retained resin-bonded fixed partial dentures.

STATEMENT OF PROBLEM: Inlay-retained resin-bonded fixed partial dentures (RBFPDs) are conservative prosthetic restorations; however, their resistance to fracture is not clear. PURPOSE: The purpose of this study was to compare fracture loads of posterior complete coverage metal-ceramic restorations with all-ceramic inlay-retained RBFPDs. MATERIAL AND METHODS: Thirty-two posterior ceramic RBFPD restorations were divided into 4 groups (n=8): (1) Complete metal-ceramic fixed partial dentures (MC-FPDs) fabricated of Ni-Cr-based alloy (Wirolloy) and veneered with a ceramic (IPS d.SIGN) as the control group; (2) inlay-retained metal-ceramic (MC RBFPDs) with the same materials as the control; (3) inlay-retained lithium disilicate (LD) glass-ceramic (IPS Empress 2) RBFPDs; and (4) inlay-retained zirconia-based (Z) ceramic (Cercon) RBFPDs. Control specimens were prepared to receive conventional complete MC-FPDs designed to include a 1.3-mm-circumferential, 90-degree flat shoulder with rounded angles. Inlay-retained RBFPD specimens were prepared with 2-mm occlusal reduction but without bevels at the occlusal or gingival margins. Specimens were loaded and fracture loads (N) measured at fracture with a universal testing machine at a crosshead speed of 1.0 mm/min and 250 kgf load cell. Data were analyzed with 1-way ANOVA and Duncan test (alpha=.001). RESULTS: Fracture loads (mean +/- SD) were greatest for control specimens (1318.43 +/- 211.00 N) and Z-RBFPD (1247.70 +/- 262.51 N) specimens as compared to MC-RBFPD or LD-RBFPD (P < .001). MC-RBFPD exhibited the next highest fracture loads (958.01 +/- 194.29 N), and LD-RBFPD exhibited the significantly lowest values (303.23 +/- 92.54 N) of the materials tested (P < .001). CONCLUSION: Inlay-retained zirconia-based ceramic RBFPDs demonstrated the greatest fracture resistance among all inlay-retained restorations tested.

Ceramics↗

PubMed2002

Systematic review of ceramic inlays.

The purpose of the present study was to conduct a systematic review of ceramic inlays, assess the quality of published clinical studies, and determine the clinical effectiveness of ceramic inlays compared to other forms of posterior restorations. Prospective clinical trials of ceramic inlays published from 1990 to 2001 were retrieved by electronic and hand searching. The methodological quality of each study was assessed by two calibrated reviewers using a standardised checklist. The clinical effectiveness of ceramic inlays was evaluated in terms of failure rate, postoperative pain, and aesthetics. The results were compared to those of other forms of posterior restorations by means of an odds ratio. Among 46 articles selected for quality assessment, only five (10.6%) reported randomised controlled trials and 15 (32.6%) presented controlled clinical trials. The remaining 26 papers (56.5%) were longitudinal clinical trials lacking control groups. Only three papers fulfilled the requirement for statistical analysis to evaluate the clinical effectiveness of ceramic inlays. The results indicate no significant differences in longevity or postoperative sensitivity between ceramic and other posterior restorations over assessment periods of up to 1 year. It is concluded that no strong evidence is available to confirm the clinical effectiveness of ceramic inlays in comparison to other posterior restorations. Greater attention is required to the design and reporting of studies to improve the quality of clinical trials of ceramic inlays.

Clinical Trials as Topic↗

PubMed1976

In vivo evaluation of marginal leakage of four inlay cements.

Marginal leakage was demonstrated in all the inlays at all time intervals with all cements by the use of the isotope Ca45. Gross marginal leakage was observed in all inlays luted with the cyanoacrylate cement at all time intervals. The setting time of this cement is very short, making it difficult to completely seat the inlay before the cement sets. The results of this study indicate that the cyanoacrylate cement is not a satisfactory luting medium for Class V inlays. Inlays cemented with EBA demonstrated leakage patterns similar to those of inlays seated with polycarboxylate and zinc phosphate cements in the specimens taken at 72 hours. In the 3 month and 6 month specimens, greater marginal leakage was seen with EBA cement than with polycarboxylate and zinc phosphate cements. Leakage patterns associated with polycarboxylate and zinc phosphate cements were very similar at all time intervals. The polycarboxylate and zinc phosphate cements showed less marginal leakage than the other two cements at 3 months and 6 months. The results of this study indicate that inlays cemented with polycarboxylate cement and zinc phosphate cement exhibit significantly less marginal leakage than the cyanoacrylate cement and EBA cement over a 6 month period of time.

Animals↗

PubMed1991

Stress analysis of cemented or resin-bonded loaded porcelain inlays.

Ceramic inlays have become an interesting alternative to amalgam fillings. There are two main ways to affix the inlay to the tooth: by use of either a cement or a composite adhesion system. The aim of the investigation was to examine the two methods' influence on stresses in the inlay and the shear-stress state in the gluing materials. The finite element method (FEM) was used to calculate the stresses and displacements. A two-dimensional inlay was modeled with a 200-N point load on the occlusal surface just over the isthmus. Composite and cement linings were stimulated with and without adhesion, and the stresses were calculated. The results showed a marked compression of the dentin below the proximal part of the inlay. The direct effects of the different elastic constants of the two lining materials influenced the stresses in only a minor way. Complete adhesion reduced stresses in the inlay, compared with cemented inlays, with no adhesion along the pulpal wall. Higher shear stresses were also calculated in the cement compared with the composite.

Dental Bonding↗

PubMed1996

Marginal breakdown of 5-year-old direct composite inlays.

OBJECTIVES: The marginal fit of tooth-coloured inlays luted with composite resin luting materials has been considered to be the weak link of the inlays. The marginal breakdown of 5-year-old direct composite resin inlays was evaluated by scanning electron microscopy. METHODS: Replica impressions were made of the occlusal, axial-proximal and accessible cervical-proximal margins of 21 inlays and the marginal quality was quantified. RESULTS: More than 84% of the total investigated length of the enamel/luting composite agent-luting composite/composite inlay interfaces revealed gap free margins. Proximal margins showed the largest breakdown at the enamel/composite resin interface, while the occlusal margin interfaces showed only a slight difference between the interfaces. The composite inlay and the luting composite resin showed a similar degree of wear in more than 50% of the evaluated marginal length. Medium gap width varied between 60 microns for the occlusal and axial-proximal and 87 microns for the cervical-proximal margins, with a range of 7.6-266 microns. CONCLUSIONS: The direct composite inlays investigated showed good marginal integrity after 5 years in clinical service.

Bisphenol A-Glycidyl Methacrylate↗

PubMed2003

Effect of different luting materials on the marginal adaptation of Class I ceramic inlay restorations in vitro.

OBJECTIVES: The aim of this in vitro study was to assess the marginal adaptation of prefabricated Class I ceramic inlay restorations placed with various luting materials. METHODS: Forty-two standardized occlusal cavities were prepared in extracted human molars with diamond burs exactly corresponding to the dimensions of prefabricated glass ceramic inlays. The prepared teeth were randomly assigned to seven groups of six teeth each and restored using (1). the composite resin Tetric Ceram in increment technique [Group I] or (2). ceramic inlays (Cerana) luted with: the composite based materials Dual Cement [Gr. II] and Panavia 21 [Gr. III], the compomer material Dyract Cem [Gr. IV], Dyract Cem with additional use of Prime & Bond 2.1 [Gr. V], the silicophosphate cement Trans-Lit [Gr. VI], or the ethylcyanoacrylate Cyano-Veneer [Gr. VII]. Marginal adaptation was evaluated by SEM-analyses before and after thermal cycling (2500 cycles; 5-55 degrees C) and mechanical loading (100N; 500000 cycles) using replica models. Kruskal-Wallis H-test and Mann-Whitney U-test were used for statistical analyses. RESULTS: Group I (increment technique) as well as Groups II-V (inlay technique) revealed high percentages of perfect marginal adaptation in over 95% of the analyzed margins, both before and after thermo-mechanical loading. Statistical significant differences could not be detected within these groups. All inlays luted with silicophosphate cement (Group VI) and four of six inlays applied with Cyano-Veneer (Group VII) fractured under occlusal load. SIGNIFICANCE: A stable bonding to the enamel and to the ceramic inlay was achievable with the composite luting resins Dual Cement and Panavia 21 as well as with the compomer based luting material Dyract Cem but not with the use of the silicophosphate cement Trans-Lit or the ethylcyanoacrylate Cyano-Veneer.

Compomers↗

PubMed2003

Dentin bond strengths of two ceramic inlay systems after cementation with three different techniques and one bonding system.

STATEMENT OF PROBLEM: Cementation of inlay restoration is critical. Because of its high organic content, dentin is a less favorable substrate for bonding than enamel. Therefore it is important to improve dentin adhesion when placing ceramic inlay restorations. PURPOSE: The purpose of this study was to compare the dentin bond strengths of 2 different ceramic inlay systems after cementation with 3 different techniques and 1 bonding system. MATERIAL AND METHODS: One hundred twenty freshly extracted caries- and restoration-free molar teeth used in this study were stored in saline solution at room temperature. Standardized Class I preparations were made in all teeth. Each preparation had a length of 6 mm, a width of 3 mm, a depth of 2 mm, and 6-degree convergence of the walls. Teeth were randomly assigned to 2 groups of 60 each to evaluate the bonding of 2 ceramic systems, Ceramco II (Group I) and IPS Empress 2 (Group II), to dentin. Each of the 2 groups were further divided into 3 cementation technique groups of 20 each (Group I A, B, and C and Group II A, B, and C). Groups I A and B and Groups II A and B used dentin bonding agent (DBA) Clearfil Liner Bond 2V, and resin cement (Panavia F). Groups I C and II C served as control groups and used Panavia F without the dentin-bonding agent. In Groups I A and II A, the DBA was applied immediately after the completion of the preparations (D-DBA). Impressions were then made, and the ceramic inlays were fabricated according to the manufacturers' guidelines. In Groups I B and II B the DBA was applied just before luting the inlay restorations (I-DBA). In Groups I C and II C, no bonding agent was used before the cementation of the inlay restorations (No DBA). Cementation procedures followed a standard protocol. After cementation, specimens were stored in distilled water at 37 degrees C for 24 hours. The teeth were sectioned both mesial-distally and buccal-lingually along their long axis into three 1.2 x 1.2 mm wide |-shaped sections. The specimens were then subjected to microtensile testing at a crosshead speed of 1 mm/min, and the maximum load at fracture (in kilograms) was recorded. Two-way analysis of variance and Tukey honestly significant difference tests were used to evaluate the results (P<.05). Scanning electron microscopy analysis was used to examine the details of the bonding interface. The fractured surfaces were observed with a stereomicroscope at original magnification x22 to identify the mode of fracture. RESULTS: Although no significant difference was found among the 2 ceramic systems with regard to dentin bond strengths (P>.05), the difference between the cementation techniques was found to be significant (P<.001). Comparison among techniques showed that the dentin bond strength in the D-DBA technique had a significantly higher mean (40.27 +/- 8.55 Kg) than the I-DBA (30.20 +/- 6.78 Kg) and No DBA techniques (32.43 +/- 8.58 Kg). As a result of scanning electron microscopy analysis, a distinct and thicker hybrid zone with more, and longer resin tags were found in specimens treated with the D-DBA technique than with the other 2 techniques. Most failures (353 of 360) were adhesive in nature at the bonding resin/dentin interface. Only 7 specimens showed cohesive failure within the bonding resin. CONCLUSION: Within the limitations of this in vitro study, the cementation of the ceramic inlays tested with the D-DBA technique used resulted in higher bond strengths to dentin.

Adhesiveness↗

PubMed1995

Ceramic inlay systems: some clinical aspects.

Due to their inertness and unsurpassed aesthetic properties, ceramic materials are increasingly used as inlay materials. Based on a questionnaire, the frequency and character of complications related to ceramic inlay therapy were assessed and some important pitfalls and clinical relevant factors discussed. A majority of the dentists performed between 1 and 10 ceramic inlays per month using several different ceramic materials. As many as 85% of the dentists had observed complications in connection with ceramic inlays. Most frequency reported was hypersensitivity of a transient nature (15%). The material revealed an overall inlay fracture frequency of 5%, but the individual variations were high. Tooth fracture, loss of retention and other complications such as secondary caries, endodontic envolvement, colour mismatch and a surface and edge deterioration occurred with a varying but lower frequency. Failure analysis revealed a large number of causative factors among which cavity and inlay design, bonding procedures, selection of luting material and proper case selection were regarded as the most important. Due consideration to the strength of remaining tooth substance was found to be important in reducing the problem of hypersensitivity and the risk of tooth and inlay fracture.

Dental Caries↗

PubMed2005

Evaluation of internal adaptation in ceramic and composite resin inlays by silicon replica technique.

This study was aimed at investigating the internal adaptation of a ceramic (Ceramco II) and two composite resin inlay materials (SureFil and 3M Filtek Z 250) using silicon replica technique as an indicator. Forty-five standard mesial-occlusal-distal (MOD) cavities were prepared into brass moulds by using computer numerically controlled system. Inlays were prepared according to manufacturers' instructions with indirect methods. Replicas of the prepared cavities and inlays were produced with a polyvinyl siloxane material (Elite H-D). The spaces between inlays and cavities were filled by different coloured light-body polyvinyl siloxane material. Two parallel slices (mesio-distally) were obtained from the replicas with a sharp blade. Different coloured polyvinyl siloxane material thickness between cavity and inlay was measured at seven points (mesial, occlusal and distal). The data were evaluated with anova and Tukey's honestly significantly different (HSD) statistical tests. In the SureFil and Ceramco II groups, the sizes of the contraction gaps at mesial and distal gingival floors were greater than that of the occlusal marginal walls. In comparison of gap formation at occlusal regions, while the 3M composite group showed highest gap values (204.33 +/- 75.45 microm), the Ceramco II group revealed the lowest (141.17 +/- 23.66 microm) (P < 0.05). At the gingival floors, gap formation of Ceramco II group was the highest (227.08 +/- 51.95 microm). Neither the 3M Filtek Z250 nor SureFil group showed any statistical difference between gap values of their self-occlusal and gingival floors (P > 0.05). In conclusion, our results showed that ceramic inlays did not confer any big advantage for internal adaptation over the composite inlays.

Ceramics↗

PubMed1995

Ceramic inlay movement during polymerization of resin luting cements.

In cavities with no support for inlays, polymerization contraction of the resin cement may move the ceramic inlay axially. The purpose of this study was to determine the velocity and extent of such movement. Cylindrical ceramic inlays were placed in dentin cavities filled with one of four commercially available resin composite cements. An initial standardized 200-microns-thick cement film was created. The movement of the ceramic inlay during polymerization of one of the resin cements was measured by a dial gauge. The velocity of the inlay movement decreased exponentially with time and with a velocity constant of 0.09 min-1. The majority of the movement occurred within the first 12 min after photopolymerization and probably continued for several days, reaching an estimated value of 5.8 microns. After 1-2 d of water storage, 1-2-microns contraction gaps at the cavity floors were observed microscopically for every cement used. It is concluded that in cavities without support for the inlay, about 2/3 of the resin cement contraction results in movement of the inlay and about 1/3 results in formation of gaps at the cavity floors.

Analysis of Variance↗

PubMed1999

Margin gap size of ceramic inlays using second-generation CAD/CAM equipment.

OBJECTIVE: The goal of this study was to determine if the fit of second-generation computer-assisted design/computer-assisted manufacturing (CAD/CAM) (CEREC 2, Sirona Dental Systems, Bensheim, Germany) inlays within Class II cavity preparations were within the range of 50 to 100 microns and were equal or better to CEREC 1 inlays. MATERIALS AND METHODS: Extracted human molars free of surface defects and caries were prepared with standard mesio-occlusodistal cavity preparations. Ceramic inlays were fabricated with CEREC 2 CAD/CAM equipment and seated into cavity preparations. Digital images were captured at 100 times magnification. Marginal gaps were measured with an image analysis program. For each restoration, gaps were measured at 12 locations along interproximal margins and 10 locations along occlusal margins. RESULTS: No difficulty occurred in seating any of the milled inlays. Average marginal gaps for occlusal (59 +/- 35 microns) and interproximal (97 +/- 66 microns) margins were statistically different (t-test, p < or = .01). Average marginal gap for all sites combined was 80 +/- 57 microns. Marginal gap widths were smaller than those obtained from a similar study done earlier with the CEREC 1 unit for occlusal (89 +/- 65 microns) and interproximal (105 +/- 81 microns) margins. Ease of seating with CEREC 2 inlays was much better than with CEREC 1. CLINICAL SIGNIFICANCE: Improvements in software and hardware allow the CEREC 2 to adapt well to standard inlay cavity preparations. The ability of the device to create inlays that seat without interference is remarkable. The improved fit and ability to create the occlusal surface in a variety of ways make CEREC 2 an attractive restorative option for all-ceramic restorations.

Ceramics↗

PubMed1990

An in vivo study of glass ceramic (Dicor) inlays. Preliminary report.

For the purpose of evaluating the clinical quality of glass ceramic (Dicor) inlays 15 patients with 37 inlays were examined 1 to 22 months after placement. In addition to certain periodontal variables, the inlays were rated by two independent examiners using the California Dental Association (CDA) quality evaluation system. The results of the present study showed that dental plaque was seen less often on proximal surfaces with inlays than on homologous proximal surfaces. Three patients reported hypersensitivity of the dental pulp. The examination using the CDA criteria showed that 54% of the inlays had a slight color mismatch, and slightly roughened surfaces were occasionally seen (35.5%). In nearly 30% of the inlays there was visible evidence of ditching along the margins. At present, no judgement can be made about the longevity of ceramic inlays.

Adult↗