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A clinical evaluation of the 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. A total of 57 patients with 205 inlays (mean age, 8.1 months) were examined 1 to 32 months after placement by means of using a slightly modified form of the California Dental Association criteria. Periodontal variables such as plaque index, gingival index, and margin index were also recorded. Eight patients reported postoperative but not persistent hypersensitivity in relation to the Optec therapy. No differences between Optec proximal surfaces and homologous control surfaces were seen with regard to plaque or bleeding on probing. The examination using the CDA criteria showed that 59% of the inlays had a slight color mismatch. Slightly roughened surfaces were most common (86%). As to anatomic form and margin integrity, 24% and 67%, respectively, of the inlays were rated excellent. A difference between the dentist with regard to the clinical quality of the inlay treatment procedure was seen. The present results cannot allow a definitive judgement with regard to the long-term clinical quality of the Optec inlay system but will serve as a base for further studies.

Adolescent↗

Effects of cavity form and setting expansion of refractory dies on adaptability of Class II (MO and MOD) fired ceramic inlays.

This study investigated the effects of cavity divergence and setting expansion of refractory die material on the adaptability of Class II (MO and MOD) fired ceramic inlays. Standardized Class II (MO and MOD) cavities with two kinds of lateral wall divergence (10 and 20 degrees) were prepared in epoxy resin blocks. A refractory die was prepared from an impression of the epoxy resin cavity in which the setting expansion ranged from 0.04 to 1.14%. A ceramic inlay was fired on each die. The fabricated inlay was inserted into the epoxy resin cavity, and the interfacial distance between the ceramic inlay and the cavity wall at the margin was measured using a reflecting microscope at x100 magnification. The internal fit was measured after sectioning the specimen longitudinally. The results indicate that the setting expansion of the refractory die materials and the divergence of the lateral walls had significant effects on the adaptability of Class II (MO and MOD) fired ceramic inlays. The inlays fabricated on the refractory dies with small setting expansion showed small internal gaps in Class II (MO) cavities. Significantly good adaptation was achieved when the setting expansion was 0.32% or less (p < 0.05). The inlays fabricated on the refractory dies with large setting expansion showed small internal gaps in Class II (MOD) cavities. Significantly good adaptation was achieved when the setting expansion was 0.87% and greater (p < 0.05).

Analysis of Variance↗

Microleakage in ceramic inlays luted with different resin cements.

PURPOSE: The objective of this in vitro study was to evaluate the microleakage in ceramic inlays using different resin cements with margins in enamel and cementum/dentin interfaces. MATERIALS AND METHODS: Standard Class II MOD inlay cavities were prepared in 32 noncarious human premolars. The cavities were randomly divided into 4 groups (n = 8): CONTROL GROUP: cavities were treated with Single Bond and incrementally filled with a composite resin (P60); Enforce group: feldspathic ceramic inlays were luted using Prime & Bond 2.1 and Enforce; RelyX group: inlays were cemented with Single Bond and RelyX ARC; Resin Cement group: ceramic inlays were bonded using Single Bond and Resin Cement. Ceramic inlays were previously treated with 10% hydrofluoric acid for 2 min, followed by silane application. After 7 days of storage in distilled water, teeth were submitted to thermocycling. After applying nail varnish, specimens were immersed in 2% aqueous solution of methylene blue for 8 h. After washing, teeth were cut into three sections through the restorations, and the leakage was assessed using a standardized score. RESULTS: Data were submitted to statistical analysis using nonparametric tests (Mann-Whitney and Kruskal-Wallis). Dye leakage at margins in enamel was statistically lower (p < 0.01) than at cementum/dentin interfaces. RelyX ARC performed better (p < 0.05) than resin cement (enamel) and composite restorations (cementum/dentin). No other statistical differences were observed. CONCLUSIONS: Both the material and the substrate interface influenced microleakage of the ceramic inlays.

Acid Etching, Dental↗

Interfacial gaps following ceramic inlay cementation vs direct composites.

This study compared the interfacial integrity of Class II ceramic inlay restorations and direct resin composite restorations. The influence of a flowable resin composite liner was also evaluated. Class II DO cavities were prepared in 40 recently extracted mandibular molars and assigned to four treatment groups. Group A: direct composite restoration; Group B: Cerec inlays fabricated and cemented with a resin cement; Group C: adhesive lining with a flowable resin composite used prior to resin composite restoration; Group D: lining with a flowable resin composite prior to cementation of Cerec inlays. After finishing, polishing and thermocycling (4 degrees C and 60 degrees C x 500), the samples were cross-sectioned in a mesio-distal direction along the center of the fillings or inlays. The cross-sectioned surface was polished, and the adhesive interfaces between resin and enamel or dentin were observed under a scanning laser measurement microscope. Ceramic inlay restorations showed no interfacial gaps in enamel, but direct resin composite restorations showed a significantly higher incidence of gaps at the interface or cracks in the interfacial enamel (p=0.0002). No differences were found in the resin-dentin interfaces for both the inlay and direct resin composite restorations. The use of a flowable resin composite as an adhesive liner produced a significantly greater gap-free resin-dentin interface in Cerec inlay and direct resin composite restorations (p=0.0233 & 0.0009), but it did not reduce gap formation at the resin-enamel interface.

Cementation↗

[The inlay computer aided design based on reverse engineering technology].

OBJECTIVE: This study was to explore a CAD method for constructing occlusal and proximal surfaces of inlays using reverse engineering (RE) software and to develop a CAD software for the inlay fabrication. METHODS: The dentition model of a volunteer with individual normal occlusion was scanned with a 3D mechanical scanner. The scanned objects were prepared teeth with G. V. Black class I, class II and class VI (MOD) cavities, neighbor teeth, intercuspal position (ICP) record, and functional bite record (or functional generate path, FGP). Inlays were constructed based on RE technology using the database of Chinese normal teeth. RESULTS: The technique guideline of inlay CAD was developed based on RE softwares. Inlays designed with CAD technique showed smooth and continuous contours. The occlusal and proximal contacts of inlay met physiologic demands. CONCLUSIONS: It is a feasible method to develop a CAD software for inlay fabrication based on RE software.

Adult↗

In vitro evaluation of wall-to-wall adaptation of a self-adhesive resin cement used for luting gold and ceramic inlays.

PURPOSE: This in vitro study evaluated the wall-to-wall adaptation of a new self-adhesive resin-based cement (RelyX Unicem) in comparison with that of other cements when luting gold and porcelain inlays in standardized Class II cavities in extracted teeth. MATERIALS AND METHODS: In each experimental group (n = 10), a different combination of inlay and luting material was tested. Group 1: Porcelain Empress II (Ell) and RelyX Unicem (U); group 2: Ell and resin-based cement Variolink II in combination with primer and bonding Excite DSC; group 3: gold inlays (G) and U; group 4: G and Harvard zinc-oxy-phosphate cement; group 4: G and glass-ionomer cement Fuji Cem. After storage and thermocycling, microleakage testing was carried out and dye penetration was examined at the occlusal and cervical margins of each inlay. The differences in microleakage score were tested for statistical significance first comparing all groups, then pooling the groups for inlay material (Kruskal-Wallis nonparametric ANOVA and Mann-Whitney U test, p < 0.05). SEM observations of the tooth/cement/restoration interfaces were also made in each group. RESULTS: Harvard cement had the highest microleakage. The sealing ability exhibited by RelyX Unicem was satisfactory with both gold and porcelain inlays, and comparable to that of Fuji Cem and Variolink II. CONCLUSION: RelyX Unicem achieved an adequate seal on both enamel and dentin when used to lute in vitro gold and porcelain inlays.

Dental Cavity Preparation↗

Luting composite thickness of two ceramic inlay systems.

The purpose of this in vitro study was to evaluate the luting composite thickness of two ceramic inlay systems, a direct chairside ceramic inlay system (Cerec, CAD/CAM), and an indirect laboratory inlay system (IPS Empress). The luting composite thicknesses were measured at the approximal margin, at the inner axial wall and at th occlusal cavosurface area. The luting composite thickness at occlusal margins and inner axial walls were found to be smaller in Empress inlays. However, the fit of inlays was poorer in Empress inlays at distal proximal margins, which most probably resulted from displacement of Cerec inlays during cementation due to inaccurate inner fit.

Aluminum Silicates↗

Intracorneal inlay complicated by intrastromal epithelial opacification.

OBJECTIVE: To report epithelial perilenticular opacity as a new complication of intracorneal inlay implantation for the correction of hyperopia. DESIGN: Prospective observational case series. PARTICIPANTS: Eleven eyes of 7 patients underwent intracorneal inlay implantation for the correction of hyperopia. METHODS: Intracorneal inlays were implanted onto the stromal bed by using a microkeratome cut to create an inferior hinged corneal flap. MAIN OUTCOME MEASURES: Postoperative complication occurrence of intracorneal perilenticular opacity, microbiological laboratory analysis, histopathological analysis, and confocal microscopy study. RESULTS: Of 11 implanted eyes, 5 showed diffuse perilenticular opacity of varying intensity that was unresponsive to steroid use following intracorneal inlay implantation. All patients had moderate to severe loss of best-corrected visual acuity. The inlays showed deposits at the edge and on the surface. Confocal microscopy in all eyes produced images compatible with the confocal morphologic features of epithelial cells. Explantation of inlays was performed in 5 eyes. The histopathologic study showed the presence of epithelial cells, and microbiological analysis and cultures were negative for bacteria, fungi, and mycobacteria. CONCLUSION: Epithelial perilenticular opacity is a new and serious complication in patients with intracorneal inlay implantation for the correction of hyperopia.

Adult↗

Tibiofemoral contact stress after total knee arthroplasty: comparison of fixed and mobile-bearing inlay designs.

We measured tibiofemoral contact stresses and the load-bearing contact area of fixed and mobile-bearing inlay knee prostheses under dynamic loading conditions. An electronic resistive pressure-measuring sensor was used to detect contact stresses and contact area in five cadaver knees. Stresses were measured with the tibial component aligned normally, as well as in internally- and externally-rotated positions. The average peak contact stresses measured on the fixed inlay were greater (medial 21 MPa and lateral 21 MPa) than those on the mobile inlay (medial/lateral 7.7/5.3 MPa, p = 0.04). Although the average peak contact stresses of the fixed standard inlay greatly exceeded the contact stresses of the other two inlay designs in each malrotated position tested, no statistically significant differences were seen. The data suggest that the ability of the inlay to translate on the tibial baseplate permits the inlay to align itself on the femoral component so that the contact surface area is maximized and contact stresses are reduced.

Aged↗

Effects of metal-inlay thickness in polyethylene cups with metal-on-metal bearings.

A way to prevent polyethylene wear in total hip replacements is to use metal-on-metal bearings. The cup design of these bearings may be a metal inlay in a polyethylene cup. However, these metal inlays are relatively thin and may deform on loading. The purpose of the current study was to determine whether these potential problems become actual for a realistic range of metal-inlay components having a thickness greater than 1 mm. For this purpose, the effects of thickness variation of a metal inlay in an ultrahigh molecular weight polyethylene cup were determined using three-dimensional finite element techniques. The results showed no indications for jamming of the bearing assuming a realistic inlay thickness (3-5 mm), even with a small clearance (25 microm). The metal inlay acted rigidly beyond a thickness of approximately 5 mm. Metal inlays thinner than 1.5 mm led to a considerable increase in contact area and a reduction in contact peak stress, which may be beneficial for the bearing performance. Currently, these thin liners have too many unknown characteristics and therefore the current authors recommend using rigid metal liners that have a thickness greater than 5 mm.

Biomechanical Phenomena↗

Two-year preclinical testing of perfluoropolyether polymer as a corneal inlay.

PURPOSE: To assess the long-term biocompatibility and optical clarity of a perfluoropolyether (PFPE) polymer as a corneal inlay. METHODS: A 4-mm-diameter PFPE inlay was implanted under a microkeratome flap in the corneas of rabbits (n = 16) and maintained for predetermined time points of 6, 12, or 24 months. These were compared with normal (n = 3) and time-matched sham-wounded rabbit corneas (n = 8). All corneas were monitored clinically with a slit lamp. Histology was performed on all eyes on termination to assess the tissue response. RESULTS: Some sham and implanted animals were discontinued from study 1 to 2 days after surgery because of flap dislodgement. Ten animals with PFPE inlays remained in the study, and 7 of these were maintained to their predetermined time point for up to 2 years (3 were discontinued because of peripheral corneal defects). The corneas of these 7 animals remained clear and healthy, tear film remained normal, and there were no signs of inflammation, neovascularization, or increased conjunctival redness. All inlays remained centered and optically clear (clarity 85% or greater). Histology showed PFPE was biostable. The epithelia of operated corneas were stratified but slightly thinned compared with those of normal corneas. Stromal tissue anterior and posterior to each inlay appeared normal. Keratocytes in the vicinity of the inlay were normal in distribution but showed increased vacuolation, indicating tissue repair after the surgery. CONCLUSIONS: The PFPE polymer maintained a high level of optical clarity and showed long-term biocompatibility for up to 2 years when implanted as an inlay in the rabbit cornea.

Actins↗

In vitro two-body wear of inlay-onlay composite resin restoratives.

Inlay-onlay composite resin restorations have been introduced to the profession as alternatives to amalgam and direct composite resins. Two-body wear testing was performed on three inlay-onlay resins and one direct composite resins using a machine designed to produce sliding wear. The composite resins were opposed by human enamel, type III gold alloy, and porcelain. Of the investigated materials, the homogeneously microfilled inlay-onlay material showed significantly less wear. The direct composite resin showed significantly the greatest wear. The hybrid inlay-onlay resins showed intermediate wear. The hybrid inlay-onlay resins and the direct composite (small particle, heavily filled) resin created wear tracks in the opposing surfaces while the homogeneous microfill inlay-onlay resin did not. The depth of the observed wear tracks in the opposing surface was sufficiently substantial to warrant further investigation into the wear of materials that oppose composite resin restorations.

Analysis of Variance↗

Current status of the cast metal inlay: a survey of dental schools in the UK and Hong Kong.

This study reports on the current status of the gold inlay in the undergraduate curriculum of Dental Schools in the UK and at the Prince Philip Dental Hospital, Hong Kong, to determine if the decline in the use of the cast gold inlay over the past 20 years is reflected in teaching at undergraduate level. A questionnaire, which was mailed to all the heads of departments of conservative dentistry in the UK, was designed to determine current teaching in respect of cast inlays. The results show that although the majority of UK dental schools continue to teach direct and indirect inlay techniques, a minority (4 and 5 respectively) no longer incorporate a practical exercise in this teaching. Reasons cited for the discontinuation of the technique are varied but the availability of simpler, more conservative techniques is emphasized. Examination of the treatment records at the Prince Philip Dental Hospital, Hong Kong, where the Class II inlay technique is taught both theoretically and practically, shows that only a small proportion of all posterior cast restorations fitted between May 1983 and April 1988 were inlays (4.6 per cent).

Dental Records↗

Cavity convergence angles for direct composite inlays.

Direct composite inlays may sometimes be difficult to remove from the cavity following primary polymerization. The aim of this work was to find the lowest cavity convergence angle (taper) which would allow reliable inlay removal. Cavity finish and cavity size were also taken into account. Standardized mesio-occlusal-distal cavities of 6 degrees taper were cut into 10 teeth of varying mesiodistal width and finished with either 12-bladed tungsten carbide or 25 microns diamond burs. After separating medium had been applied. Coltene Brilliant Dentin composite resin was packed into the cavity and light cured. The force required to remove the inlay was measured with an Instron Universal Testing Machine. The cavities were then refinished with the alternative finish and the experiment repeated. The same sequence was used for cavities of 12 degrees and finally 18 degrees convergence angle which were cut consecutively in the same 10 teeth. Force levels related to cavity convergence angle, cavity finish and tooth size were tested by ANOVA and regression analysis. The forces required to remove some of the inlays from the 6 degrees, and to a lesser extent 12 degrees angled cavities, proved unacceptably high, while an 18 degrees convergence angle resulted in statistically significant lower forces which were unlikely to damage tooth or inlay. Cavity finish and tooth size did not influence inlay withdrawal force.

Analysis of Variance↗

Quality assessment of amalgam and inlay restorations on posterior teeth: a retrospective study.

This study was designed to assess and compare the quality of posterior proximo-occlusal amalgam and inlay restorations relative to type of restoration (material, surfaces involved, and cusp protection) and length of service of the restorations. A clinical evaluation system based on operationally defined and clinically important criteria was used. Clinically and statistically significant differences were found between overall ratings for amalgam and inlay restorations and between small (two-surface) amalgam and inlay restorations, as well as between larger (three-surface) amalgam and inlay restorations. In all cases, inlay restorations were of higher quality. A not acceptable rating for marginal integrity was the most frequent reason for not acceptable overall ratings. There was no difference in satisfactory/not acceptable ratings for inlay restorations with or without protected cusps (p = .95).

Bicuspid↗

Clinical performance of pressed ceramic inlays luted with resin-modified glass ionomer and autopolymerizing resin composite cements.

STATEMENT OF PROBLEM: Several in vitro studies have been published showing the incapability of the chemical cure of dual-cured resin composite luting agents to compensate for absence of visible light activation. PURPOSE: This study evaluated and compared pairs of Empress ceramic inlays luted with 2 chemical-cured luting agents: a resin-modified glass ionomer cement and a resin composite within individual patients. MATERIAL AND METHODS: Seventy-nine ceramic inlays were placed in class II cavities in 29 patients. In each patient half of the inlays were luted with a resin-modified glass ionomer cement and the other half with a chemical-cured resin composite cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months, and 1 and 2 years. RESULTS: No failed inlays were observed during the 2-year follow-up. A slight ditching of the cement margins was observed in both luting groups. No significant difference was seen between the 2 luting techniques. CONCLUSION: IPS Empress inlays luted with both chemical-cured luting agents functioned satisfactorily in the short-term follow-up. Longer observation periods are necessary to evaluate the long-term clinical behavior of both luting techniques.

Adult↗

Time-and-motion study on class II copy-milled ceramic inlays.

OBJECTIVES: To obtain an estimate of working times of Class II copy-milled ceramic inlays as an indication of their efficiency, and to analyse factors of influence. METHODS: In a controlled clinical trial, 173 MO/DO or MOD ceramic inlays of the Celay system were constructed in 101 patients. Treatment was carried out by seven dentists. The inlays were replacements of existing amalgam restorations in both molar and premolar teeth. Net-times needed for the treatment and for the laboratory stage were registered. Variables of influence on the working time were assessed by using ln-working times in ANOVA. Differences of working times were expressed as the relative difference between the upper and lower value of each variable (Delta). RESULTS: The mean clinical treatment time was 67(+/-22)min. The laboratory stage required 60(+/-17)min working time. 'Cavity modification technique' (composite basing/conventional, Delta=17%), 'clinical operator' (seven dentists, Delta=57%), and 'size of the restoration' (large/medium, Delta=16%) significantly influenced the clinical treatment time (p<0.001). Although the dentists were familiar with inlay construction, they showed a 25% decrease in working time towards the end of the study. CONCLUSIONS: Class II copy-milled ceramic inlays in this time-and-motion study required about 125min of working time. Working time increased by applying composite basing and making large restorations. The dentist influenced working times, while efficiency increased over time. Dentists needed more laboratory time to produce an inlay than the dental technician.

Adult↗

In vitro milling accuracy and fit of 'natural inlays'.

OBJECTIVE: This study aimed to investigate the milling behaviour of natural inlays (NI) dental restorations constructed from sound extracted teeth. This was done by comparing the milling accuracy and fit of NI to those of industrial porcelain inlays (PI), milled in the same way. METHODS: A calibration pro-inlay was used to mill three NI and three PI. These were cemented in six acrylic cavities reproduced from the calibration mould, using composite luting cement. No etching and bonding were done. After storage for 24 h in water at room temperature the specimens were sliced buccolingually in a standardised way. For each specimen, two sections were photographed under a light-microscope, resulting in enlarged pictures of the sections. An acetate matrix with the measurement points was placed over each picture in a standardised way. The interfaces between inlays and moulds were measured at 13 fixed points per section using computerised image analysis software. The mean vertical- and floor-interfaces were calculated for each picture, and the overall means were found for each group. Confidence intervals were used for comparison of the differences. The profiles of the milled materials were examined using scanning electron microscopy. RESULTS: There were no differences between NI and PI in the mean interfaces (NI, 102 +/- 8 micrometers; PI, 107 +/- 8 micrometers). Electron microscopy revealed no apparent differences in the profiles of the milled surfaces. CONCLUSION: These findings indicate that the milling accuracy and the fit of natural inlays and milled porcelain inlays are comparable.

Calibration↗