RESTO II:

Chapter 17: Class II Cast Metal Restorations

 Cast Metal Restoration:

-versatile -applicable to class II onlay preparation Inlay: involves occlusal surface and one or more proximal surfaces of posterior tooth. Onlay: involves cusp tips.

INLAY VS. ONLAY

 Large Restorations

Endontically Treated Teeth

Teeth at Risk for Fracture Dental Rehabilitation with Cast Metals Alloys

Diastema Closure and Occlusal Plane Correction

Removable Prosthodontic Abutment

 High Carries rate

Young Patients
Esthetics Small Restorations

 Advantages: Strength Biocompatibility Low Wear Control of Contours and

Disadvantages: Number of

Contacts

Appointments and Higher Chair Time Temporary Restorations Cost Technique Sensitivity Splitting Forces

Class II Cast Metal Inlays

Initial Preparation:

Carbide burs: 271-Tapered Fissure Bur 169L-Elongated Tapered Fissure Bur

smooth vertical walls

Diamond bur: 8862-Flame-shaped

marginal bevels

 Occlusal Step:

No.271 bur Punch cut: 1.5mm depth Outline preparation extends mesially along the central groove or fissure to include the mesial fossa or pit. Minimal facio-lingual cut.

 Proximal box:

No.271 bur Proximal ditching: mesiodistal width 0.8mm approximately two thirds (0.5mm) of dentin and one third (0.3mm) of the expense of enamel.

Final preparation:
Removal of Infected Carious Dentin and Pulp Protection: No.2 or 4 bur-Round bur/Spoon Excavator-Used to excavate extensive carries

Glass Ionomer-Base Calcium Hydroxide-Pulp protection

 Preparation for Bevels and Flares

Flame-shaped, fine grit diamond bur is used to bevel the occlusal and gingival margins; it is also used to apply flares on distolingual and distofacial walls. Flaring results to 30-40-degree marginal metal to inlay. The cavosurface design helps seal and protect the margins and results in strong enamel margins with an angle of 140-150 degrees.

Gingival Bevel purposes:

Weak enamel is removed. If the gingival margins is in the enamel, it would be week if not beveled because of gingival declination of enamel rods.

The bevel results in 30-degree metal that is burnishable because of its angular design. Bulky 110-degree metal along an unbeleved margin is not burnishable.

A lap, sliding fit is produced at the gingival margin. This helps improve the fit of the casting in this region. With the prescribed gingival bevel, if the inlay fails to seat by 50m, the void between the bevel on the tooth may be 20m; however failure to apply such bevel would result in a void as great as failure to seat.

 Partial onlay is used when a cast metal restoration

covers and restores at least one but not all of the cusp tips of a posterior tooth.

 Full Onlay restorations covers entire occlusal

surface.

 Located completely in dentin Can be located at the mesial & distal wall/the

gingival floor of the facial or lingual portion of a cavity preparation adjacent to the axial wall

Should be located as internally as possible,

Prevent lateral displacement of the mesial, distal,

facial & lingual parts of restoration

 Can also be located

externally in extra coronal preparation, they can be placed anywhere where there is sufficient dentin bulk without impinging on the pulp chamber, root canal system or other anatomy

 Minimal amount of taper on the vertical walls of

preparation Addition of proximal retention grooves Preparation of facial/lingual surface groove extensions

 Placed at expense of the gingival floor, creating an

internal dentinal plane including gingivally-axially, locking the restoration & preventing proximal displacement

Most efficient intact proximal wall immobilizing retention, resistance means Should have a minimum size of 2mm Prepared in dentin with in three dimensions, four vertical but should not have surrounding walls equal length, width & joining a floor at depth. definite line & point angles

Can be located next to marginal ridge with

A preparation opening to the axial tooth surface with three, four or five surrounding walls & floors They can be proximal, facial or lingual

Pins Can be cemented & threaded, parallel & non parallel, vertical & horizontal, cast & wrought Collar Is a surface extension completely surrounding a cusp or a surface of a tooth Skirt Is a specific extension involving a part of the axial angle of a tooth

 Skirts are thin extensions of the facial or lingual

proximal margins of the cast metal onlay that extend from the flare to a termination just past the transitional line angle of the tooth. A skirt extension is a conservative method of improving the retention and resistance forms of the preparation; usually prepared entirely in enamel.

Slot is a internal cavity within a floor of preparation having a continuous surrounding walls & floors Junction between the floor & surrounding walls is rounded

Less locking than an internal box Slot should have a 2 to 3 mm depth

Interocclusal Record: If the patient has sufficient canine guidance to provide disocclusion of posterior teeth, the necessary registration of the opposing teeth can be obtained by:
(1) making a maximum intercuspation interocclusal

record with commercially available bite registration paste

(2) making full-arch impressions and mounting the

casts made from these impressions on a simple hinge articulator

 Interocclusal record: one tooth

Full-arch casts: two or more prepared tooth are

involved
Most commonly used bite registration pastes are

composed of heavily filled PVS impression materials

Temporary Restoration: Requirements:

(1) should be non-irritating and protect the prepared

tooth from injury (2) should protect and maintain the health of the periodontium (3) should maintain the position of the prepared, adjacent, and opposing teeth (4) should provide for esthetic, phonetic, and masticatory function, as indicated (5) should have adequate strength and retention to withstand the forces to which it will be subjected

Technique for Indirect Temporary Restoration Advantages:

(1) avoids the possibility of locking on the set

temporary material into undercuts on the prepared tooth or adjacent teeth (2) avoids placing polymerizing temporary material directly on freshly prepared dentin and investing soft tissue, reducing potential irritation to these tissues(3) post-operative cast made in the indirect technique affords an opportunity to evaluate the preparation (before the final impression) and serves as an excellent guide when trimming and contouring the temporary restoration (4) fabrication of the temporary restoration can be delegated to a well-trained dental auxiliary

 Making a post-operative plaster cast for indirectly

forming a temporary restoration

 Forming indirect temporary restorations

 Trimming and adjusting the indirect temporary

restorations

Technique for Direct Temporary Restoration

Advantages: (1) involves fewer steps and materials because no post-operative impression and gypsum cast are required (2) much faster than the indirect technique

Disadvantages: (1) chance of locking hardened temporary materials into small undercuts on the prepared tooth and adjacent teeth (2) marginal fit may be slightly inferior to the indirect technique (3) more difficult to contour the temporary restoration without the guidelines offered by the post-operative cast

 Forming the direct temporary restoration with pre-

operative impression

Final Impression Qualities:

(1) must became elastic after placement in the

mouth (2) must have adequate strength (3) must have adequate dimensional accuracy, stability, and reproduction of detail (4) must have handling and setting characteristics that meet clinical requirements (5) must be free of toxic or irritating components (6) must be possible to disinfect it without distorting it

 Tissue Retraction

 Polyvinyl Siloxane Impression

Tray Selection and Preparation Must be rigid Two types: commercial stock and custom made Stock plastic tray: convenient and saves time Custom resin tray made over a 2-3mm wax spacer on the study cast is an excellent tray Adequate bonding: special adhesive

Impression Technique Advantages of automixing systems

(1) speed
(2)consistent and complete mixing of accelerator

and base pastes (3) incorporation of very few air voids during mixing and delivery to teeth