Dental Indirect Restorations

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Questions and Answers

What type of occlusal forces can lead to the fracture of ceramic restorations?

Normal everyday occlusal forces

Low functional occlusal forces

External thermal forces

Para functional occlusal forces (correct)

Which of the following is a critical factor for successful adhesive techniques in dental restorations?

Patient's age and health

Time of day treatment is performed

Moisture control in the field (correct)

Length of the dental procedure

What condition is considered a relative contraindication for deep subgingival preparations?

Minimal gingival recession

Presence of strong enamel

Difficulty in impression making (correct)

Lack of tooth sensitivity

Why is bonding to enamel margins preferred over dentin bond strength?

Dentin bond strength is not as reliable Signup and view all the answers

What is the primary advantage of indirect tooth-colored restorations over direct restorations?

Improved physical properties Signup and view all the answers

Which restorative type is noted for having higher wear resistance?

Indirect ceramic and composite resin restorations Signup and view all the answers

What should be done when rubber dam placement is inadequate for subgingival restorations?

Opt for traditional cemented restorations Signup and view all the answers

What can indicate a patient's bruxing or clenching habits?

Heavy wear facets on teeth Signup and view all the answers

What reduces stresses during the cementation of indirect composite resin restorations?

Minimal use of resin cement Signup and view all the answers

Which of the following is an advantage of using indirect composite resin restorations?

More precise control of contours and contacts Signup and view all the answers

Which factor primarily influences pulpal biocompatibility in indirect restorations?

Resin cements used Signup and view all the answers

What is a significant disadvantage of indirect composite restorations compared to direct techniques?

Greater technique sensitivity required Signup and view all the answers

What does the indirect technique allow for in terms of resource allocation?

Delegation of restoration fabrication to dental laboratory Signup and view all the answers

Which aspect of indirect restorations requires attention during the try-in and delivery phase?

Accessibility to marginal areas Signup and view all the answers

Why might indirect composite restorations be considered to have higher costs?

Laboratory fees and provisional restorations Signup and view all the answers

What is a key disadvantage of ceramics used in indirect restorations regarding finishing?

Their hardness makes polishing difficult Signup and view all the answers

What is the purpose of applying a silicone-releasing agent during the Flexible Model Technique?

To prevent bonding of silicone impression materials. Signup and view all the answers

What is the recommended curing time for the characterizing stain applied to the inlay?

40 seconds. Signup and view all the answers

Which step is NOT part of the CAD/CAM workflow for producing a restoration?

Making a polyvinyl siloxane impression. Signup and view all the answers

What process follows the design of the restoration in the CAD/CAM system?

Milling the restoration. Signup and view all the answers

What characteristic of CAD/CAM fabricated indirect composites is highlighted in the content?

They show improved physical and mechanical properties. Signup and view all the answers

Why is the inlay polished with composite polishing paste on a buff wheel?

To create a smooth finish. Signup and view all the answers

During the layer application of composite resin to the polyvinyl siloxane cast, what is crucial for the overall process?

Light curing between layers. Signup and view all the answers

What is a critical component of the initial step in the Flexible Model Technique?

Making a polyvinyl siloxane impression. Signup and view all the answers

What characterizes an onlay restoration?

It is a partial-coverage restoration that restores one or more cusps and adjoining occlusal surfaces. Signup and view all the answers

Under which circumstance would indirect restorations be indicated?

For extensively damaged teeth where direct restorations struggle to achieve proper occlusion. Signup and view all the answers

Which type of restoration is considered an occlusal veneer?

An occlusal ceramic shell that covers the occlusal table without axial cavity preparation. Signup and view all the answers

What distinguishes an endocrown from other indirect restorations?

It derives retention from the pulp chamber in molars that have undergone root canal treatment. Signup and view all the answers

Which of the following cases would NOT typically benefit from indirect esthetic restorations?

Deep subgingival cavities where moisture control is difficult. Signup and view all the answers

What is one significant drawback of direct restorations in certain cases?

Achieving proper contour, contact, and occlusion can be challenging with large defects. Signup and view all the answers

Which of the following pertains to the definition of a vonlay restoration?

A partial-coverage restoration restoring the entire occlusal surface and extending to the buccal surface. Signup and view all the answers

What is one of the problems that indirect restorations can solve?

They resolve occlusal discrepancies such as severe attrition and loss of vertical dimension. Signup and view all the answers

What is the primary purpose of ceramic etching in machined ceramics?

To increase surface area for mechanical retention Signup and view all the answers

Which component is NOT mentioned as part of the composition of machined glass ceramics?

Calcium carbonate Signup and view all the answers

What is the influence of silane when applied to an etched ceramic surface?

It enhances chemical adhesion to resin cements Signup and view all the answers

Which of the following is a recommended method to prepare indirect composite restorations for better adhesion?

Sandblasting with aluminum oxide Signup and view all the answers

Which statement regarding machined glass ceramics is true?

They are biocompatible and resistant to abrasion. Signup and view all the answers

How long should silane be applied to the etched ceramic surface during the silanization process?

1 minute Signup and view all the answers

What is a characteristic feature of reactive silanes used in ceramic treatment?

Have bifunctional properties Signup and view all the answers

What effect does the porous surface of etched ceramics have on resin cements?

Increases chemical retention Signup and view all the answers

Study Notes

Indirect Tooth-Colored Restorations

Indirect restorations are restorations made outside the mouth, typically in a lab or using CAD/CAM technology.
Examples of indirect restorations:
- Inlay: fills a cavity within a tooth, restored with adhesive.
- Onlay: partially covers a tooth, restoring one or more cusps and the adjacent occlusal surface, retained by adhesive.
- Occlusal overlay: covers the entire occlusal surface, retained by adhesive.
- Occlusal veneer: a ceramic shell covering the occlusal surface without axial cavity preparation.
- Endocrowns: partially covers the occlusal surface with additional retention from the pulp chamber of root-canal treated molars.
- Vonlay: covers the occlusal surface, extending to the buccal surface, retained by adhesive.

Indications for Indirect Restorations

Extensively damaged teeth: where direct restorations cannot adequately restore contour, contact, and occlusion.
Uncooperative patients: who cannot tolerate extended chair time.
Deep subgingival cavities: difficult to finish and polish with direct restorations.
Occlusal problems: such as severe attrition with decreased vertical dimension.
Esthetic correction: for excessive discoloration caused by fluorosis or tetracycline.
Lack of accessibility: for difficult-to-reach areas.
Solving problems of direct restorations: Addressing limitations of direct restorations.

Contraindications for Indirect Restorations

Parafunctional occlusal forces: Excessive bite forces, such as bruxism or clenching, can fracture ceramic restorations.
Inability to maintain a dry field: Moisture control is crucial for successful adhesive techniques.
Very poor oral hygiene: May compromise bonding and longevity of restorations.
Deep subgingival preparations: Difficult to accurately record and finish, and the bonding strength at the gingival floor is weak.
Insufficient remaining tooth structure: Insufficient enamel margins, hypoplastic or demineralized enamel can hinder bonding strength.

Advantages of Indirect Restorations

Improved physical properties: High strength, tooth-colored restorative materials, including laboratory-processed and computer-milled ceramics, can be used.
Wear resistance: Increased wear resistance compared to direct composite restorations.
Reduced polymerization shrinkage: Indirect composite restorations have less polymerization shrinkage than direct composites, reducing stress on the tooth structure.
Support of remaining tooth structure: Indirect restorations can strengthen weakened teeth.
Precise control of contours and contacts: Better contouring and occlusal contacts compared to direct restorations due to improved visibility and access outside the mouth.
Biocompatibility and good tissue response: Ceramics are biocompatible and well-tolerated by soft tissues.
Increased auxiliary support: Delegation of fabrication to a dental lab allows more efficient use of the dentist's time.

Disadvantages of Indirect Restorations

Increased cost and time: Typically requires two appointments and fabrication of a provisional restoration, increasing the cost and time commitment.
Technique sensitivity: Requires a high level of skill from the dentist and lab technician.
Difficult try-in and delivery: Polishing indirect composite restorations can be challenging due to limited access. Polishing ceramics is even more difficult.

Flexible Model Technique for Inlay Fabrication

Steps:
- Impression of the preparation with a polyvinyl siloxane material.
- Silicone-releasing agent sprayed onto the impression.
- Heavy-bodied polyvinyl siloxane is injected into the impression to create a flexible working model.
- Composite resin is layered onto the polyvinylsiloxane cast and light-cured between layers.

CAD/CAM Workflow for Indirect Restorations

Optical impression: A scanning device collects information about the preparation and surrounding structures.
CAD design: The dentist or auxiliary personnel use the software to design the restoration, confirming details like gingival margin position.
CAM milling: The milling device fabricates the restoration from a block of high-quality ceramic or composite.

Machined Glass Ceramics

Composition: Contain feldspar, silicon, and aluminium oxides.
Properties: Biocompatible, resistant to abrasion and compressive forces, highly esthetic, but low strength and toughness compared to other ceramics.
Surface Treatment:
- Ceramic etching: Hydrofluoric acid etching enhances surface area for improved retention
- Ceramic silanization: Application of silanes improves adhesion to resin cements.

Indirect Composite Surface Treatments

Resin composite etching: Air abrasion with aluminum oxide enhances retention between resin cements and indirect composite restorations.

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Description

Explore the various types and indications for indirect tooth-colored restorations. This quiz covers inlays, onlays, and other restorations designed for extensively damaged teeth. Test your knowledge on when and how to use these restorative techniques.