Long-term Clinical Performance of Composite Resin or Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis

Clinical Relevance Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates. SUMMARY Objective: This study evaluated the long-term clinical performance and complications of composite resin or ceramic inlays, onlays, and overlays, as well as identified the factors that might influence the clinical outcome of the restorations. Method: A systematic literature search was conducted in the Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases until April 30, 2019, without language restrictions. Randomized clinical trials, clinical retrospective, and prospective cohort studies with a mean follow-up period of five years were included. Two reviewers extracted the study data independently. Newcastle-Ottawa Scale was applied for quality assessment. Meta-analysis was performed by the random-effects model and fixed-effects model. Results: After removal of duplicates, 2818 studies were identified. Finally, 13 observational studies were included in the meta-analysis based on retrospective and prospective cohort studies. The cumulative survival rate and success rate of composite resin inlays, onlays, and overlays were 91% and 84% after five years of follow-up, respectively. The survival rates of ceramic inlays and onlays were 90% at 5 years, 89% at 8 years and 85% at 10 years, while the success rates of ceramic inlays and onlays were 88% at 5 years and 77% at 10 years. Secondary caries and endodontic complications were the predominant failures for composite resin inlays, onlays, and overlays, while restoration fractures and endodontic complications were the main failures for ceramic inlays and onlays. No direct association between parafuntional habits and bruxism and the fractures of restorations was found. Nonvital teeth and multiple-surface restorations tended to increase the risk of failure. Regarding other factors influencing the clinical outcome, no definite conclusion could be drawn due to inconsistent results. Conclusions: The long-term clinical outcomes have been demonstrated to achieve high survival and success rates based on 10-year data for ceramic inlays and onlays, as well as 5-year data for resin inlays, onlays, and overlays.

Semidirect vital tooth onlay restoration: a case report

In the loss of much of the coronary structure, either through caries or a fracture, it is indicated to perform restorative laboratory techniques in order to re-establish the patient's health, function and aesthetics, through conservative and minimally invasive techniques. The aim of this manuscript is to report on a clinical case of a posterior restoration using a semidirect composite resin onlay restoration. Initially, a direct morphological reconstruction of bulk-fill resin was performed, followed by cavity preparation with diamond tips. Alginate melding and a model of elastomer-based material were performed. The professional made the onlay piece in micro-hybrid composite resin in the model incrementally. Cementation was performed with dual resin cement following manufacturer's recommendations. Finally, the occlusal adjustment was performed in the maximum habitual intercuspal position and during eccentric mandible movements. We conclude that the semidirect restorative technique in composite resin is as effective as direct and indirect restorations; however, the correct indication of these restorative procedures will define the clinical prognosis.Descriptors: Dental Restoration; Permanent; Molar. Rehabilitation.ReferencesAngeletaki F, Gkogkos A, Papazoglou E, Kloukos D. Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent. 2016;53:12-21.Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Özcan M. Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis. J Dent Res. 2016;95:985-94.Spreafico RC, Krejci I, Dietschi D. Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo. J Dent. 2005;33:499-507.Lins R, Vinagre A, Alberto N, Domingues MF, Messias A, Martins LR, Nogueira R, Ramos JC. Polymerization Shrinkage Evaluation of Restorative Resin-Based Composites Using Fiber Bragg Grating Sensors. Polymers (Basel). 2019a;11;E859.Lins RBE, Aristilde S, Osório JH, Cordeiro CMB, Yanikian CRF, Bicalho AA, Stape THS, Soares CJ, Martins LRM. Biomechanical behaviour of bulk-fill resin composites in class II restorations. J Mech Behav Biomed Mater. 2019b;2:255-261.Opdam NJM, Roeters FJM, Feilzer AJ, Verdonschot EH. Marginal integrity and postoperative sensitivity in Class 2 resin composite restorations in vivo. J. Dent. 1998;26: 555-62.Bicalho AA, Valdívia AD, Barreto BC, Tantbirojn D, Versluis A, Soares CJ. Incremental filling technique and composite material–part II: shrinkage and shrinkage stresses. Operat. Dent. 2014;39:E83–E92.Soares CJ, Faria-E-Silva AL, Rodrigues MP, Vilela ABF, Pfeifer CS, Tantbirojn D, Versluis A. Polymerization shrinkage stress of composite resins and resin cements - What do we need to know? Braz Oral Res. 2017;28:e62.van Dijken JW. A 6-year evaluation of a direct composite resin inlay/onlay system and glass ionomer cement-composite resin sandwich restorations. Acta Odontol Scand. 1994;52:368-76.Ferracane JL, Stansbury JW, Burke FJ. Self-adhesive resin cements - chemistry, properties and clinical considerations. J Oral Rehabil. 2011;38:295-314.Bacelar-Sá R, Sauro S, Abuna G, Vitti R, Nikaido T, Tagami J, Ambrosano GMB, Giannini M. Adhesion Evaluation of Dentin Sealing, Micropermeability, and Bond Strength of Current HEMA-free Adhesives to Dentin. J Adhes Dent. 2017;19:357-364.Alharbi A, Rocca GT, Dietschi D, Krejci I. Semidirect composite onlay with cavity sealing: a review of clinical procedures. J Esthet Restor Dent. 2014;26:97-106.Hirata R, Kabbach W, de Andrade OS, Bonfante EA, Giannini M, Coelho PG. Bulk Fill Composites: An Anatomic Sculpting Technique. J Esthet Restor Dent. 2015;27:335-43.Fron Chabouis H, Prot C, Fonteneau C, Nasr K, Chabreron O, Cazier S, Moussally C, Gaucher A, Khabthani Ben Jaballah I, Boyer R, Leforestier JF, Caumont-Prim A, Chemla F, Maman L, Nabet C, Attal JP. Efficacy of composite versus ceramic inlays and onlays: study protocol for the CECOIA randomized controlled trial. Trials. 2013;3:278.Torres CRG, Zanatta RF, Huhtala MFRL, Borges AB. Semidirect posterior composite restorations with a flexible die technique: A case series. J Am Dent Assoc. 2017;148:671-676.Marcondes M, Souza N, Manfroi FB, Burnett LH Jr, Spohr AM. Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements. J Adhes Dent. 2016;18:59-67.Liu X, Fok A, Li H. Influence of restorative material and proximal cavity design on the fracture resistance of MOD inlay restoration. Dent Mater. 2014;30:327-33.Fruits TJ, Knapp JA, Khajotia SS. Microleakage in the proximal walls of direct and indirect posterior resin slot restorations. Oper Dent. 2006;31:719-27.

Effect of Deep Margin Elevation on CAD/CAM-Fabricated Ceramic Inlays

Clinical Relevance Using the deep margin elevation technique in preparations extending beyond the cemento-enamel junction appears to be beneficial in maintaining structural integrity of CAD/CAM-fabricated feldspathic ceramic inlays. SUMMARY Objective: To evaluate the effect of deep margin elevation on structural and marginal integrity of ceramic inlays. Methods and Materials: Forty extracted human third molars were collected and randomly separated into four groups (n=10/group). In group 1 (enamel margin group), the gingival margin was placed 1 mm supragingival to the cemento-enamel junction (CEJ). In group 2 (cementum margin group), the gingival margin was placed 2 mm below the CEJ. In group 3 (glass ionomer [GI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with GI to the CEJ. In group 4 (resin-modified glass ionomer [RMGI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with RMGI to the CEJ. Standardized ceramic class II inlays were fabricated with computer-aided design/computer-aided manufacturing and bonded to all teeth, and ceramic proximal box heights were measured. All teeth were subjected to 10,000 cycles of thermocycling (5°C/55°C) and then underwent 1,200,000 cycles of vertical chewing simulation at 50 N of force. Ceramic restorations and marginal integrity were assessed with a Hirox digital microscope. The Fisher exact test (two-tailed) with adjusted p-values (α=0.05) and logistic regression were used for statistical analysis. Results: The cementum margin group had a significantly higher ceramic fracture rate (90%) compared to other groups (10% in enamel margin and GI margin groups, p=0.007; 0% in RMGI group, p<0.001). Logistic regression showed that with increased ceramic proximal box heights, the probability of ceramic fracture increased dramatically. Conclusion: Deep marginal elevation resulted in decreased ceramic fracture when preparation margins were located below the CEJ. There was no difference found between margin elevation with GI or RMGI. Increased heights of ceramic proximal box may lead to an increased probability of ceramic fracture.

Clinical-statistical Study on the Biomimetic Adhesion of Whole Ceramic Inlays

Currently, a new approach to restorative dentistry is possible, from biomimetic point of view, by using restorative materials with a natural tooth-like structure and very strong adhesion to the hard remaining tissues. The objective of the study was to compare in vitro the marginal adaptation of restorations with whole ceramic inlays, using the biomimetic method compared to the classical method. A batch of 60 extracted impacted molars was used for the study. Large cavities were prepared at occlusal proximal surfaces according to minimally invasive therapy principles. The teeth were divided into 4 study groups (A, B, C, D). Batches A and C contain teeth prepared and restored through classical method, with entirely ceramic inlays. Batches B and D contain teeth restored through biomimetic adhesive method. After preparation, fluid composite (Gradia Direct Flo - GC) was used as a basic filling material to seal dentine wounds and dental canaliculi according to biomimetic principles. Cementing was done with Variolink Esthetic DC-Ivoclar (lot A and B) and with Maxcem Elite - Kerr (lot C and D). Samples were cut and prepared for microscopic analysis. The analysis of the four batches revealed the existence of the microfissure in the dentine wounds and the presence of fragments detached from the cementing material layer. The hybrid layer is homogeneous with qualitative dental canaliculi sealing. The difference between the two methods is the size of these defects, in the case of the classical method being approximately 2 times larger. The difference between the two types of cementing material used is due to the fact that in case of Maxcem Elite - Kerr cement, discontinuities have been observed at the level of cementing material - inlay material interface. The biomimetic method is superior to the classical one, the integrity of the layers of materials used in the biomimetic treatment is clearly superior to the integrity of the layers of material used in the classical treatment.

All-Ceramic inlays and onlays for posterior teeth

The increasing requirement for aesthetic restorations has been matched by the continuing improvements in dental materials and fabrication techniques. These factors have resulted in the development of newer ways of making tooth-coloured restorations for posterior teeth. The value of preserving tooth tissue is widely appreciated and the use of partial coverage restorations can assist this aim. The use of porcelain inlays and onlays etched with hydrofluoric acid together with improved composite resin-luting agents offers the dentist and patient the option of a conservative and aesthetic restoration for more extensively damaged posterior teeth. The paper describes the indications and clinical procedures for the use of these restorations. CPD/Clinical Relevance: Porcelain inlays and onlays offer a predictable alternative to full coverage crowns and should be part of the clinician's armamentarium.