Posterior Inlay using Posterior Inlay using CristobalCristobal®®+, “The Indirect +, “The Indirect Composite System” Composite System” with with Prime & BondPrime & Bond® ® NTNT™™ and and

CalibraCalibra®® Esthetic Resin Esthetic Resin CementCement

Case completed by Case completed by Dr. Stephen PossDr. Stephen Poss

Presented by Dentsply Caulk

Figure 1: Pre-operative photo: A 48 year old male Figure 1: Pre-operative photo: A 48 year old male presented with thermal sensitivity on his upper right presented with thermal sensitivity on his upper right quadrant.quadrant.

Figure 2: After removal of amalgam restorations, it Figure 2: After removal of amalgam restorations, it was determined that due to the extensive decay in the was determined that due to the extensive decay in the second molar, the use of an all ceramic crown was second molar, the use of an all ceramic crown was indicatedindicated

Figure 3: The first molar and the two premolars will be Figure 3: The first molar and the two premolars will be restored using the indirect resin restorative, restored using the indirect resin restorative, Cristobal®+. Cristobal®+ was selected due to its Cristobal®+. Cristobal®+ was selected due to its strength, aesthetics, and long term clinical history.strength, aesthetics, and long term clinical history.

Slightly diverging margins (no more than 15 degrees) for path of insertionNo sharp internal

line angles

Butt joint or heavy champher

Interproximal line angles should be 90 to 120 degrees--Do not flare

Figure 4: During preparation of the inlay, Figure 4: During preparation of the inlay, several key points of the preparation details several key points of the preparation details must be observed.must be observed.

Figure 5: The teeth were prepared for impression by Figure 5: The teeth were prepared for impression by packing cord. Use of Aquasil Fast Set Smart Wettingpacking cord. Use of Aquasil Fast Set Smart Wetting®® Impression material (shown here) is recommended to obtain Impression material (shown here) is recommended to obtain clean, clear margins. If excess tissue is present, use clean, clear margins. If excess tissue is present, use laser or electrosurge to remove. laser or electrosurge to remove.

Create a matrix Create a matrix of the prepared of the prepared teeth directly teeth directly in the mouth in the mouth using, for using, for example, example, JeltrateJeltrate®®, or , or RegisilRegisil®® Rigid Rigid Super Fast Set Super Fast Set Bite Bite Registration Registration Material. Material.

Alternatively, a Alternatively, a matrix may be matrix may be prepared from an prepared from an ideal wax-up on a ideal wax-up on a model. This can be model. This can be accomplished using accomplished using a putty matrix like a putty matrix like Aquasil Easy Mix Aquasil Easy Mix Putty.Putty.

After preparation, load the matrix with IntegrityAfter preparation, load the matrix with Integrity®® and replace the matrix to fit in the mouth for 2-3 and replace the matrix to fit in the mouth for 2-3 minutes. minutes.

Remove and allow the provisional to self-cure for Remove and allow the provisional to self-cure for about 5 minutes. Adjust and trim the provisional about 5 minutes. Adjust and trim the provisional with a slow speed acrylic bur and/or a high speed with a slow speed acrylic bur and/or a high speed diamond bur. Larger shape burs and diamonds work diamond bur. Larger shape burs and diamonds work well.well.

Figure 6: Before temporary cementation, the preparations Figure 6: Before temporary cementation, the preparations were cleaned with chlorhexidine, air dried, and an were cleaned with chlorhexidine, air dried, and an antibacterial agent (e.g. Super Seal or Tublicid Red) was antibacterial agent (e.g. Super Seal or Tublicid Red) was placed. After air drying, the provisionals were cemented placed. After air drying, the provisionals were cemented with Integritywith Integrity®® TempGrip TempGrip™™ & polished with Enhance & polished with Enhance®® Finishing Finishing Cups.Cups.

Figure 7: IntegrityFigure 7: Integrity®® Provisionals in Place Provisionals in Place

Figure 8: Upon return of the patient, the Figure 8: Upon return of the patient, the CristobalCristobal®® inlay restorations were inspected inlay restorations were inspected on the modelon the model

Figure 9: The IntegrityFigure 9: The Integrity®® provisionals were removed and provisionals were removed and a rubber dam was placed. The teeth were again cleaned a rubber dam was placed. The teeth were again cleaned with chlorhexidine rinse for 15 seconds and then with chlorhexidine rinse for 15 seconds and then thoroughly rinsed.thoroughly rinsed.

Figure 10: There are options when placing the CristobalFigure 10: There are options when placing the Cristobal®®++ indirect resin restorative. One may use the “total-etch” indirect resin restorative. One may use the “total-etch” bonding technique or the more recently developed self-etching bonding technique or the more recently developed self-etching adhesives and/or cements. In this case, the total-etch adhesives and/or cements. In this case, the total-etch technique was used. Thus, the teeth were etched using technique was used. Thus, the teeth were etched using phosphoric acid, beginning application on the enamel.phosphoric acid, beginning application on the enamel.

Figure 11: Next, the application of Caulk Tooth Figure 11: Next, the application of Caulk Tooth Conditioner Gel was extended to the dentin, making sure not Conditioner Gel was extended to the dentin, making sure not to leave etchant on the dentin more than 15 seconds. This to leave etchant on the dentin more than 15 seconds. This procedure ensures lack of over etching of the dentin. The procedure ensures lack of over etching of the dentin. The teeth are thoroughly rinsed and lightly dried until the teeth are thoroughly rinsed and lightly dried until the dentin has a moist matte finish. dentin has a moist matte finish.

Figure 12: Prime & BondFigure 12: Prime & Bond®® NT NT™ ™ Dual CureDual Cure is mixed with its is mixed with its Self Cure Activator and applied generously to the teeth, Self Cure Activator and applied generously to the teeth, allowing to remain in contact for 20 seconds. The excess allowing to remain in contact for 20 seconds. The excess solvent is then evaporated using a gentle air stream. solvent is then evaporated using a gentle air stream. The treated surfaces should have a uniform glossy The treated surfaces should have a uniform glossy appearance as shown above.appearance as shown above.

Figure 13: Prime & BondFigure 13: Prime & Bond®® NT™ Dual Cure is NT™ Dual Cure is light cured for 10 seconds per toothlight cured for 10 seconds per tooth

In this case, CalibraIn this case, Calibra®® Esthetic Resin Cement was used. The Esthetic Resin Cement was used. The light cured resin paste was mixed with the catalyst paste light cured resin paste was mixed with the catalyst paste to activate the dual cure setting mechanism. to activate the dual cure setting mechanism.

The internal surface of the CristobalThe internal surface of the Cristobal®®++ indirect resin indirect resin restoration was blasted with a silicate ceramic material restoration was blasted with a silicate ceramic material (CoJet--3M), silanated, and let air dry for one minute. (CoJet--3M), silanated, and let air dry for one minute. Then a thin coat of the Prime & BondThen a thin coat of the Prime & Bond®® NT NT™™ Dual Cure mixture Dual Cure mixture was placed on the internal parts of the restorations, and was placed on the internal parts of the restorations, and air dried.air dried.

Figure 14: The CristobalFigure 14: The Cristobal®®++ restorations were then firmly restorations were then firmly seated in place and the excess cement wiped off. The teeth seated in place and the excess cement wiped off. The teeth were carefully flossed and the restorations light cured. were carefully flossed and the restorations light cured. The excess cement was removed with various scalers or with The excess cement was removed with various scalers or with a 7404 carbide bur. a 7404 carbide bur.

Figure 15: Enhance® Finishing System polishing cups were used.

Figure 16: Completed Cristobal®+ Indirect Inlay Resin Restoration