INDIRECT

COMPOSITE
RESTORATIONS
Dr. Shubham
PG 1st Year
INTRODUCTION
Dental restorations are the conjunction of different materials and techniques performed in
which a tooth or teeth can be repaired or replaced to recover the form, function, and
esthetic

An Ideal Restorative material should :-

• Permit the most conservative approach to cavity preparation.

• Optimally restore the morphology and function of the tooth

• Ensure adaptation and seal.

• Biologically compatible.

• Provide longevity.
• Earlier materials used were Amalgam, Gold but with advent of Esthetic
Dentistry, It has created new dimensions in providing Esthetics and Functional
Rehabilitation.

• Esthetic alternatives to amalgam restorations and cast gold inlays include direct
and indirect composite resins.
 COMPOSITE
• Highly crosslinked polymeric materials reinforced by a dispersion of
amorphous silica glass bonded to the matrix by a coupling agent.

• Major constituents of a composite resin are

a) Resin matrix
b) Filler particles
c) Coupling agent
d) Activator-initiator-accelerator System
e) Color modifiers
 DIRECT COMPOSITE
RESTORATIONS
 In direct restorations, light-cured resin composite material is placed directly
into the prepared cavity.

Advantages-

• Preservation of tooth structure

• They are usually performed in one appointment, at relatively low costs.
Disadvantages-

• Mechanical strength of these restorations is inferior to that of indirect

composite restorations
• Occlusal And Proximal Wear
• Surface Roughness
• Loss Of Marginal Integrity
• Postoperative Sensitivity
• Secondary Caries
 INDIRECT COMPOSITE RESTORATIONS

 In Indirect technique restorations are fabricated outside the patients mouth.

 Most indirect restorations are made on a replica of the prepared tooth  which it
is luted to the tooth with resin cement

 It provides better physical and mechanical properties

 Indirect composite restorations include

• Inlay
• Onlay
• Veneers
 NEED FOR INDIRECT COMPOSITE
RESTORATIONS
• Degree of polymerization: . The degree of conversion (DC) ranges from 55% to 65%
only in direct composite restorations whereas DC is increased to about 75%–81% in
indirect composite restorations.

• Contacts and contours: Establishing a proper proximal contour and ensuring a tight
contact in direct restorations is a challenge.

• Wear: Direct composite restorations exhibit excessive wear in areas of high occlusal
stress.
 Advantages

Reduced Polymerization Improved physical

shrinkage properties Resistance to occlusal
wear

Improved contact and Better Esthetics

contours
Disadvantages • Increased cost to the
patient
Click icon to add picture
• Difficult chair side
modifications

• More tooth structure

removal
 CLASSIFICATION OF INDIRECT COMPOSITE
RESTORATIONS

Based on Generation Based On Method Of Based On The Type Of

Fabrication Fillers

I. First generation I. Direct-indirect/ I. A. Microfilled

semi-direct method composite, e.g., SR
Isosit
II. Second generation II. Indirect fabrication II. B. Fine hybrid
composite, e.g., Coltene
method
Brilliant
III. Newer Materials III. C. Coarse hybrid
composite, e.g., Kulzer
Inlay
FIRST GENERATION IRC

• Touati et al. and Mormann et al. were the first to develop the
technique for using early generation composite resin.

• The composition was similar to that of direct composite resin

material.

Examples:Visio-gem (ESPE), Dentocolo (Kulzer), Concept

(Ivoclar).
• In spite of their secondary curing, they exhibited low levels
of flexural strength (60–80 MPa) and elastic modulus (2–3.5
GPa).

• These first-generation IRC materials are polymerized by light

either by direct–indirect method or totally indirect method
DISADVANTAGES:-

1. Poor clinical performance

2. Deficient bonding between the organic matrix and

inorganic fillers

3. Unsatisfactory wear resistance

4. High incidence of bulk fracture

 SECOND GENERATION IRC
• To overcome the disadvantages of first generation indirect
composites, in the early 1990s, a second generation of
indirect composites was introduced.

• This generation was introduced with improvements in their

compositions and different curing mechanisms.
• These materials contain microhybrid fillers with a diameter of
0.04–1 micrometer.

• The filler content is twice that of the organic matrix.

• The higher filler loading reduced the polymerization shrinkage,

increased modulus of elasticity, and improved the mechanical
properties and wear resistance of this second-generation indirect
composite materials.

• The flexural strength increases to 120–160 MPa and the modulus of

elasticity ranges between 8500 MPa and 12,000 MPa
• Examples of second-generation IRC materials

1. BelleGlass HP (Kerr Lab Corporation) uses heat and nitrogen

atmospheric pressure.

2. Solidex® (Shofu Inc.)

3. Artglass (Heraeus-Kulzer) uses light and heat applied simultaneously

 POLYMERIZATION TECHNIQUES USED IN SECOND
GENERATION
1. HEAT POLYMERIZATION

• This concept was first used by Heraeus­Kulzer.

• The temperature applied for IRC ranges from 120–140°C.

• The heat can be applied in autoclaves, cast furnaces, or special ovens.

• It was observed that the wear resistance increased by 35% on curing with both light
and heat when compared to curing with light only.
NITROGEN ATMOSPHERE
• Some IRC materials use an oxygen-free nitrogen atmosphere under
80 psi pressure at 140°C.

• The advantage of using nitrogen pressure is that it eliminates internal

oxygen before the material begins to cure, thus preventing inhibition
of polymerization.

• It also prevents voids and microscopic inclusions of air in the setting

material.

• Nitrogen atmosphere at elevated temperature also improves DC. A

higher monomer conversion leads to better wear and abrasion
resistance.

• BelleGlass HP (Kerr Lab) employs this method from the beginning

to the end of the curing process.
SOFT START OR SLOW CURING

• The concept of slow curing described by Mehl.

• This is based on concept of slower rate of curing is that it will allow a

greater DC.

• Faster rate of curing will lead to rapid premature rigidity in the newly
formed polymerized branches which will not allow further propagation.

• Cristobal Plus (Dentsply, Ceramco) uses this method of processing

composite.

• There is a combination of a programmed level of low-light intensity

followed by high-intensity curing. This processing method results in a
composite which is more wear resistant.
 NEWER MATERIALS
• Higher density of inorganic ceramic microfillers

• Large “reinforcement” particles that average 1 mm in size are added to this composite
in addition to the nanoparticles that further improve the strength.

• Hence, this composite is named “reinforced microfill.”

• This indirect composite material also exhibits increased polishability and durability of
polish as well as increased wear and fracture resistance owing to increased filler content

• Example-TESCERA™ ATL™ (Bisco), Gradia Light Cured Micro Ceramic Composite

(GC America), Sculpture® Plus™ Nano-Hybrid Composite (Pentron Laboratory
Technologies)
INDIRECT COMPOSITE RESTORATIONS

1. Inlays

2. Onlays

3. Veneers
 INLAY
 Inlay is defined as fixed intracoronal restoration , a dental
restoration made outside of a tooth to correspond to the form of
prepared cavity,which is then luted into the tooth

 The Class II inlay involves the occlusal and proximal surfaces

of a posterior tooth and may cap one or more, but not all, of the
cusps.
 ONLAY
 An onlay is combination of intracoronal and extracoronal
restoration.

 The Class II onlay involves the proximal surfaces of a posterior

tooth and caps all of the cusps.
 INDICATIONS:
• It is indicated where maximum wear resistance is desired from a
composite restoration

• Large defects or replacement of compromised existing restorations

especially those that require cusp coverage.

• Achievement of proper contours and contacts would be difficult

otherwise.

• In areas of esthetic importance to the patient

• In areas where ceramic restorations is not indicated because of concerns

of wear to opposing dentition.
CONTRAINDICATIONS:

• Heavy occlusal forces/ Bruxism/ Clenching habits.

• Difficulty in isolation of field.

• Deep subgingival preparations

 CAVITY PREPARATION
• The occlusal step should be prepared 1.5 to 2 mm in depth.

• Isthmus be at least 2 mm wide to decrease the possibility of fracture of the

restoration.

• All line and point angles, internal and external, should be rounded to avoid stress
concentrations in the restoration and tooth, reducing the potential for fractures.

MESIO-OCCLUSAL INLAY PREPARATION IN MAXILLARY FIRST

PREMOLAR
• All margins should have a 90-degree butt-joint cavosurface angle to ensure
marginal strength of the restoration.

• The facial, lingual, and gingival margins of the proximal boxes should be
extended to clear the adjacent tooth by at least 0.5 mm.

• Tapered carbide bur or diamond should be used for tooth preparation that creates
occlusally divergent facial and lingual walls

• A shoulder finish is given on the facial and lingual margins.

• The axial wall of the shoulder should be sufficiently deep to allow for adequate
thickness of the restorative material and should have the same path of draw as the
main portion of the preparation
• Gingival-occlusal divergence of the preparation should be greater than the 2
to 5 degrees.

• If cusps have to capped, they should be reduced 1.5 to 2 mm.

MESIO-OCCLUSAL-DISTAL AND LINGUAL INLAY PREPARATION IN

MAXILLARY FIRST PREMOLAR
 IMPRESSION

• An optimal rubber base (elastomeric) impression with proper

extensions of the cavity should be taken.

• Silicone based impression materials, either addition or

condensation cured are the most preferred impression materials.

• The impression along with the model of the opposing arch and
occlusal records is sent to the laboratory for fabrication of the IRC
restoration.
• Composite inlays impression can also be taken with
CAD/CAM technology.

• This technology was introduced during the 1980s from Duret

• Cerasmart (GC) is one of the latest composite blocks used.

• The system exhibits superior physical and aesthetic

properties.
• In a study done by Emir yuzbasioglu et al on Comparison of digital and
conventional impression techniques: evaluation of patients’ perception,
treatment comfort, effectiveness and clinical outcomes.Digital impressions
resulted in a more time-efficient technique than conventional impressions.
Patients preferred the digital impression technique rather than
conventional techniques

• In another study done by Anamika sharma et al on Comparative

Evaluation of the Marginal Fit of Inlays Fabricated by Conventional and
Digital Impression Techniques: A Stereomicroscopic Study showed that
Inlays made with Conventional Technique had more marginal discrepancy
in comparison to Digital Impression techniques.
TEMPORARY
RESTORATION
During the time period between tooth preparation and fit of an indirect restoration it
is important to provide patient with high quality provisional restoration.

Temporary restoration protects the oral tissues and allows the patient to function
while maintaining their appearance until the definitive restoration can be fitted

Temporary restoration can also be fabricated with both

• Direct Technique

• Indirect Technique
Materials used for temporary restoration

I. Fermit N (Ivoclar)
II. Tempit-L/C

III. Clip (Voco)

FABRICATION OF INLAY

• DIRECT-INDIRECT METHOD

• INDIRECT METHOD
 DIRECT-INDIRECT METHOD
 Direct step: The composite material is condensed into the tooth preparation after
application of the suitable separating media.

After the intraoral curing, the composite restoration is removed from the cavity.

 Indirect step: After removal from the oral cavity, the restoration is subjected to an
additional or secondary extraoral light or heat curing at 110°C for 7 minutes depending
on the manufacturers’ recommendations for their product.

This technique eliminates the need for an impression and it is possible to complete the
procedure in one setting
INDIRECT METHOD

• In the indirect method, an impression of the prepared cavity

is taken.

• Models are prepared, and the inlay is fabricated on a die.

• After the application of a suitable separating medium on the

die, the IRC material is condensed and light cured in
increments.

• After completion of initial curing, the inlay is removed and

subjected to further curing by light and/or heat
 CEMENTATION
• For proper adhesive bonding, the internal surface of the inlay/onlay must be
treated before cementation.

• Some systems require the use of a solvent to soften the internal surfaces of the
restoration before cementation.

• Other systems recommend sandblasting (air abrading) the inside of the

composite restoration with aluminum oxide abrasive particles to increase
surface roughness and surface area for bonding

• Usually a dual cure or light cure resin cement is recommended.

INDIRECT METHOD

Pre-operative clinical picture of lower Pre-operative periapical radiograph

right first molar with large cavity over
mesial side
Caries removal under rubber dam isolation. Composite Restoration fabricated on
silicone die
Before Cementation After Cementation

Cementation under rubber dam isolation

After finishing and polishing
VENEER
A veneer is a layer of tooth-colored material that is applied to a tooth
to restore localized or generalized defects and intrinsic
discolorations.

Veneers can be made

• Composite
• Porcelain
• Pressed ceramic materials
INDICATIONS

Enamel defect Tetracycline Acid-induced erosion

staining

Diastema Microdens Discoloration by pulp

necrosis
CONTRAINDICATIONS

A decreased success is seen

 With inadequate enamel and tooth structure.

 When there is existing large restoration or root canal treated teeth with less
tooth structure.

 With oral habits causing excessive stress on restoration and excessive

interdental spacing.
 CLASSIFICATION OF VENEERS
• BASIS OF COVERAGE OF
TOOTH

• PARTIAL VENEERS

• FULL VENEERS
a) Full veneers with window
preparation
b) Full veneers with incisal lapping
FULL VENEERS
Full Veneers are again classified on the BASIS OF METHOD OF
FABRICATION

• Direct method

• Indirect method
DIRECT METHOD
In this method composite veneers are made chairside in one
appointment

This method is usually indicated

• When the entire facial surface is not faulty (i.e., partial veneers)

• For cases involving young children or a single discolored tooth

• When economics or patient time is limited,

DIRECT PARTIAL VENEERS

Models illustrate fault (x) and

Evident White Spots
cavity preparation (y).
Intraenamel preparations for partial veneer
restorations Conservative esthetic result of completed partial
veneers
The clinician should use a coarse, elliptical or
round diamond instrument with air-water coolant
to prepare the tooth to a depth of about 0.5 to 0.75
mm
INDIRECT METHOD
This method requires two appointments and is prepared in the laboratory

Advantages

• Indirectly fabricated veneers are much less sensitive to operator technique. Indirect
veneers are made in the laboratory and are typically more esthetic.

• If multiple teeth are to be veneered, indirect veneers usually can be placed much
more expeditiously.

• Indirect veneers typically last much longer than direct veneers

PROCEDURE

Preoperative photograph Preoperative cast Cast with sectioned silicon

index of wax-up
Frontal view of the mock-up Provisional cementation of mock up
formed using bisacrylic resin

Minimal tooth preparation areas marked on the

preoperative cast
 Light Body Material Injection

Detail of the final elastomeric impression

Wax-up for definitive Wax-up silicon index Microhybrid resin composite
restorations veneers fabrication

Finished and polished restorations

Etching of enamel with Phosphoric acid Postoperative photograph
CASE

The window preparation is made with

a tapered, rounded-end diamond Left central incisor
Patient with six defective
instrument to a depth of isolated, etched, and ready
direct-composite veneers
approximately 0.5 to 0.75 mm for veneer bonding
midfacially, diminishing to a
depth of 0.3 to 0.5 mm along the
gingival margin
Veneer is positioned and Veneer-bonding medium is Completed indirect-composite
seated with blunt instrument light cured veneers
or finger
 CONCLUSION
• According to a study done by Karaarslan et al. in which seventy patients were
included and 140 teeth were equally divided into two groups (n = 70). Seventy
patients were in Group-I (direct composite) and Group-II (indirect composite).

• Variables evaluated were surface texture, marginal discoloration, color match,

retention, marginal integrity, gingival adaptation, postoperative symptoms, and
secondary caries.

• This study concluded that indirect restorations have less surface roughness,
postoperative sensitivity, and soft-tissue irritation than direct restorations. The
clinical performances of the indirect restorations were more satisfactory than
the direct restorations.
THANK YOU
A tooth restoration is any artificial substance or structure that
replaces missing teeth or part of a tooth in order to protect the
mouth’s ability to eat, chew, and speak.
REPAIR OF VENEERS
Failures of esthetic veneers occur because of breakage, discoloration, or wear.

• Small chipped areas on veneers often can be corrected by recontouring and polishing.

• When a sizable area is broken, it usually can be repaired if the remaining portion is sound
Fractured veneer on maxillary
canine
Roughen the damaged surface Undercuts placed in existing
of the veneer or tooth or both veneer with small, round bur
with a coarse,
tapered,rounded-end diamond
instrument to form a
chamfered cavosurface margin
Impression tray is filled with heavy body Occlusal surfaces of adjacent teeth are covered with light-body

Impression tray is seated Completed impression

TWO STAGE IMPRESSION
TECHNIQUE
• Thick putty (heavy body) material is placed in a stock tray and preliminary impression is
made. This will create a custom tray of the putty.
• The space for light body or syringe material is created by either removing a layer of
putty or by using a spacer to create space in the putty tray.
• Preliminary impression made with a high-consistency material is relined with a lower-
consistency material.

• The high-hardness property of the high-consistency vinyl polysiloxane generates a

hydraulic pressure that propels the low-consistency impression material into the sulcus
and all the internal aspects of the preparation
ONE STAGE IMPRESSION
TECHNIQUE
• Heavy body and light body are mixed simultaneously.

• Fill the impression tray with the heavy-bodied impression material.

• Light body is applied on the tooth surface.

•
• Impression should be made with the same applied pressure on the tray in the
mouth during impression making
Completed preparation is shown Veneer restored to original color and
isolated and etched. contour.
 Restorations

Direct Indirect

Composite and
Composite Ceramic inlay, Cast gold
Amalgam
GIC onlay, crown Metal crown
and veneers

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DIRECT FULL VENEERS
Gingival tissue level is marked
Tetracycline stained teeth
on facial surfaces of the teeth to
be veneered by preparing
a shallow groove with a No. 1/4
round, carbide bur
The tooth is prepared with a coarse, tapered,
rounded end diamond instrument by
removing
approximately one half of the enamel
thickness (0.3 mm
in the gingival region to 0.75 mm in the
midfacial and
incisal regions).
Etched surface of Application of resin opaquing Additions of composite
completed preparation material completed
Curing the composite Retainer moved to next All veneers completed
material tooth and stabilized
Curing device for additional Finishing composite inlay on die Composite inlay, polished and
polymerization ready for delivery
CONTRAINDICATIONS:

• Heavy occlusal forces/ Bruxism/ Clenching habits.

• Difficulty in isolation of field.

• Deep subgingival preparations

 Meet our team

Takuma Hayashi Mirjam Nilsson Flora Berggren Rajesh Santoshi

President Chief Executive Officer Chief Operations Officer VP Marketing

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 Meet our extended team

Takuma Hayashi Mirjam Nilsson Flora Berggren Rajesh Santoshi

President Chief Executive Officer Chief Operations Officer VP Marketing

Graham Barnes Rowan Murphy Elizabeth Moore Robin Kline

VP Product SEO Strategist Product Designer Content Developer
 Planning
Synergize scalable e-commerce

Marketing

Plan for
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product
Design
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launch  Strategy
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Launch
Deploy strategic networks with compelling e-business
needs
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scenarios​ •Visualize customer directed convergence

•Iterative approaches to corporate strategy

Cloud-based opportunities •Establish a management framework from the inside

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 How we get there​
ROI​ Niche markets Supply chains​

Envision multimedia-based Pursue scalable customer Cultivate one-to-one customer

expertise and cross-media
growth strategies​
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capital​
service through sustainable
strategies​
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with cutting-edge deliverables​
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enabled technologies​
​

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Summary
At Contoso, we believe in giving 110%. By using our
next-generation data architecture, we help organizations
virtually manage agile workflows. We thrive because of
our market knowledge and great team behind our
product. As our CEO says, “Efficiencies will come from
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