Class II Cast Metal

Restorations
Dr Khadija Akhtar
Postgraduate trainee
Department of Operative dentistry
IOD CMH Lahore Medical College
 Cast Metal Restoration
The cast metal restoration is an indirect restoration
that involves numerous steps and dental materials, with meticulous
attention to details.

 Class II inlay
 Partial onlay
 Class II onlay
• The class II inlay is an intra-coronal cast metal resto- that involves the
occlusal and proximal surfaces of posterior teeth

• The partial onlay is a cast metal restoration that involves occlusal and
proximal surfaces of posterior teeth and covers at least 1 or more
cusps.

• The class II onlay is a cast metal restoration that involves occlusal and
proximal surfaces of posterior teeth and all the cusps.
 Cast Metal Alloys
Cast metal restorations can be made from variety of casting alloys
4 distinct group of alloys:

 Traditional high gold alloy

 Low gold alloys
 Palladium-silver alloys
 Base metal alloys
Indications
• Large restorations
• Superior contact and contours
• Endodontically treated teeth
• Dental rehabilitation with cast metal alloys
• Posterior diastema closure
• Correction of occlusal plane
• Removable prosthetic abutment
Contraindications
• High caries rate
• Young patients
• Esthetics
• Small restorations
Advantages
• Strength
• Biocompatibility
• Low wear
• Control of contacts and contours
Disadvantages
• No. of appointments
• Increase chair time
• Temporary restorations required
• Cost
• Technique sensitivity
• Splitting forces
Preoperative procedures
 Occlusion
 Anesthesia
 Temporary restorations
 Alginate impressions
 Polyvinyl siloxane impression
Tooth preparation
• Class II inlay (DO in max. 2nd premolar)
• Partial onlay
• Complete onlay (MOD mand. 1st molar)
Armamentarium
Initial preparation
• Occlusal step
• Proximal box

Final preparation
• Removal of infected carious dentine
• Preparation of bevels and flare
Initial preparation

Occlusal step Proximal Box

1. Orienting the bur 1. Proximal ditch preparation
2. Occlusal punch cut 2. Proximal box preparation
3. Occlusal extension 3. Planing the walls
4. Dovetail extension 4. Placement of retention
5. Occlusal outline form grooves
Intial preparation
Proximal box
1. Proximal ditch preparation
2. Proximal box preparation
3. Planing the walls
4. Placement of retention grooves
Final preparation
1. Inspection
2. Removal of infeced caries
3. Removal of old restorative material
4. Pulp protection with Ca(OH)/GIC
Bevels and flare
1. Occlusal bevel 40 degree metal
2. Axiopulpal line angle bevel 40 degree metal
3. Prepare secondary lingual flare
4. Gingival margin bevel
5. Prepare secondary facial flare
Cusp capping partial onlay
Definition:
A cast metal restoration that covers and restores atleast one but
not all of the cusp tips of posterior teeth
Concept
• When occ. Outline form extended up the cusp slopes by more than
half the distance from any primary occ. groove to cusp tip, capping of
cusp should be considered

• If prep outline is extended 2/3rd the distance from any primary occ.
Groove or more, capping the cusp is usually necessary so as to:
 protect the weak, underlying cuspal structure from fracture caused
by masticatory forces
Remove the occ. Margin from a region subjected to heavy stress and
wear
Preparation for full cast metal Onlays
Definition:
The full onlay caps all the cusps of posterior tooth and can be
designed to help strengthen a tooth that has been weakened by caries
or previous restoration.
Concept

• The cast metal onlay resto- spans the gap b/w the inlay, which is
primarily an intra-coronal resto- and full crown,which is totally extra-
coronal restoration.
• It can be designed to distribute occlusal load over the tooth in a
manner that greatly decreases the chance of future fracture.
• It is more conservative of the tooth structure than the full crown
prep. And its supra-gingival margins are less irritating to the gingiva.
Clinical steps
1. Preparation of pulpal floor
2. Preparation of depth guage grooves
3. Cusp reduction
4. Occlusal step
5. Reverse bevel/counterbevel
6. Proximal box
7. Removal of infected dentine and pulp protection
8. Preparation of bevel and flares
9. Verification of occlusal clearance
Enhancement of resistance and retention
form
• 1. minimal amount of taper 2⁰/9wall on vertical walls of the
preparation
• Preparation of facial (or lingual) surface groove extension
• Proximal retention grooves
• Skirt preparation
• Collar preparation
• Slot preparation
Stages of lab fabrication of a cast metal
restoration