International Journal of Applied Dental Sciences 2016; 2(2): 81-84 

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2016; 2(2): 81-84 Adjacent Interproximal caries – The best treatment of
© 2016 IJADS
www.oraljournal.com
choice is mod inlay: A case report
Received: 12-02-2016
Accepted: 13-03-2016
Dr. Deshpande PM, Dr. Kirankumar Metta, Dr. Prashanth BR and
Dr. Deshpande PM Dr. Naik RR
BDS, MDS Reader, Dept. of
Conservative Dentistry &
Abstract
Endodontics S B Patil Dental
College & Hospital, Bidar -
The inlay is indicated where in high strength of cast restoration is required. Inlay provides superior
585402, Karnataka, India. control of contact and contours. The cast restoration withstands occlusal forces of mastication and
distributes the forces uniformly and directs along the long axis of the tooth structure and thus it prevents
Dr. Kirankumar Metta tooth fracture. Inlay also conserve the intact facial and lingual enamel and thus the health of the
BDS, MDS, Assistant Professor, surrounding periodontium is maintained and the gingival attracts less plaque and thus prolongs the
Dept. of Conservative Dentistry longevity of the restoration. In this article a case-report is discussed of MOD cast inlay restoration.
& Endodontics, Ibn Sina
National College for Medical Keywords: Adjacent Interproximal, case report, choice
Studies, Jeddah.

Dr. Prashanth BR
1. Introduction
Reader, Dept. of Conservative In the year 1897, Dr. Philbrook was the first to introduce inlay in dentistry who gave the
Dentistry & Endodontics, concept of forming an investment around a wax pattern, eliminating the wax, and filling the
KLE Institute of Dental Sciences resultant mold with a gold alloy. And in the year 1907 – Taggart changed the practice of
& Research, Bangalore, INDIA. restorative dentistry by introducing his technique for cast gold restorations [1].
Dr. Naik RR
Senior Lecturer, Dept. of 1.1. Definition of Inlay An inlay is defined as a restoration which has been constructed out of
Conservative Dentistry & the mouth from gold, porcelain or other metal and then cemented into the prepared cavity of
Endodontics S B Patil Dental the tooth.
College & Hospital, Bidar -
585402, Karnataka, India.
2. Classification

Correspondence
Dr. Deshpande PM 3. Indications for Cast Restorations
BDS, MDS Reader, Dept. of A. Extensive tooth involvement.
Conservative Dentistry & B. As an adjunct to successfully periodontal therapy by correction of tooth anomalies which
Endodontics S B Patil Dental predispose to periodontal problems. Cast restorations can do this by;
College & Hospital, Bidar -
585402, Karnataka, India.
a. Physiologically restoring and permanently maintaining the dimensions of the contact
contour, marginal ridges, and embrasures, which are vital for the health of the periodontium.
~ 81 ~ 
International Journal of Applied Dental Sciences
 

b. Splinting teeth loosened by periodontitis to a better bone- 1. A cavity’s width does not exceed one-third the intercuspal
supported tooth or teeth. distance.
C. Correction of occlusion 2. Strong, self-resistant cusps remain.
D. Restoration of endodontically treated teeth. 3. Indicated teeth have minimal or no occlusal facets and if
E. Support for and preparatory to partial or complete dentures; present, are confined to the occlusal surfaces.
most removable prostheses will need cast restorations on or in 4. The tooth is not to be an abutment for a fixed or
the abutment teeth to hold or accommodate the retainers for removable prosthesis.
the denture. 5. Occlusion or occluding surfaces are not to be changed by
F. Retainers for fixed prostheses. the restorative procedure.
G. Partial subgingival restorations.
H. Low incidences of plaque accumulation or decay. 7.2 General shape: (fig 1)
I. Functionally sound stomato-gnathic system with complete The outline of the occlusal portion of this preparation is dove-
freedom of the mandible to move without any premature tailed. The proximal portion is usually boxed in shape.
contacts.
J. Cracked teeth (vertically, horizontally, or diagonally). 7.3 Location of margins
In the occlusal portion, the facial, lingual, and sometimes,
Contraindications for Cast Restorations proximal margins are located on the inclined planes of the
A. Developing and deciduous teeth. corresponding cusps, triangular ridges or the marginal ridges
B. High plaque/caries indices. (crossing ridges). This is designed so that the bucco-lingual
C. Occlusal disharmony. width of the cavity preparation (distance measured between
D. Dissimilar metals. the buccal and lingual wall proper), especially at the isthmus
portion, does not exceed one-third the intercuspal distance.
5. Advantages Gingival margins should be accomplished with the bevel and
Cast restorations for single teeth have several advantages over not with the wall proper.
other types of restorations, namely:
1. Yield, compressive, tensile and shear strengths of alloys 7.4 Internal anatomy
and ceramics used for cast dental restorations are far In the occlusal portion, the facial and lingual walls and
greater than those of any other materials used intraorally. sometimes the proximal walls (if marginal ridge is intact), will
2. Casting techniques and materials are capable of be formed of two parts:
reproducing precise form and minute detail. 1. The wall proper, constituting about the pulpal two-thirds
3. Any of the metal alloys used for cast restorations contain of the facial or lingual (proximal) walls, is formed
as one or more of their component metals, a noble or completely of dentin. These walls should taper from each
passivated metal. other on the average of 2-50, or be parallel to each other, if
4. The very nature of building a metallic or ceramic necessary.
restoration instantaneously with a casting procedure, this 2. The occlusal bevel, which is a long bevel, constituting
leads to a strong structure, which is less susceptible to almost one-third of the facial and lingual (proximal) walls.
corrosion. This bevelled outer plane of the walls will have an
5. Cast restorations can be finished, polished or glazed average angulation of 30-450 to the long axis of the crown
outside the oral cavity. (or the wall proper).
3. In the inlay cavity preparation, the pulpal floor should be
6. Disadvantages flat over most of its extent. Generally speaking pulpal
1. Being a cemented restoration, several interphases will be depth should be 1-1.5 mm from the DEJ.
created at the tooth-cement-casting junction. 4. In the proximal portion of the inlay cavity preparation, the
2. Cast restorations necessitate extensive tooth involvement axial wall should be either flat or slightly rounded in the
in the preparation. bucco-lingual direction, and either vertical or slightly
3. The cathodic nature of cast dental alloys toward other divergent (5-100) towards the pulpal floor in the gingivo-
metals used in the same mouth may lead to galvanic occlusal direction. Furthermore, the depth, axially, should
deterioration. ideally be 1-1.5 mm from the DEJ.
4. The procedure for cast restoration fabrication is lengthy, 5. Sometimes it is necessary to impose a third plane in the
requiring more than one visit, with temporary coverage form of a secondary flare, placed on enamel peripherally.
between visits. This serves to simplify impressions and wax pattern
5. Some cast alloys and ceramics have a very high abrasive manipulations and for the other reasons previously
resistance, much more than that of tooth enamel. mentioned.
There are five general designs of tooth preparation to 6. The gingival floor, proximally should be flat in the bucco-
accommodate a cast restoration, namely: lingual direction, making a slightly obtuse angle with the
I. Inlays buccal and lingual walls.
II. Onlays 7. The junction between the occlusal bevel and the
III. Cast restorations with surface extensions secondary or primary flare proximally, and also, the
IV. Pin-lays junction between the primary or secondary flares
V. Full veneer cast or cast based restorations. proximally and the gingival bevel should be very rounded
and smooth.
Tooth preparations for inlay cast restorations 8. Some of the retention means previously mentioned can be
7.1 Indications used in this design, in addition to or in lieu of other
These are purely intracoronal restorations, which have limited means, to be described (e.g., facial, lingual and gingival
indications. These are: grooves proximally, internal boxes or slots occlusally,
capping corners of cusps, etc.).
~ 82 ~ 
International Journal of Applied Dental Sciences
 

8. Case Report
A patient of 34yrs age, reported to the Dept. of Conservative
Dentistry and Endodontics with the chief complaint of food
lodgement in lower right back tooth region. On examination
patient had old class I silver fillings on 46 & 47, with frank
class II caries in between 46 & 47. Radiograph showed no
pulpal involvement. Treatment procedure of cast inlay
restoration explained to the patient. Advantages, disadvantages
of amalgam, composite restoration and crowns discussed with
the patient. Patient wanted Class II Inlay, accordingly Class II
Inlay planned & written informed consent taken.
Initial old Class I silver filling removed and extended 1mm
into dentin at the central fossa. Burs 169 L used for giving 3-50
divergence and bur no. 7404 for giving bevels. Materials and
equipments for forming and spruing the indirect wax pattern
include gas burner, articulated casts and die, soft inlay wax,
Type II inlay wax, [2] die lubricant and applicator brush,
Ward’s C carver, No. 7 wax carver, sprue former, sticky wax. Fig 3: Try-in On Cast for accurate adaptation.
Indirect class II cavity prepared, Inlay wax pattern fabricated
on the cast with sprue former for 46 & 47.

Fig 4: Clinical try-in done and cemented.

9. Case Discussion
Fig 1: Inlay Cavity Preparation 9.1 Treatment options for class ii in between two Posterior
Teeth
- Silver amalgam restoration
- Composite restoration
- Crowns
The silver amalgam is the oldest restorative material with good
compressive strength but has the disadvantage of restoration
fracture if it is a large cavity [3]. The composite is a tooth
colored restorative material but has the disadvantage of less
strength, polymerization shrinkage and hypersensitivity [4].
Stainless steel or porcelain fused to metal or full ceramic are
indicated for large cavity but has the disadvantage of not being
conservative [5], thus the best treatment for Class II caries
occurring in between two teeth (adjacent caries) is Class II
Inlay cast restoration. The inlay is considered the best
conservative restoration as it has the advantage of good
compressive strength to withstand heavy masticatory forces
and thus in this case report the same is followed to restore 46
& 47.

10. Conclusion: Cast restoration form an integral link in the

Fig 2: Class II Direct Wax Pattern with sprue attached dental restorative chain. They are an excellent choice in many
demanding situations. Understanding the principles of tooth
preparations and the intricacies of cast restorations will enable
the dentist to optimally utilize this excellent option, when the
clinical situation demands.
~ 83 ~ 
International Journal of Applied Dental Sciences
 

11. References
1. Taggart WH. A new and accurate method of making gold
inlays. Dent. Cosmos, 1907; 49:1117.
2. Phillips RW, Biggs DH. Distortion of wax pattern as
influenced by storage time, storager temperature and
temperature of wax manipulation. J Am Dent Assoc.
1950; 41:28.S
3. Latzel H, Van’t Hof MA, Vrijhoef MMA et al. A
controlled clinical study of amalgam restorations:
Survival, failures, and causes of failure. Dent Mater 1989;
5:115.
4. Roulet JF. The problems associated with substituting
composite resins for amalgam: A status report on posterior
composites. J Dent 1988; 16:101.
5. Council on dental materials, instruments and equipment:
report on base metal alloys for crown and bridge
applications: benefits and risks. J Am Dent Assoc 1985;
111:479.
6. Art and science of operative dentistry – sturdevant.
7. Principles and practice of Operative Dentistry –
Charbeneau.
8. Fundametals of Operative Dentistry – Marzouk.
9. Textbook of Operative Dentistry – Summit.
10. Atlas of inlays, onlays, crown and bridges – Shillinberg
11. Inlays, Crowns & Bridges – Cowell and Curson

~ 84 ~