Case Report

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J Res Adv Dent 2014; 3:2s:72-77.

All Ceramic Inlay: A Case Report

Priti D Desai1* Pathik P Patel2 Khyati Shah3 Pankaj N Patel4

1Professor, Department of Conservative Dentistry, Gurunanak Institute of Dental Science and Research, Kolkata, WB, India.
2Post Graduate Student, Department of Conservative Dentistry, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.
3Private Consultant, Prosthodontics, Kalol, Gandhinagar, Gujarat, India.
4Private Practitioner, Conservative Dentistry and Endodontics, Kalol, Gujarat, India.

ABSTRACT

Introduction: Esthetic restoration is a prime concern for everyone in todays’ world. Dentists are in search of a
durable and tooth coloured restorative material. All ceramics with high strength are better alternative to
composite, amalgam and gold for posterior tooth restoration.

Case description: A patient comes for restoration of carious lesion involving proximal contact on mesial side of
maxillary first molar. The cavity was prepared, rubber base was taken and all ceramic inlays were prepared with
e max –cad material (Ivoclar vivadent). After preparation, it was cemented with resin cement (U1003M ESPE).
Follow up was done after seven days, one month, three months, six months uptil two years respectively.

Discussion: All ceramic inlays showed better esthetic and marginal adaptation immediately after restoration
and after 7 days, one month and three months, six months, one year and two years. The patient is comfortable
with restoration. There were no marginal deterioration, no crack formation, and no discoloration after two years.
All ceramic restorations overcome the weakness of other esthetic restorative material and give good esthetic as
well as function.

Conclusion: All ceramic inlays are better alternatives as esthetic restoration for medium to large size carious
lesion, among different all ceramic material cad cam inlay is best for marginal adaptation and function of
restoration.

Keywords: Inlay, All ceramic, IPS e-max.

INTRODUCTION are in search of a durable and restorative tooth

colour material for teeth.
Aesthetic treatment is one of the most
required dental treatments coming after pain Various materials used are Glass ionomer
related treatments in conservative dentistry. cement, Composite resin, ceramic bonded to metal
Aesthetics is playing an increasingly important role and All Ceramic. All ceramic material with high
in the choice of dental restorations. Re-creating the strength is becoming popular as aesthetic
original tooth as faithfully as possible is a restoration. As the aesthetic aspect of dental care
challenging task for both the operator and the becomes increasingly important to patients, the
dental material. Colour, shape and the surface dental practitioner should be aware of the
texture are very important in aesthetic applications and limitations of the various tooth-
characterization and personalizing a smile. Dentists

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Fig 1: Carious lesion preoperatively. Fig 4: After preparing inlay.

Fig 2: Preoperative radiograph. Fig 5: Cement for cementation.

Fig 3: After cavity preparation. Fig 6: Immediately after restoration.

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Fig 7: Postoperative radiograph. Fig 10: After one month of restoration.

Fig 8: Postoperative view in occlusion Fig 11: After 6 months of restoration.

Fig 9: After seven days of restoration. Fig 12: After 2 years of restoration

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 CASE REPORT

A 30 year old male patient came to private

dental clinic for treatment of broken composite
restoration in 26 with no pain and sensitivity in
tooth. Patient was interested in aesthetical durable
restoration, it was decided to give all ceramic inlay
as restoration. Cavity preparation was done with
the principle of cavity preparation. After the cavity
preparation impressions were made and send to
laboratory, where IPS e.max CAD Ceramic inlay was
prepared. In laboratory –Image was scanned from
the cast and dye cut was prepared, milling of
ceramic inlay was done with IPS e.max CAD block
Fig 13: Post operative radiograph after 2 years (Ivoclar vivadent, Europe). After preparing the
inlay, it was etched and silanated and cemented
coloured restorative systems available for with RelyXTMU100 self-adhesive Universal Resin
the restoration1. Cement. (3M ESPE USA).
Introduction of ceramic material for The patient was observed clinically after 7
aesthetic is limited due to its abrasiveness to days, one months, six months and two year for
natural tooth structure which may accelerate the restoration for pain, sensitivity, marginal
wear of natural enamel. Once a vivo study was adaptation, crack formation, fracture and
conducted to quantify the wear of natural enamel discoloration. Clinical photograph and radiographs
opposing three ceramic materials as influenced by were done to correlate clinical and radiographic
ceramic. It was concluded that equivalent wear evaluation. (Figure – 1, 2, 3, 4, 5, 6, 7, 8)
occurs between ceramic/enamel and
enamel/enamel pairs and ceramics offer a RESULT
restorative option.2 The survival rate of Ceramic
restoration and ceramic inlay onlay shows 94 % for Result showed that there was no pain, no
4-5 years and 91 % up to 7 years.3 sensitivity, no marginal deterioration, no crack
formation, no fracture and no discoloration even
All ceramic based inlays provide aesthetics after two years of restoration. Radiographs after 7
and durability as restoration. It maintains a better days, one month, six months and two year of
anatomic forms, exhibits a better marginal integrity, restoration also shows there is no development
and colour stability in oral cavity. All Ceramic-based marginal gap and secondary caries around the
inlays also reinforce the remaining dental hard restoration. (Figure - 9, 10, 11, 12, 13)
tissue as they bond to the tooth with adhesive
cement.4 DISCUSSION

All ceramic material with high strength is a As the aesthetic aspect of dental care
better alternative to composite, amalgam and gold. becomes important to patients, aesthetics is playing
All ceramic inlay and onlay is recently most useful an increasingly important role in their choice for
for moderate to large size restorations. Various type dental restorations. There are various options of
of all ceramic material are available, among them aesthetic restoration for anterior teeth but aesthetic
IPS e-max is recently introduced with high strength restoration for posterior teeth is a challenge for
and excellent aesthetic. Herewith we would like to dental practitioner. Various aesthetic materials for
report case treated with IPS e max inlay observed posterior teeth include direct composite
for two years. restoration, indirect composite restoration, metal
ceramic restoration, all ceramic restoration.

Direct composite is generally used for small

to medium size preparation and can be placed in

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one appointment but there are certain reasons like other posterior restorations over assessment
difficulty in placement, improper marginal periods of up to 1 year and concluded.7
adaptation, difficulty in finishing & in developing
contour and contacts, chances of voids which leads Evaluation the performance of Class
to weakening of the restoration, chances for II Cerec inlays after 10 years of clinical service
microleakage and post-operative sensitivity. So it found that patient satisfaction with and acceptance
becomes difficult to use in day to day practice. of the Cerec inlays were high, and the performance
after 10 years of clinical service was acceptable.8
Indirect composite restorations provide Another study regarding clinical performance of
good color match, easy to finish, intra oral repair is bonded leucite-reinforced glass ceramic inlays and
possible but there are chances of poor marginal fit, onlays after eight years proved that IPS Empress
marginal failure, require laboratory support, inlays and onlays demonstrated to be successful
technique sensitive, adhesion to tooth may be even in large defects. Neither the absence of enamel
weak. margins, nor cuspal replacement significantly
affected the quality of the restorations.9
Metal ceramic restorations for small to
medium size carious lesion in posterior teeth are A Longitudinal clinical evaluation of
difficult to fabricate and do not provide good bonded composite inlays shows that composite
aesthetics. Metal ceramic is generally used for full inlay gives high success rate in clinical practice that
coverage restoration. not related to size of lesion or tooth type. These
proves that bonded restoration always helps in
All ceramic material with high strength strengthens of remaining tooth structure and
provide good restorative alternative to moderate to increase survival rate of tooth (Barone A et al,
large size carious lesion. Cavity preparation is also 2008)10. Clinical study by R. T. Lange showed that
simple for example the line angles and point angles indirectly manufactured Evopress ceramic inlays
are rounded, floor and gingival sheet area is smooth performed better than direct Filtek Z250 composite
and flat, cavo-surface angle is 900, walls are restorations in marginal adaptation, colour match
diverging, isthmus is wide, if any undercuts are and anatomic form.11
present can be blocked with glass-ionomer cement,
0.5mm clearance from adjacent teeth and all cavity
walls should have the same path to draw.
The monolithic leucite and lithium
In one study clinical assessment and disilicate glass ceramic systems have shown
survival rate ceramic inlay showed that the lack of promising laboratory and clinical results for small
recurrent caries, the only slight changes in marginal restoration such as inlay, onlay, crown and
discoloration and colour match, combined with the laminates.12
excellent longevity prove that ceramic inlays are a
valuable tool for the restoration of posterior teeth.5 IPS e.max (Ivoclar vivadent) newly
Evaluation of clinical performance of ceramic inlay developed glass ceramic material containing the
and composite inlay proved that posterior tooth- lithium disilicate (LS2) shows that esthetics and
colour inlays exhibited a success rate of 100% for strength can be successfully combined. It has high
ceramic inlays and 90% for composite inlays even if strength up to 400 Mpa. For single-tooth
placed by relatively inexperienced but supervised restorations, this innovative ceramic produces good
student operators.6 One esthetic as well as offers a flexural strength that is
systematic review of ceramic inlays had assessed 2.5 times higher than that of other glass-ceramics. It
the quality of published clinical studies, and is available as pressable ceramic blocks and CAD
determines the clinical effectiveness of CAM blocks. Self-adhesive or conventional
ceramic inlays compared to other forms of posterior cementation methods can be used for it.
restorations. They wrote that many study result
In large carious lesion or in replacement of
indicates no significant differences in longevity or
failed restoration cavity preparations significantly
postoperative sensitivity between ceramic and
weaken the remaining tooth structure. Acid etching

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and adhesive technique do reinforce dental inlays for four and a half years. J Prosthet
structures in a way that stiffness values of restored Dent 78:346–353.
teeth approximate the value of sound teeth. There
are certain limitations of ceramic inlay restoration 5. Fuzzi M, Rappelli G (1999). Ceramic inlays:
like it requires 2-3 appointments, good laboratory clinical assessment and survival rate. J
support, difficult to repair and somewhat costly. Adhes Dent 1:71–79.

CONCLUSION 6. Manhart J, Scheibenbogen-Fuchsbrunner A,

Chen HY, Hickel R. A 2-year clinical study of
All ceramic restorations overcome the composite and ceramic inlays. Clin Oral
weakness of other esthetic restorative materials like Investig. 2000 Dec; 4(4):192-8.
Glass ionomer, composite resin and give good
esthetic as well as function. Ceramic inlay is a better 7. Hayashi M, Wilson NH, Yeung CA,
alternative as esthetic restoration compared to Worthington HV . Systematic review of
direct and indirect composite resin restoration for ceramic inlays. Clin Oral Investig 2003 7:8–
medium to large size carious lesion. Among 19.
different All ceramic material IPS e.max CAD inlay is
8. Sjögren G, Molin M, van Dijken JW. A 10-
best for marginal adaptation and function. More
year prospective evaluation of CAD/CAM-
studies are required to know long term
manufactured (Cerec) ceramic inlays
performance of IPS e.max CAD All ceramic inlay.
cemented with a chemically cured or dual-
CONFLICT OF INTEREST cured resin composite. Int J Prosthodont
2004 17:241–246.
No potential conflict of interest relevant to this
article was reported. 9. Krämer N, Frankenberger R (2005). Clinical
performance of bonded leucite-reinforced
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