APPLICATION OF APPLICATION OF FIXED-FIXED-MOVABLEMOVABLE INLAY IN INLAY INLAY IN INLAY

CONSTRUCTIONS-CONSTRUCTIONS-A 6 YEARS CLINICAL SURVEYA 6 YEARS CLINICAL SURVEY

D.FiltchevD.Filtchev

The question of the restoration The question of the restoration of defects of the tooth row, of defects of the tooth row, limited by intact teeth , is still a limited by intact teeth , is still a controversial question in the controversial question in the dental practice. Several types dental practice. Several types of retainers are available for of retainers are available for use in the bridgework, and the use in the bridgework, and the choice will depend on:choice will depend on:

• The amount of The amount of retention requiredretention required

• The amount of The amount of abutment crown abutment crown available available

• The resistance of The resistance of crown remaining crown remaining after the after the preparation of the preparation of the toothtooth

• The extend of The extend of existing existing restoration to be restoration to be coveredcovered

• The amount of The amount of occlusal or incisal occlusal or incisal protection protection requiredrequired

The casted metal crowns however The casted metal crowns however have some disadvantages :have some disadvantages :

1.1. break off the interchange break off the interchange between the tooth and the between the tooth and the salivasaliva

2.2. sensitive grinding of hard sensitive grinding of hard tooth tissuetooth tissue

3.3. difficult restoration of the difficult restoration of the individual occluso-articulativeindividual occluso-articulative correlationcorrelation

• The use of inlays without cuspal coverage as The use of inlays without cuspal coverage as retainers in a fixed-fixed bridge , involves a retainers in a fixed-fixed bridge , involves a risk that the weaker retainer will eventually risk that the weaker retainer will eventually fail at the cement seal between retainer and fail at the cement seal between retainer and abutment tooth.The reason is that the abutment tooth.The reason is that the abutment tooth can be depressed in the abutment tooth can be depressed in the socket , whilst the retainer is supported by socket , whilst the retainer is supported by the remainder of the bridge. This conflict of the remainder of the bridge. This conflict of the forces may cause the eventual fracture of the forces may cause the eventual fracture of the cement seal.the cement seal.

• The minor retainer of fixed-movable bridge is The minor retainer of fixed-movable bridge is not rigidly connected to the rest of the bridge not rigidly connected to the rest of the bridge and is free to move in a vertical direction and is free to move in a vertical direction towards the alveolus. It must however ,have a towards the alveolus. It must however ,have a sufficient retention to withstand stresses from sufficient retention to withstand stresses from other than a vertical directionother than a vertical direction..

AIMAIM After six years clinical After six years clinical survey , our survey , our

aim was to apply a restoration of aim was to apply a restoration of limited defects of the tooth rows, limited defects of the tooth rows, treatment after hemisection and treatment after hemisection and prophylactics of Godon prophylactics of Godon phenomena,by means of fixed-phenomena,by means of fixed-movable bridge with a retainer movable bridge with a retainer ceramo-metal inlay in abutment inlay ceramo-metal inlay in abutment inlay by a composite material.by a composite material.

• For a period of 6 years we have restoredFor a period of 6 years we have restored

64 defects of the tooth row .64 defects of the tooth row .

• We have made 49 ceramo-metal fixed-We have made 49 ceramo-metal fixed-

movable bridges, 8 crowns for treatment movable bridges, 8 crowns for treatment

after hemisection , and 7 crowns for after hemisection , and 7 crowns for

prophylaxis of Godon phenomenaprophylaxis of Godon phenomena with a with a

retainer ceramo-metal inlay in abutment retainer ceramo-metal inlay in abutment

inlay by a composite material inlay by a composite material

First clinical stepFirst clinical step

1.1. prepare medio-occlusal prepare medio-occlusal or a disto-occlusal cavity or a disto-occlusal cavity limited in the enamel limited in the enamel with 2.0mm depth with 2.0mm depth

2.2. 15 sec. – etching gel15 sec. – etching gel3.3. 10 sec. wash with water 10 sec. wash with water 4.4. apply Optibind Solo apply Optibind Solo

(Kerr, USA) (Kerr, USA) 5.5. light-polymerize for 20 light-polymerize for 20

sec.sec.6.6. put the composite put the composite

(Herculite ,Kerr,USA)in (Herculite ,Kerr,USA)in the cavity the cavity

7.7. polimerize for 40 sec.polimerize for 40 sec.

• form the cavity by a form the cavity by a round borer and round borer and then by a cylindrical then by a cylindrical one, trying to one, trying to widen widen the vestibulo-lingual the vestibulo-lingual size . size .

• when the lost tooth when the lost tooth is a molar , it is is a molar , it is obligatory for the obligatory for the cavity to be cavity to be mediodistalmediodistal

We have taken a We have taken a two –step,two two –step,two layer impresslayer impressionion by a by a condensational condensational silicon silicon Silaplast Silaplast and corrector and corrector Silasoft (Detax, Silasoft (Detax, Germany) Germany)

• The bridge has The bridge has been casted by been casted by metal-VIRONmetal-VIRON 99.99.

Second clinical stepSecond clinical step

• We have tested We have tested the metal the metal skeleton of the skeleton of the constructionconstruction

• defined the defined the colour colour

• In the dental-mechanic In the dental-mechanic laboratorlaboratoryy the retainer the retainer inlay has been covered inlay has been covered by a minimal ground by a minimal ground coat and a dentine coat and a dentine ceramic till the moment ceramic till the moment of getting balanced of getting balanced point contactspoint contacts..

• When the esthetics was When the esthetics was not leading factor , we not leading factor , we leave the edge of the leave the edge of the inlay metalinlay metal

• We have permanantly We have permanantly fixed the bridge with fixed the bridge with PROTECPROTEC CEM CEM ((VIVADENT,VIVADENT,LiechtensteLiechtenstein)in)but without but without cementing the cementing the retainer-ceramo-retainer-ceramo-metal inlaymetal inlay..

• We have examined the We have examined the patients thoroughly patients thoroughly every 6 months and every 6 months and we have done an we have done an electroelectrooodontic and x-dontic and x-ray diagnostic.ray diagnostic.

We have observedWe have observed

• 2 unstucked bridges 2 unstucked bridges

• no fractured ceramic or metalno fractured ceramic or metal

• no breaking of the composite inlay no breaking of the composite inlay

• no secondary cariesno secondary caries

for the period of 6 yearsfor the period of 6 years

According to us the According to us the good results are due to good results are due to the good mechanical the good mechanical qualities of the qualities of the contemporary composite contemporary composite materials. The aesthetics materials. The aesthetics of the constructions in of the constructions in the area of the retainer-the area of the retainer-ceramo-metal inlay has ceramo-metal inlay has completely satisfied the completely satisfied the patients. They have not patients. They have not had subjective had subjective complaints or a feeling complaints or a feeling of discomfortof discomfort..

AdvantagesAdvantages

1.1. A good prophylactic effect towards the A good prophylactic effect towards the dental tissue and the parodontium ,which dental tissue and the parodontium ,which diminishes the possibility of development diminishes the possibility of development of a secondary caries, because of the of a secondary caries, because of the precise forming in the approximal area.precise forming in the approximal area.

2.2. Good functional indexes, because it Good functional indexes, because it keeps a big part of the natural occlusal keeps a big part of the natural occlusal relief of the abutment tooth.relief of the abutment tooth.

3.3. Responds to the aesthetic requirements.Responds to the aesthetic requirements.

AdvantagesAdvantages

4.4. Allows a correction when a secondary Allows a correction when a secondary caries or a fracture of the composite caries or a fracture of the composite inlay appears.inlay appears.

5.5. The time for making the composite The time for making the composite inlay by the direct method is reduced inlay by the direct method is reduced with one clinical and laboratory step.with one clinical and laboratory step.

6. The interchange between the 6. The interchange between the abutment tooth and the saliva is not abutment tooth and the saliva is not interrupted.interrupted.

First clinical caseFirst clinical case

Second clinical caseSecond clinical case

Third clinical caseThird clinical case

ConclusionsConclusions

The retainer inlay in inlay made of The retainer inlay in inlay made of composite material, might be successfully composite material, might be successfully used as a method of choice for restoration used as a method of choice for restoration of a defect on the tooth-row limited of a defect on the tooth-row limited medially and distally by an intact medially and distally by an intact abutment tooth. abutment tooth.

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