11: Indirect Restorations in the Posterior Quadrants

Indirect Restorations in the Posterior Quadrants

Gold Inlays

The gold inlay technique, which for many years represented the mainstay treatment for restorations in the posterior quadrants, has fewer applications today because of not only the higher esthetic expectations of patients but also the improved quality of adhesive materials.

Nevertheless, there are still indications for which—in our opinion—gold inlays represent the first choice of treatment. Moreover, we must not overlook the extraordinary educational value that the Tucker technique represented for indirect restorative dentistry, owing to the very rigorous approach of the step-by-step method and the importance of the buildup. We employed the method developed by this great master for over 20 years, and around the world it is used by many dentists who are part of a single academy counting more than 500 active members.

At first we prepared small cavities that, despite the more invasive preparation required with respect to the adhesive technique, ensured much greater longevity.

This chapter presents other clinical cases in which deep interproximal caries, when there are no great esthetic concerns, are treated with a gold inlay, which will ensure a perfect marginal fit verifiable over time.

Complex cases with an important occlusal component benefit from an occlusal surface made of gold, which is a material quite similar to natural teeth in terms of hardness and malleability.

In the case of multidisciplinary treatments, inlays and, to an even greater extent, metal onlays represent a very conservative technique for splinting together periodontally compromised teeth.

Case Reports

Case Report 1

The decision to employ gold inlays in the first case was dictated by the patient’s lack of esthetic concerns in the lateral sectors, and the fact that the case required occlusal stability that had to be controlled and maintained over time. This was a complex case that required prior orthodontic treatment, surgery, and a final orthodontic stage.

Cavity Large  
Cervical enamel Yes No
Vitality Yes No
Occlusal loads Yes  
Esthetic concerns Yes No
Age Adult  

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Figure 11-2 Before and after.

Case Report 2

This case was treated by Dr. Alberto De Chiesa. A carious lesion that extends into the biologic width calls for a clinical crown-lengthening procedure. Conservative partial restoration performed either in the same session as the surgery or as soon as possible helps the healing process.

Cavity Large  
Cervical enamel No  
Vitality Yes  
Esthetic concerns Yes No

image

Figure 11-10 Checkup 4 weeks later.

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Figure 11-11 Checkup 9 years later.

Case Report 3

As discussed in the previous case, a clinical crown-lengthening procedure is frequently performed at the same time as inlay preparation. This approach makes it possible to position the margin correctly when crown lengthening is required and to better assess the actual need to resort to surgery, which in this specific case was considered unnecessary.

Cavity Large
Cervical enamel No
Vitality Yes
Esthetic concerns No

image

Figure 11-14 A, Radiograph after cementation. The comparison with the initial radiograph (Figure 11-12) shows that the invasion was caused by the faulty amalgam restoration. B, Radiographic checkup 5 years later.

Jan 1, 2015 | Posted by in Dental Materials | Comments Off on 11: Indirect Restorations in the Posterior Quadrants
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