Indirect Restorations in the Posterior Quadrants
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.
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.
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.
Figure 11-2 Before and after.
Figure 11-3 Gold inlays on teeth 2, 3, 21, and 30.
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.
Figure 11-6 When decay extends deep into the interproximal zone, after restoration of the biologic width a gold margin that lies on a chamfer situated entirely on root cementum can provide a good marginal seal for a long time.
Figure 11-10 Checkup 4 weeks later.
Figure 11-11 Checkup 9 years later.
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.
Figure 11-13 Removal of the old amalgam filling. Perfect isolation of the operative field was not achieved initially because of inflammatory hypertrophy of the papilla caused by the faulty filling. Subsequently the retraction action of the heavy rubber dam permits the required isolation. The buildup technique allows for a more conservative preparation. As opposed to Case 2, here the margin does not invade the biologic width, and therefore a clinical crown-lengthening procedure is not required.
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.
The advent of implants has completely revolutionized the approach to the periodontal patient. In our opinion there are clinical situations in which the preservation of teeth with reduced sound periodontal support is still the first treatment choice. Sometimes these teeth have to be splinted, and using partial preparations to achieve such results is undoubtedly a conservative approach.
When a patient with periodontal disease requires a prosthetic rehabilitation, the same traditional prosthetic principles apply because the final prosthesis will be prepared on healed periodontium. Nevertheless, in this case several operating steps are required, and they are />