WHY do we do full crowns? Think hard before you send the tooth up the suction

Endodontically treated teeth

Carter et al. indicated that dentin from endodontically treated teeth shows significantly lower shear strength and toughness than dentin from vital teeth.

Carter JM, Sorenson SE, Johnson RR. Punch shear testing of extracted vital and endodontically treated teeth. J Biomech. 1983;16:8418.

Endodontically treated teeth

32. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent. 2002;87:25663. [PubMed]

When you are missing a bunchof tooth structure

A giant amalgam is better than a giant composite

composite restorations required seven times as many repairs as did amalgam restorations. CLINICAL IMPLICATIONS: Composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.

Soncini Ja, et alJ Am Dent Assoc. 2007 Jun;138(6):763-72The Forsyth Institute, Boston, MA, USA

Risk of secondary caries was 3.5 times greater in the composite group. CONCLUSION: Amalgam restorations performed better than did composite restorations. The difference in performance was accentuated in large restorations and in those with more than three surfaces involved.

Bernardo M, et. Al.J Evid Based Dent Pract, 2008 Dec;8(4)225-6

Smales and Hawthorne, however, reported 15-year survival rates (48%) for complex cusp covering silver amalgam restorations compared to higher success rate of crowns (89%). Martin and Barder also compared the survival of large four- and five-surface silver amalgam restorations to crowns and reported that crowns had both a higher success rate and lower chance of catastrophic failure.

Smales RJ, Hawthorne WS. Long-term survival of extensive amalgams and posterior crowns. J Dent. 1997;25:2257. [PubMed] Martin JA, Barder JD. Five-year treatment outcomes for teeth with large amalgams and crowns. Oper Dent. 1997;22:778. [PubMed]

ADA Endorsed Indications for resin

Small and moderately sized restorations conservative tooth preparations Areas where esthetics is important

Includes class I and IIReplacement of failed restorationsPrimary caries

Pascal Magne: 'It should not be about aesthetics but tooth-conserving dentistry'

tooth-conserving dentistry

The OnlayThe Inlay

The Crownlay

4%

96%

crown inlay/onlayCrown Onlay/Inlay

ENAMEL

ENAMELPRECIOUS

Longevity

Class II Longevity

11years Amalgam 6-8 years Composite

1372Mjor,I.A.,J.E.Dahl,andJ.E.Moorhead.Ageofrestorationsatreplacementinpermanentteethingeneraldentalpractice.ActaOdontol.Scand.58:97101,2000.3.ChristensonJG.Shouldresin-basedcompositedominaterestorativedentistrytoday?JADA141(12)December2010page1490-93

1,748 restorations 7 years

J Am Dent Assoc 2007;138;775-783and Timothy A. DeRouenMartin, Brian G. Leroux, Tessa Rue, Jorge LeitoMario Bernardo, Henrique Luis, Michael D.Survival and reasons for failure of amalgam

=7 year longevity

80% Amalgam 50% CompositeJ Am Dent Assoc 2007;138;775-783and Timothy A. DeRouenMartin, Brian G. Leroux, Tessa Rue, Jorge LeitoMario Bernardo, Henrique Luis, Michael D.Survival and reasons for failure of amalgam versus composite posterior restorations

Placed in a randomized clinical trial

6YearsYears

1. Beazoglou T, Eklund S, Heffley D, Meiers J, Brown LJ, Bailit H. Economic impact of regulating the use of amalgam restorations. Public Health Rep. 2007;122(5):657-663. 2. Bernardo M, Luis H, Martin MD, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc.

2007;138(6):775-783. 3. Christensen GJ. Should Resin-Based Composite Dominate Restorative Dentistry Today? The Journal of the American Dental Association. 2010;141(12):1490-1493. 4. DeRouen TA, Martin MD, Leroux BG, et al. Neurobehavioral effects of dental amalgam in children: a randomized clinical trial. JAMA : the journal of the American Medical

Association. 2006;295(15):1784-1792. 5. Garcia-Godoy F, Krmer N, Feilzer AJ, Frankenberger R. Long-term degradation of enamel and dentin bonds: 6-year results in vitro vs. in vivo. Dental Materials. 2010;26(11):

1113-1118. 6. Khalichi P, Cvitkovitch DG, Santerre JP. Effect of composite resin biodegradation products on oral streptococcal growth. Biomaterials. 2004;25(24):5467-5472. 7. Kramer N, Garcia-Godoy F, Frankenberger R. Evaluation of resin composite materials. Part II: in vivo investigations. American journal of dentistry. 2005;18(2):75-81. 8. Levin L, Coval M, Geiger SB. Cross-sectional radiographic survey of amalgam and resin-based composite posterior restorations. Quintessence Int. 2007;38(6):511-514. 9. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent

dentition. Operative dentistry. 2004;29(5):481-508. 10. Murray PE, Windsor LJ, Smyth TW, Hafez AA, Cox CF. Analysis of pulpal reactions to restorative procedures, materials, pulp capping, and future therapies. Critical reviews in

oral biology and medicine : an official publication of the American Association of Oral Biologists. 2002;13(6):509-520. 11. Simecek JW, Diefenderfer KE, Cohen ME. An evaluation of replacement rates for posterior resin-based composite and amalgam restorations in U.S. Navy and marine corps

recruits. J Am Dent Assoc. 2009;140(2):200-209; quiz 249. 12. Soncini JA, Maserejian NN, Trachtenberg F, Tavares M, Hayes C. The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth:

findings From the New England Children's Amalgam Trial. J Am Dent Assoc. 2007;138(6):763-772. 13. Mjor IA, Dahl JE, Moorhead JE. Age of restorations at replacement in permanent teeth in general dental practice. Acta odontologica Scandinavica. 2000;58(3):97-101. 14. Collins CJ, Bryant RW, Hodge KL. A clinical evaluation of posterior composite resin restorations: 8-year findings. Journal of dentistry. 1998;26(4):311-317.

I suggest in office milled ceramic restorations properly prepped, milled and seated can be the gold restoration

of today

Bonded Onlay Longevity

90 10YearsOtto, T. & De Nisco, S. (2002) Computer-aideddirect ceramic restorations: a 10-year prospectiveclinical study of CEREC CAD/CAM inlays andonlays. International Journal of Prosthodontics15: 122128.

El-Mowafy, O. & Brochu, J.F. (2002) Longevity andclinical performance of IPS-Empress ceramic restorations:a literature review. Journal of theCanadian Dental Association 68: 233237.

Martin, N. & Jedynakiewicz, N.M. (1999) Clinicalperformance of CEREC ceramic inlays: a systematicreview. Dental Materials 15: 5461.

Fuzzi, M. & Rappelli, G. (1999) Ceramic inlays:clinical assessment and survival rate. Journal ofAdhesive Dentistry 1: 7179.

05. Sjgren G, Molin M, van Dijken J. A 10 year prospective evaluation of CAD/CAM-manufactured (CEREC) ceramic inlays cemented with a chemically cured or dual cured resin composite. Int J Prosthodont. 2004;17(2):241246.

Hayashi M, Tsuchitani Y, Kawamura Y, Miura M, Takeshige F, Ebisu S. Eight-year clinical evaluation of fired ceramic inlays. Oper Dent. 2000;25(6):473481.

Stoll R, Cappel I, Jablonski-Momeni A, Pieper K, Stashniss V. Survival of inlays and partial crowns made of IPS empress after a 10-year observation period and in relation to various treatment parameters. Oper Dent. 2007;32(6):556563

Beier US, Kapferer I, Bustscher D, Giesinger JM, Dumfahrt H. Clinical performance of all-ceramic inlay and onlay restorations in posterior teeth. Int J Prosthodont. 2012;25(4):395402

The Inlay

The Inlay

d e n t a l m a t e r i a l s 3 1 ( 2 0 1 5 ) e77e87

d e n t a l m a t e r i a l s 3 1 ( 2 0 1 5 ) e77e87

d e n t a l m a t e r i a l s 3 1 ( 2 0 1 5 ) e77e87

In dentin and enamel the stress values are 13 times higher in the direct restoration than in the inlay. Likewise, contact stresses in the adhesive bond around the direct restoration are 7 times higher.

Margins should have sharp edges for easy identification

Occlusal reduction (1.5-2.0 mm)

Isthmus depth 1.5 mmRounded internal line angles

Internal axial walls 6-10

Margins should have sharp edges for easy identification

Occlusal reduction (1.5-2.0 mm)

Isthmus depth 1.5 mmRounded internal line angles

Internal axial walls 6-10

Margins should have sharp edges for easy identification

Occlusal reduction (1.5-2.0 mm)

Isthmus depth 1.5 mmRounded internal line angles

Internal axial walls 6-10

sharp

PREPARATION ASPECTS TOAVOID

PREPARATION ASPECTS TOAVOID

The Onlay

The Onlay"Based on my findings, the only other restoration possible was that of a full coverage crown. Please pay benefits accordingly."

Palatal Onlay

Occlusal Onlay

Full Venner coverage

J Prosthet Dent. 2013 Oct; 110(4): 264273.

Palatal Onlay Occlusal Onlay Full Venner coverage

J Prosthet Dent. 2013 Oct; 110(4): 264273.

J Prosthet Dent. 2013 Oct; 110(4): 264273.

1.5mm

1.0mm

0.5mm

The Crownlay