Journal of Dentistry and Oral Sciences ISSN: 2582-3736 Daouahi N, Et Al., 2020-J Dent Oral Sci Case Report

Journal of Dentistry and Oral Sciences ISSN: 2582-3736 Daouahi N, et al., 2020-J Dent Oral Sci Case Report

Postless Approach for the Restoration of Nonvital Posterior Teeth: Clinical 1Faculty of dentistry, Department of fixed Guidelines prosthodontics, Monastir, Tunisia

2Faculty of Dental Medicine, Research Nissaf Daouahi1*, Dalenda Hadyaoui1,2, Zohra Nouira1,2, Ameni Ben Laboratory of Occlusodontics and Ceramic 3 1 1 Abdallah , Moncef Omezzine , Mounir Cherif and Belhassen Prostheses LR16ES15, University of 1,2 Harzallah Monastir, Monastir, Tunisia

3 Abstract Faculty of Dentistry of Monastir, Tunisia *Corresponding Author: Nissaf Daouahi, This article describes a case of a 42-year-old male patient who Assistant professor, Faculty of Dental presented with a chief complaint of pain, bleeding, and disability to Medicine, Department of fixed maintain good oral hygiene in the inter proximal zones between the prosthodontics, University of Monastir, Tunisia. first and second maxillary molar. Received Date: 10-23-2020 A comprehensive examination revealed a composite resin restoration in Published Date: 11-12-2020 the maxillary first molar. In the inter proximal zones, plaque © accumulation was also detected. Copyright 2020 by Daouahi N, et al. All rights reserved. This is an open access article distributed under the terms of the Radiographic examination showed bone loss in the proximal zone. The Creative Commons Attribution License, endodontic filling was rated as good. Options of treatment were which permits unrestricted use, discussed. The decision of ceramic inlay was retained. The patient was distribution, and reproduction in any satisfied thanks to well-planned approach. medium, provided the original author and source are credited. The purpose of this paper is to present a simplified clinical protocol for the restoration of non-vital teeth using ceramic inlay onaly.

Keywords: Nonvital tooth; ceramics; Bonding; inlay-onlay.

Introduction

The restoration of nonvital teeth presents a amount of remaining sound tissue is the challenging task for clinicians and even most significant factor influencing the with fiber posts; failure still of concern [1]. success of the approach. From a clinical point of view, specific Non-vital teeth present high risk of biomechanical alterations which are related to endodontic procedures are fracture than vital teeth, therefore it still a debate regarding which technique would confusing issues for the practitioner [2]. be ideal [2,4,5]. Full crown, direct adhesive Preserving tooth structure is essential in maintaining the balance between restorations and indirect bonded mechanical and esthetic outcomes [3]. The Daouahi N | Volume 3; Issue 1 (2020) | Mapsci-JDOS-3(1)-063 | Case Report Citation: Daouahi N, Hadyaoui D, Nouira Z, Abdallah AB, Omezzine M, Cherif M, et al. Postless Approach for the Restoration of Nonvital Posterior Teeth: Clinical Guidelines. J Dent Oral Sci. 2020;3(1):1-6. DOI: https://doi.org/10.37191/Mapsci-2582-3736-3(1)-063 restorations are available treatment these parameters with loss of integrity of options. the bond to peripheral tooth structure [14]. This clinical report illustrates a situation Adhesive procedures have changed the way where a posterior tooth was restored with a to restore nonvital teeth. To improve the ceramic inlay-onlay. The purpose of this chances of repair, restorations without paper is to provide a correct step-by-step using posts have been proposed as protocol for clinicians. minimally invasive alternatives [6]. In this context, glass-ceramic Onlays and Inlays Clinical Presentation and Discussion are considered to be successful for the Regarding the use of photographs, a verbal restoration of posterior teeth. However, consent was obtained from the patient. their indication on non-vital teeth still controversial issue [7]. Foudda Homsy Data do not, also, contain any personal detail showing the patient’s identity. reported that marginal adaptation and marginal discoloration were the same A 42-year-old male patient presented to when they are indicated for both vital and the department of prosthodontic dentistry non-vital teeth. According to him, no with a chief complaint of pain and gingival difference for similar inlay-onlay cavity bleeding. He, also, expressed his disability design [8]. Authors consider that to maintain good oral hygiene in the inter remaining vertical coronal tooth structure proximal zone between the first and named ‹ ferrule › is crucial factor for second maxillary molar. success of indirect minimally restorations [9-13]. After A comprehensive examination, a resin composite restoration was noticed in Compared to direct resin composite the maxillary first molar. Food and plaque restorations, the shrinkage is limited to the accumulation were also detected in the resin luting layer. To achieve durable and interproximal zone. Radiographic strong bond, it is important to understand examination showed bone loss in the inter the structural particularities of ceramics. proximal zone. Root filling was rated as The selection of adequate surface good (Figure 1). treatment is important for bonding success. The clinician’s operative skills are Figure 1: Initial situation (a,b). also determining aspects for long term success of inlays.

According to Dietschi et al., the configuration and the depth of the cavity are highly critical factors that can reduce the risk of fracture [2]. Peumans evaluated the success of indirect inlay onlay by rating marginal fit and leakage and he correlated Different treatment options were discussed restore the architecture of the inter with the patient. The decision of ceramic proximal zone conducting to an effective inlay was retained because there was no oral hygiene control. compromised cusp. It permits to, correctly, Daouahi N | Volume 3; Issue 1 (2020) | Mapsci-JDOS-3(1)-063 | Case Report Citation: Daouahi N, Hadyaoui D, Nouira Z, Abdallah AB, Omezzine M, Cherif M, et al. Postless Approach for the Restoration of Nonvital Posterior Teeth: Clinical Guidelines. J Dent Oral Sci. 2020;3(1):1-6. DOI: https://doi.org/10.37191/Mapsci-2582-3736-3(1)-063

Firstly, the old restoration was removed paper. Then, the cavity was prepared using and non-surgical periodontal debridement diamond burs and based on morphological was performed. The first step was to mark considerations in terms of geometry the patient's bite with an articulating (Figure 2). Figure 2: Preparation Design.

In this context, several points should be is not supported by underlying dentin considered. First, a minimal thickness of should be reduced. Undercuts has to be ceramic material which should be at least avoided with a cervico axial wall 1.0 to 2 mm is required (Figure 3). In this convergence of 10º to 20º. Occlusal tissue clinical situation Lithium Dissilicate reduction is depending on the importance ceramic is used with a thickness 2.5 mm of occlusal functional strain during (Figure 3). Second, enamel quantity which chewing [15]. Figure 3: Measurement of the restoration thickness; at 2,5 mm from the Groove (a,b,c).

Regarding cavity design, several designs no need to ﬁll the pulp chamber with a have been proposed. According to Tsai-Wu ceramic core, with adequate tooth strength ratio index, wide preparations in structure remaining [15]. molars should be restored with ceramic onlays, not inlays [16,17]. According to a systematic review including laboratory studies, computer simulations According to Hannig. C, the depth of the and clinical trials; the presence of a 1.5- to preparation is among the most critical 2-mm ferrule had a positive effect on the factors conducting to reduced fracture fracture resistance. In fact, adopting an resistance of teeth. In a human study, adequate ferrule optimizes the longevity of Foudda Homsy et. al reported that there is the final restoration [10-12,18] (Figure 4).

Daouahi N | Volume 3; Issue 1 (2020) | Mapsci-JDOS-3(1)-063 | Case Report Citation: Daouahi N, Hadyaoui D, Nouira Z, Abdallah AB, Omezzine M, Cherif M, et al. Postless Approach for the Restoration of Nonvital Posterior Teeth: Clinical Guidelines. J Dent Oral Sci. 2020;3(1):1-6. DOI: https://doi.org/10.37191/Mapsci-2582-3736-3(1)-063

Figure 4: Etching of the ceramic internal surface (a, b, c).

The luting should be performed after the most reliable and effective surface rubber dam isolation, the try-in and the treatment for ceramic restoration [7,13]. shade control. Proximal contacts, marginal adaptation and passive fit should be also Surface treatment with H.F and silane is widely used and accepted for lithium checked (Figures 5 and 6). disilicates ceramics. Universal adhesives Figure 5: Application of the silane. present, also, a new simplified approach for this procedure. But until now, few studies are available in the literature regarding the bonding efficiency of lithium disilicate ceramics to luting resin cements using this surface treatment [1,9,15,19].

The cavity surface is prepared for luting. It is conditioned with orthophosphoric acid; 15s for dentin and 30 sec for enamel are

required (Figure 7). Figure 6: Application of adhesive material. Figure 7: Etching of teeth surface.

The longevity of the restoration is highly Figure 8: Application of the adhesive. depending on the bond established between the ceramic materiel and the tooth structure which aims on creating micro mechanical inter lock between the ceramic and the resin cement. Bonding effectiveness may directly influence the clinical success of ceramic restoration. In this context, it is very important to identify

It should be, then, rinsed abundantly with Figure 11: Occlusal adjucements. water and dried with compressed air. A thin layer of adhesive material (Figure 8) and duale cured bonding resin is applied on the entire cavity without being pre- cured.

Figure 9: Application of resin cement.

Figure 12: Periodontal control.

The luting resin composite is filled in the cavity and the restoration which should be placed, then, using the optrastick (Figure 9 and Figure 10).

Figure 10: Placement of the restoration using Optrastick (a,b). Conclusion

According to authors the ceramic inlay- onlay restorations seem to give equally good results on nonvital teeth. Long-term observation periods are needed to assess the clinical behavior outcome. occlusal adjustments and periodontal Acknowledgement assessment should be performed after bonding (Figure 11 and Figure 12). The authors deny any conflict of interest related to this study. References

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