Indirect technical approach with composite Inlays/Onlays by the dentist in-office: Two clinical reports

Introduction: Indirect composite restorations are alternative technical approaches of posterior teeth rehabilitation, in certain clinical conditions. Objective: The aim of this report is to describe two clinical cases in which composite inlay/onlay, made by the dentist in-office, was used to rehabilitate posterior tooth structures considering two strategies, such as large and multi-surface restorations. Clinical/radiographic findings and treatment are presented and discussed with the literature evidence. Material and Methods: Two patients presenting different restorative problems were selected. Two clinical conditions are reported: (1) the 2.6 tooth showed a large extension composite restoration with loss of marginal integrity and cusp involvement (2) the 2.6 and 2.5 teeth with secondary caries/amalgam restorations (ICDAS 44 code) and proximal contact. Coronal rehabilitation with composite inlay/onlay made indirectly by the dentist was proposed for both clinical conditions. Cavity preparation and alginate impression were done. A silicone cast was performed to apply the nanostructured composite GrandioSO (Inlay System; Voco) that was incrementally applied and light-cured (1200mW/cm2, 20 seconds). Inlays/onlays were bonded with self-etch adhesive strategy (Futurabond DC) with enamel pre-etching and Bifix SE resin cement. Inlays/onlays occlusal/proximal adjustments, finishing and polishing were performed. Results: This indirect technique approach with composite provided an easy, convenient and efficient method to restore neighbouring teeth, to create adequate proximal contacts without having to use the time-consuming and expensive matrix systems and to better perform occlusal/proximal anatomy by extraoral modelling. Discussion and Conclusions: The indirect application of a composite is a predictable and economic approach to perform stress-free fabrication of tooth-coloured and durable restorations even in patients who are low- or non-compliant. This indirect rehabilitation is an aesthetic, functional and biological alternative face to direct techniques in coronal extensively weakened and multisurface restorations of posterior teeth, providing a refreshing alternative that can be processed in dental office by the dentist. Keywords: inlays, onlays, posterior restoration, resin-based composite, indirect restoration technique, operative dentistry