Case completed by Dr. Stephen Poss Posterior Inlay using Cristobal®+, “The Indirect Composite System” with Prime & Bond® NT™ and Calibra® Esthetic Resin Cement Case completed by Dr. Stephen Poss Presented by Dentsply Caulk

Figure 1: Pre-operative photo: A 48 year old male presented with thermal sensitivity on his upper right quadrant.

Figure 2: After removal of amalgam restorations, it was determined that due to the extensive decay in the second molar, the use of an all ceramic crown was indicated

Figure 3: The first molar and the two premolars will be restored using the indirect resin restorative, Cristobal®+. Cristobal®+ was selected due to its strength, aesthetics, and long term clinical history.

Slightly diverging margins (no more than 15 degrees) for path of insertion No sharp internal line angles Butt joint or heavy champher Interproximal line angles should be 90 to 120 degrees--Do not flare Figure 4: During preparation of the inlay, several key points of the preparation details must be observed.

Figure 5: The teeth were prepared for impression by packing cord Figure 5: The teeth were prepared for impression by packing cord. Use of Aquasil Fast Set Smart Wetting® Impression material (shown here) is recommended to obtain clean, clear margins. If excess tissue is present, use laser or electrosurge to remove.

Alternatively, a matrix may be prepared from an ideal wax-up on a model. This can be accomplished using a putty matrix like Aquasil Easy Mix Putty. Create a matrix of the prepared teeth directly in the mouth using, for example, Jeltrate®, or Regisil® Rigid Super Fast Set Bite Registration Material.

After preparation, load the matrix with Integrity® and replace the matrix to fit in the mouth for 2-3 minutes. Remove and allow the provisional to self-cure for about 5 minutes. Adjust and trim the provisional with a slow speed acrylic bur and/or a high speed diamond bur. Larger shape burs and diamonds work well.

Figure 6: Before temporary cementation, the preparations were cleaned with chlorhexidine, air dried, and an antibacterial agent (e.g. Super Seal or Tublicid Red) was placed. After air drying, the provisionals were cemented with Integrity® TempGrip™ & polished with Enhance® Finishing Cups.

Figure 7: Integrity® Provisionals in Place

Figure 8: Upon return of the patient, the Cristobal® inlay restorations were inspected on the model

Figure 9: The Integrity® provisionals were removed and a rubber dam was placed. The teeth were again cleaned with chlorhexidine rinse for 15 seconds and then thoroughly rinsed.

Figure 10: There are options when placing the Cristobal®+ indirect resin restorative. One may use the “total-etch” bonding technique or the more recently developed self-etching adhesives and/or cements. In this case, the total-etch technique was used. Thus, the teeth were etched using phosphoric acid, beginning application on the enamel.

Figure 11: Next, the application of Caulk Tooth Conditioner Gel was extended to the dentin, making sure not to leave etchant on the dentin more than 15 seconds. This procedure ensures lack of over etching of the dentin. The teeth are thoroughly rinsed and lightly dried until the dentin has a moist matte finish.

Figure 12: Prime & Bond® NT™ Dual Cure is mixed with its Self Cure Activator and applied generously to the teeth, allowing to remain in contact for 20 seconds. The excess solvent is then evaporated using a gentle air stream. The treated surfaces should have a uniform glossy appearance as shown above.

Figure 13: Prime & Bond® NT™ Dual Cure is light cured for 10 seconds per tooth

In this case, Calibra® Esthetic Resin Cement was used In this case, Calibra® Esthetic Resin Cement was used. The light cured resin paste was mixed with the catalyst paste to activate the dual cure setting mechanism. The internal surface of the Cristobal®+ indirect resin restoration was blasted with a silicate ceramic material (CoJet--3M), silanated, and let air dry for one minute. Then a thin coat of the Prime & Bond® NT™ Dual Cure mixture was placed on the internal parts of the restorations, and air dried.

Figure 14: The Cristobal®+ restorations were then firmly seated in place and the excess cement wiped off. The teeth were carefully flossed and the restorations light cured. The excess cement was removed with various scalers or with a 7404 carbide bur.

Figure 15: Enhance® Finishing System polishing cups were used.

Figure 16: Completed Cristobal®+ Indirect Inlay Resin Restoration