1. APPLICATION OF FIXED- MOVABLE INLAY IN INLAY CONSTRUCTIONS- A 6 YEARS CLINICAL SURVEY D.Filtchev

2. The question of the restoration of defects of the tooth row, limited by intact teeth, is still a controversial question in the dental practice. Several types of retainers are available for use in the bridgework, and the choice will depend on: The question of the restoration of defects of the tooth row, limited by intact teeth, is still a controversial question in the dental practice. Several types of retainers are available for use in the bridgework, and the choice will depend on:

3. The amount of retention required The amount of retention required The amount of abutment crown available The amount of abutment crown available The resistance of crown remaining after the preparation of the tooth The resistance of crown remaining after the preparation of the tooth The extend of existing restoration to be covered The extend of existing restoration to be covered The amount of occlusal or incisal protection required The amount of occlusal or incisal protection required

4. The casted metal crowns however have some disadvantages : 1. break off the interchange between the tooth and the saliva 2. sensitive grinding of hard tooth tissue 3. difficult restoration of the individual occluso-articulative correlation

5. The use of inlays without cuspal coverage as retainers in a fixed-fixed bridge, involves a risk that the weaker retainer will eventually fail at the cement seal between retainer and abutment tooth.The reason is that the abutment tooth can be depressed in the socket, whilst the retainer is supported by the remainder of the bridge. This conflict of the forces may cause the eventual fracture of the cement seal. The use of inlays without cuspal coverage as retainers in a fixed-fixed bridge, involves a risk that the weaker retainer will eventually fail at the cement seal between retainer and abutment tooth.The reason is that the abutment tooth can be depressed in the socket, whilst the retainer is supported by the remainder of the bridge. This conflict of the forces may cause the eventual fracture of the cement seal. The minor retainer of fixed-movable bridge is not rigidly connected to the rest of the bridge and is free to move in a vertical direction towards the alveolus. It must however,have a sufficient retention to withstand stresses from other than a vertical direction. The minor retainer of fixed-movable bridge is not rigidly connected to the rest of the bridge and is free to move in a vertical direction towards the alveolus. It must however,have a sufficient retention to withstand stresses from other than a vertical direction.

6. AIM AIM After six years clinical survey, our aim was to apply a restoration of limited defects of the tooth rows, treatment after hemisection and prophylactics of Godon phenomena,by means of fixed- movable bridge with a retainer ceramo-metal inlay in abutment inlay by a composite material. After six years clinical survey, our aim was to apply a restoration of limited defects of the tooth rows, treatment after hemisection and prophylactics of Godon phenomena,by means of fixed- movable bridge with a retainer ceramo-metal inlay in abutment inlay by a composite material.

7. For a period of 6 years we have restored For a period of 6 years we have restored 64 defects of the tooth row. 64 defects of the tooth row. We have made 49 ceramo-metal fixed- We have made 49 ceramo-metal fixed- movable bridges, 8 crowns for treatment movable bridges, 8 crowns for treatment after hemisection, and 7 crowns for after hemisection, and 7 crowns for prophylaxis of Godon phenomena with a prophylaxis of Godon phenomena with a retainer ceramo-metal inlay in abutment retainer ceramo-metal inlay in abutment inlay by a composite material inlay by a composite material

8. First clinical step First clinical step 1. prepare medio-occlusal or a disto-occlusal cavity limited in the enamel with 2.0mm depth 2. 15 sec. – etching gel 3. 10 sec. wash with water 4. apply Optibind Solo (Kerr, USA) 5. light-polymerize for 20 sec. 6. put the composite (Herculite,Kerr,USA)in the cavity 7. polimerize for 40 sec.

9. form the cavity by a round borer and then by a cylindrical one, trying to widen the vestibulo-lingual size. form the cavity by a round borer and then by a cylindrical one, trying to widen the vestibulo-lingual size. when the lost tooth is a molar, it is obligatory for the cavity to be mediodistal when the lost tooth is a molar, it is obligatory for the cavity to be mediodistal

11. We have taken a two –step,two layer impression by a condensational silicon Silaplast and corrector Silasoft (Detax, Germany) We have taken a two –step,two layer impression by a condensational silicon Silaplast and corrector Silasoft (Detax, Germany)

12. The bridge has been casted by metal- VIRON 99. The bridge has been casted by metal- VIRON 99.

13. Second clinical step We have tested the metal skeleton of the construction We have tested the metal skeleton of the construction defined the colour defined the colour

14. In the dental-mechanic laboratory the retainer inlay has been covered by a minimal ground coat and a dentine ceramic till the moment of getting balanced point contacts. In the dental-mechanic laboratory the retainer inlay has been covered by a minimal ground coat and a dentine ceramic till the moment of getting balanced point contacts. When the esthetics was not leading factor, we leave the edge of the inlay metal When the esthetics was not leading factor, we leave the edge of the inlay metal

15. We have permanantly fixed the bridge with PROTEC CEM (VIVADENT,Liechtenstein) but without cementing the retainer-ceramo- metal inlay. We have permanantly fixed the bridge with PROTEC CEM (VIVADENT,Liechtenstein) but without cementing the retainer-ceramo- metal inlay. We have examined the patients thoroughly every 6 months and we have done an electroodontic and x-ray diagnostic. We have examined the patients thoroughly every 6 months and we have done an electroodontic and x-ray diagnostic.

17. We have observed 2 unstucked bridges 2 unstucked bridges no fractured ceramic or metal no fractured ceramic or metal no breaking of the composite inlay no breaking of the composite inlay no secondary caries no secondary caries for the period of 6 years for the period of 6 years

18. According to us the good results are due to the good mechanical qualities of the contemporary composite materials. The aesthetics of the constructions in the area of the retainer-ceramo- metal inlay has completely satisfied the patients. They have not had subjective complaints or a feeling of discomfort. According to us the good results are due to the good mechanical qualities of the contemporary composite materials. The aesthetics of the constructions in the area of the retainer-ceramo- metal inlay has completely satisfied the patients. They have not had subjective complaints or a feeling of discomfort.

19. Advantages Advantages 1. A good prophylactic effect towards the dental tissue and the parodontium,which diminishes the possibility of development of a secondary caries, because of the precise forming in the approximal area. 2. Good functional indexes, because it keeps a big part of the natural occlusal relief of the abutment tooth. 3. Responds to the aesthetic requirements.

20. Advantages Advantages 4. Allows a correction when a secondary caries or a fracture of the composite inlay appears. 5. The time for making the composite inlay by the direct method is reduced with one clinical and laboratory step. 6. The interchange between the abutment tooth and the saliva is not interrupted.

21. First clinical case First clinical case

24. Second clinical case Second clinical case

25. Third clinical case Third clinical case

27. Conclusions Conclusions The retainer inlay in inlay made of composite material, might be successfully used as a method of choice for restoration of a defect on the tooth-row limited medially and distally by an intact abutment tooth. The retainer inlay in inlay made of composite material, might be successfully used as a method of choice for restoration of a defect on the tooth-row limited medially and distally by an intact abutment tooth.

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