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 bunch

of 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 al
J Am Dent Assoc. 2007 Jun;138(6):763-72
The 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 II
Replacement of failed restorations
Primary caries

Pascal Magne: 'It should not be about

aesthetics but tooth-conserving dentistry

tooth-conserving dentistry

The Inlay
The Onlay
The Crownlay

Crown
crown

Onlay/Inlay
inlay/onlay

4%

96%

ENAMEL

ENAMEL
PRECIOUS

Longevity

Class II Longevity
11years Amalgam

6-8 years Composite

1372Mjor, I. A., J. E. Dahl, and J. E. Moorhead. Age of restorations
at replacement in permanent teeth in general
dental practice. Acta Odontol. Scand. 58:97101, 2000.

3. Christenson J G. Should resin-based composite dominate

restorative dentistry today?JADA 141(12) December 2010 page 1490-93

1,748 restorations 7 years

J Am Dent Assoc 2007;138;775-783

and Timothy A. DeRouen
Martin, Brian G. Leroux, Tessa Rue, Jorge Leito
Mario Bernardo, Henrique Luis, Michael D.
Survival and reasons for failure of amalgam

=
7 year longevity
80% Amalgam
J Am Dent Assoc 2007;138;775-783
and Timothy A. DeRouen
Martin, Brian G. Leroux, Tessa Rue, Jorge Leito
Mario Bernardo, Henrique Luis, Michael D.
Survival and reasons for failure of amalgam
versus composite posterior restorations
Placed in a randomized clinical trial

50% Composite

6
Years

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 10

Years

Otto, T. & De Nisco, S. (2002) Computer-aided

direct ceramic restorations: a 10-year prospective
clinical study of CEREC CAD/CAM inlays and
onlays. International Journal of Prosthodontics
15: 122128.

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

El-Mowafy, O. & Brochu, J.F. (2002) Longevity and

clinical performance of IPS-Empress ceramic restorations:
a literature review. Journal of the
Canadian Dental Association 68: 233237.
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.

Martin, N. & Jedynakiewicz, N.M. (1999) Clinical

performance of CEREC ceramic inlays: a systematic
review. Dental Materials 15: 5461.

Fuzzi, M. & Rappelli, G. (1999) Ceramic inlays:

clinical assessment and survival rate. Journal of
Adhesive Dentistry 1: 7179.

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

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

mm)

Occlusal reduction (1.5-2.0

sy
ea
r
fo
s
ge
ed
rp
a
sh
ve
ha
ld
ou
sh
s
in
Marg

mnm
1.5
atio
identific

Isthmus depth

Rounded internal line angles

Occlusal reduction (1.5-2.0

Internal axial walls

6-10

Isthmus depth

mm)

1.5 mm

Rounded internal line angles

Internal axial walls

6-10

sharp

PREPARATION ASPECTS TO

AVOID

PREPARATION ASPECTS TO

AVOID

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.

1.5mm
1.0mm
0.5mm

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

The Crownlay