Fired ceramic inlays: a 6-year follow up

doi:10.1016/S0300-5712(97)00005-5

Journal of Dentistry

Volume 26, Issue 3, March 1998, Pages 219-225

https://doi.org/10.1016/S0300-5712(97)00005-5 Get rights and content

Abstract

Objectives: The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up.

Methods: One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period.

Results: Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity.

Conclusion: A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group.

References (44)

J.W.V. van Dijken
Marginal breakdown of five year old direct composite inlays
Journal of Dentistry
(1996)
K.H. Friedl et al.
In-vivo evaluation of a feldspathic ceramic system: 2-year result
Journal of Dentistry
(1996)
S. Gladys et al.
Clinical and semiquantitative marginal analysis of four tooth-coloured inlay systems at 3 years
Journal of Dentistry
(1995)
H.O. Heymann et al.
The clinical performance of CAD-CAM-generated ceramic inlays. A four-year study
Journal of the American Dental Association
(1996)
J.W.V. van Dijken et al.
Marginal break-down of fired ceramic inlays cemented with glass poly-alkenoate (ionomer) cement or resin composite
Journal of Dentistry
(1994)
F.J.T. Burke et al.
Aesthetic inlays: composite or ceramic
British Dental Journal
(1993)
J.W.V. van Dijken et al.
A.J.E. Qualtrough et al.
The porcelain inlay: a historical review
Operative Dentistry
(1990)
J.W.V. van Dijken
A 6-year evaluation of a direct composite resin inlay/onlay system and glass ionomer cement-composite resin sandwich restorations
Acta Odontologica Scandinavica
(1994)
C. Höglund Åberg et al.
Three year comparison of fired ceramic inlays cemented with composite resin or glass ionomer cement
Acta Odontologica Scandinavica
(1994)

J.F. Cvar et al.

S. Siegel

M.E. Jensen

A two-year clinical study of posterior etched-porcelain resin-bonded restorations

American Journal of Dentistry

(1988)

M. Taleghani et al.

Two-year clinical evaluation of direct porcelain inlays

Journal of Dental Research

(1989)

R. Christensen et al.

2-year clinical comparison of 6 inlay systems

Journal of Dental Research

(1991)

C. Höglund et al.

A clinical evaluation of adhesively luted ceramic inlays

Swedish Dental Journal

(1992)

M. Haas et al.

Klinische und werkstoffkundliche erfahrungen mit komposit-, keramik-und goldinlays

Deutsche Zahnärztliche Zeitung

(1992)

M. Molin et al.

A clinical evaluation of the Optec inlay system

Acta Odontologica Scandinavica

(1992)

M. Molin et al.

A 3-year clinical follow-up study of a ceramic (Optec) inlay system

Acta Odontologica Scandinavica

(1996)

B.P. Isenberg et al.

Three-year clinical evaluation of CAD/CAM restorations

Journal Esthetic Dental Association

(1992)

G. Sjögren et al.

Ceramic inlays (Cerec) cemented with either a dual-cured or a chemically cured composite resin luting agent

Acta Odontologica Scandinavica

(1995)

S. Studer et al.

Glass-ceramic inlays and onlays made by IPS-Empress: first clinical results

Journal of Dental Research

(1992)

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Fired ceramic inlays: a 6-year follow up

Abstract

Journal of Dentistry

Journal of Dentistry

Journal of Dentistry

Journal of the American Dental Association

Journal of Dentistry

Aesthetic inlays: composite or ceramic

British Dental Journal

The porcelain inlay: a historical review

Operative Dentistry

A 6-year evaluation of a direct composite resin inlay/onlay system and glass ionomer cement-composite resin sandwich restorations

Acta Odontologica Scandinavica

Three year comparison of fired ceramic inlays cemented with composite resin or glass ionomer cement

Acta Odontologica Scandinavica

A two-year clinical study of posterior etched-porcelain resin-bonded restorations

American Journal of Dentistry

Two-year clinical evaluation of direct porcelain inlays

Journal of Dental Research

2-year clinical comparison of 6 inlay systems

Journal of Dental Research

A clinical evaluation of adhesively luted ceramic inlays

Swedish Dental Journal

Klinische und werkstoffkundliche erfahrungen mit komposit-, keramik-und goldinlays

Deutsche Zahnärztliche Zeitung

A clinical evaluation of the Optec inlay system

Acta Odontologica Scandinavica

A 3-year clinical follow-up study of a ceramic (Optec) inlay system

Acta Odontologica Scandinavica

Three-year clinical evaluation of CAD/CAM restorations

Journal Esthetic Dental Association

Ceramic inlays (Cerec) cemented with either a dual-cured or a chemically cured composite resin luting agent

Acta Odontologica Scandinavica

Glass-ceramic inlays and onlays made by IPS-Empress: first clinical results

Journal of Dental Research