CDEN0109

I 23 opinion _ inlays & onlays I cosmeticdentistry 1_2009 Reason No. 4: Crowns last longer and are more predictable. Althoughlongevityisimportantandingrainedin the dental psyche, it is not the only criteria of value. In the age of adhesive dentistry, respecting remain- ing tooth structure and aesthetics have become components of value as well. Keeping in mind that patients are living longer and want and expect to keep their teeth for a lifetime (something we tell them can be done) means, in most instances, it is best to recommend a crown only when it’s truly in- dicated. The name of the game in dentistry today is ‘bank thetoothstructure’forfutureuse.Regardingdura- bility, aesthetic inlays and onlays are not new any- more. They have a track record, and it is good.4–9 With today’smaterials,longevityismainlyamatterofdi- agnosis, correct treatment planning and proper ex- ecution of technique (Figs. 1–4). Although not aesthetic, well-done gold inlays andonlaysareconsideredtohaveaprovendurabil- ity and longevity similar to crowns. If aesthetics is not an issue, gold is still the standard and what I al- waysrecommendforsecondmolarswhenaconser- vativeindirectrestorationisindicated.However,it’s interesting to note the number of people and the types of people who still desire tooth-coloured or non-metal restorations even in these teeth. Reason No. 5: Posterior direct resin restorations arelesscostlytothepatientandcanbecompletedin oneappointment. Itisafactthatmoreandmorepatientstodayare selectingtooth-colouredrestorationsfortheirpos- terior teeth,10 and there is no question that well- placed Class I and Class II direct resin restorations areprovingtobeviablealternativestoamalgam.11,12 However, the indications for these restorations do have limits. Generally, when the cavity is large or the tooth is underexcessivefunctionaldemand(heavybruxeror clencher),indirectrestorations(resinorceramic)are indicated. Certainly, when a cusp is missing, many clinicians feel the standard of care is best satisfied byanindirectrestoration(Figs.5–10).Afterall,there is no question that a laboratory technician working with mounted models at the bench is going to pro- vide a more accurate occlusal morphology, contact andoverallcontouraswellasproperlylocatedfunc- tional stops of the right intensity than we can by grindingallthebluespotsinthemouth.It’salsovery Fig. 3_Failing amalgam and poor contact due to tipped teeth. Fig. 4_Indirect resin composite inlays at 21 years. Fig. 5_Recurrent caries evident in both molars. Fig. 6_The second molar was treated with a direct composite resin restora- tion. It was thought that a better con- tact, cuspal contour, occlusal mor- phology, and correctly placed func- tional stops could be achieved in the first molar with an indirect approach. Fig. 3 Fig. 4 Fig. 5 Fig. 6