Protecting the longevity of indirect restorations

Tackling challenging indirect restorative cases

When a patient’s tooth is damaged and hard tissue is lost, be it through trauma, caries or endodontic treatment, restoration is necessary to improve the patient’s function and aesthetics. Clinicians should assess each individual case, and decide whether direct or indirect restorations are suitable. In posterior teeth, direct restorations may not always be appropriate as they are more prone to shrinkage, wear, and fracture. These, in addition to caries, are the primary reasons for the failure of direct posterior restorations. In such cases, indirect restorations might be more appropriate, to overcome the challenges which may be presented by direct options.[i]

Indirect restorative treatment can provide patients with excellent function and aesthetics, for long-lasting results. The planning stages for indirect restorations can take some time, but result in a strong, durable, aesthetic outcome. In many cases, imaging will be necessary for diagnosis and treatment planning, impression taking is needed to ensure accurate restorations, time must be allowed for the lab to produce the prosthesis, and another appointment is necessary to place it. Accuracy is key in all of these stages, ensuring the patient is receiving the treatment they need, with the right materials and the right products.[ii]

Educate your patients

It is important that patients understand the role they play in maintaining their prosthesis. Carrying out effective oral hygiene can help to extend the life of their restoration, protecting the gingiva and preventing any natural hard tissue from developing caries. It is also important that the prosthesis placed facilitates oral hygiene, giving patients the ability to access all faces of the restoration to minimise the risk of periodontal diseases. Assessments should be made as to the levels and locations of gingival margins to optimise cleaning around the restoration.[iii] In addition, the materials chosen can impact oral hygiene conditions, with some surfaces encouraging the attachment of bacteria, making cleaning more difficult, and worsening the patient’s oral health status.[iv]

Instructing patients on proper oral hygiene techniques, motivating them to undertake effective plaque control and encouraging them to comply with proper maintenance procedures are incredibly useful when they have undergone restorative treatment.[v] It is important that they feel capable of undertaking the cleaning necessary to maintain their oral health. Help patients reduce the risk of developing oral diseases, therefore protecting the investment they have made in their oral health.

The importance of adhesion in complex scenarios

Preparing the tooth properly and ensuring the prosthesis is well designed requires excellent communication between the patient, practitioner, and dental technician. Consideration of the soft tissue and occlusion also contribute to the long-term success of the restoration. Adhesion is a particularly important element here. Even if all else goes to plan, if the adhesive material chosen is of poor quality, the restoration may fail, or produce poor aesthetic results.[vi] Particularly in complex indirect restorative cases, it is vital that you are able to produce highly functional, strong, and durable restorations, while not compromising on aesthetics.

SUPERKRAFT, the concept from COLTENE, is the ideal adhesive solution for indirect restorations. SUPERKRAFT consists of SoloCem universal dental cement and ONE COAT 7 UNIVERSAL bond which, when used in combination, create ultimate strength, for reliable adhesion. Use the materials separately, or as a team for maximum versatility. Each product also displays excellent performance individually. The SoloCem cement provides colour stability and optimal integration, and ONE COAT 7 UNIVERSAL offers reliable bonding on different surfaces, as well as providing up to 300 applications per bottle, for outstanding value.

It is vital to do all you can to protect the longevity of patients’ indirect restorations. From choosing the best materials for prostheses, to encourage excellent standards of oral hygiene, and choosing the most effective bonding agents and adhesive materials, each stage of the restorative process can impact the success of the outcome. Patients should understand the part they play, and dentists and dental technicians should work closely to design the ideal prosthesis in each case.

For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.

Nicolas Coomber – COLTENE National Account & Marketing Manager

[i] Ahlholm, Pekka, et al. “Challenges of the direct filling technique, adoption of cad/cam techniques, and attitudes toward 3d printing for restorative treatments among finnish dentists.” Int J Prosthodont 32.5 (2019): 402-10. http://www.quintpub.com/userhome/ijp/ijp_32_5_Ahlholm_p402.pdf

[ii] https://www.elitedentistrynky.com/blog/whats-the-difference-between-a-direct-and-an-indirect-dental-restoration/

[iii] Srimaneepong, Viritpon, et al. “Fixed prosthetic restorations and periodontal health: a narrative review.” Journal of Functional Biomaterials 13.1 (2022): 15. file:///Users/officeone/Downloads/jfb-13-00015-v2%20(1).pdf

[iv] Srimaneepong, Viritpon, et al. “Fixed prosthetic restorations and periodontal health: a narrative review.” Journal of Functional Biomaterials 13.1 (2022): 15. file:///Users/officeone/Downloads/jfb-13-00015-v2%20(1).pdf

[v] Srimaneepong, Viritpon, et al. “Fixed prosthetic restorations and periodontal health: a narrative review.” Journal of Functional Biomaterials 13.1 (2022): 15. file:///Users/officeone/Downloads/jfb-13-00015-v2%20(1).pdf

[vi] Alsadon, Omar Abdullah. “Adhesion concepts and techniques for laboratory-processed indirect dental restorations.” The Saudi Dental Journal (2022). https://www.sciencedirect.com/science/article/pii/S1013905222001201#s0075