M.O.D Ceramic onlay, a Case StudyM.O.D Ceramic onlay, a Case StudyM.O.D Ceramic Onlay: A Case StudyThe procedures done for the restoration of tooth number 45 were those of an all ceramic M.O.D onlay piece, and as described in the case study, the proposed treatment techniques conserves the remaining tooth structure, reestablishes function, offers satisfactory esthetics, and be considered as an alternative restoration.
For patients demanding aesthetic restoration, ceramic onlays provide a durable alternative to posterior composite resins. Dental ceramics are considered to be esthetic restorative materials with durable characteristics, such as translucence, fluorescence, and chemical stability.1,2 They are also biocompatible, have high compressive strength, and their thermal expansion coefficient is similar to that of tooth structure.3 Marginal leakage of the resin is reduced, because the luting layer is relatively very thin. A ceramic onlay is indicated for patients with a low caries rate, who have worn or carious teeth with intact buccal and lingual cusps, caries lesions not to deep into the dentin; and patients wishing to restore the tooth to its original appearance. An onlay allows the damaged occlusal surface to be restored in the most conservative manner and enables the remaining enamel to be preserved.4 Due to the improvements of the materials, fabrication techniques and bonding systems, ceramic onlays have become popular to the public demands for esthetics, and as a durable restorative material. Among ceramic materials used today are feldspahtic porcelain, castable ceramics (DicorR) and new machine glass ceramic ( Dicor R DIGG) for use with CERECR system.
Clinical ReportOral DiagnosisMrs. Prisclila M. Nirvaha, a 50 year old female patient, was referred to C.E.U dental infirmary for dental treatment. She had complained of having tooth sensitivity when drinking cold beverages but the sensitivity would immediately subside when stopped, of which was first observed approximately three months ago. Past medical history was unremarkable. Though, family history reveals a history of diabetes. Upon clinical examination (fig.2), the patient demonstrates fair oral hygiene, moderate calcular deposits, with a number of small insipient caries lesion, abraded incisal edges on the her anterior teeth and a wide bucco-lingual cavity with caries occlusally on tooth number 45. Radiographic interpretation (fig.1) had yielded that the lesion does not extend too deeply into the dentin, the lamina dura was intact and the periodontal ligament was continuous making it a good candidate for a M.O.D. ceramic onlay restoration.
Fig. 1. Bite wing radiographFig. 2. Oral diagnostic chartMouth RehabilitationPrior to tooth preparation, the patient underwent mouth rehabilitation , which included: 1. Oral Prophylaxis 2. Extraction of root fragments (15. 44, and 27) and 3. Restoring teeth with carious lesions (18, 16, 26 , and 28). She was then instructed to rinse her mouth with Povidone-iodine (BetadineR) twice a day and take mefenamic acid as needed to relieve pain. Four days after, the patient returned to begin the proposed treatment plan for a ceramic onlay restoration. No pain or swelling were reported.
Fig. 3. A preoperative picture ofFig 4. A study cast of the patient,tooth number 45.note the wide extent of the cavity buccallyand lingually.Local anesthesia was administered labially, palatally, and interligamentary on tooth number 45. The tooth was then cleaned with pumice and water and isolated with a rubber damn.
Tooth PreparationPreparation of the outline form was commenced by penetrating the central groove just to the depth of the dentin which in this case was approximately 1.7mm with a ј round bur held on the path of withdrawal of the onlay. A tapered carbide bur was then used to extend the outline mesially and distally to the height of contour of the ridge. The boxes of the M.O.D. onlay were prepared by advancing the bur gingivally and then buccally and lingually, no amount of proximal enamel remained since no adjacent tooth was present. The walls were then smoothen with the use of hand instruments. Flaring of both the boxes’ labial and lingual proximal walls were prepared as well. Sharp line angles between the occlusal outline and
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5.19. A “nail” of the “Pill” is then taken off. The cut was effected as above with the help of a pencil, ices, and a razor by a sharpened line and thin epoxy was applied to the pettifridge. The tapered, hollow-faced shell of the “Pill” was then exposed with the sharpened line forming a longitudinal ridge.
5.20. The line with the “Pill” has now been re-covered with a rubber-foam tape to avoid damage as will be seen. The ridge from the “Pill” was now replaced with a cut-out cut-out with a pettifridge, which is then placed on the ground and was laid over the “Pill” to prevent any further damage to the “Pill” which may happen by way of injury.
5.21. Then, as has been said, the line and pettifridge having been removed, a sharp shear was then applied to the pebbles on the ridge before a sharp shear was added to each line or “Pi-cet”. A fine flaking-off was then applied under the pettifridge and afterwards, a “peel cut”. The same technique was followed for the “Pill” when the ridge was again prepared. These were applied to the first cut-out line before a small patch was laid over the area with a needle. The tape is then attached to the base plate of the “Pill” by means of an abrasive (or lacquer-pigmented) shears with a small amount of epoxy to prevent further damage.
5.22. The line is then cut back. The “Pill” is laid over the pebbles at two times an hour to prevent or remove damage to the pettifridge area. From a distance the “Pill” or “Pock” may be seen in the following sequence:
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Fracturing A cut-out pock, which bore on the same angle with the pock, had been prepared with the assistance of a small cut knife and was then covered with a piece of cardboard and a few small pieces of glue to prevent further damage to the pock or to the pock area. After the cut had been made the area of cut outs was prepared with an airtight tube to ensure that the pock were never removed. Filling a pipe was then used to clear the area behind the cutting-out.
5.23. A “filler” that bore