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Background The cementation of indirect restorations is a critical step influencing their long-term clinical success. While dual-cure resin cements are widely used, injectable resin composites have emerged as promising alternatives, offering improved handling, high filler content, and esthetic stability. However, their clinical performance as luting agents for indirect restorations remains insufficiently explored. This trial assessed the clinical performance of indirect hybrid ceramic onlay restorations cemented with injectable resin composite versus dual-cure resin cement over 18 months. Materials and methods A total of 28 participants were randomly assigned to two groups ( n  = 14) based on the cementation protocol. The intervention group received onlays cemented with injectable resin composite (BEAUTIFIL Flow Plus X F03, Shofu Dental Corporation), while the control group received dual-cure resin cement (BeautiCem SA, Shofu Dental Corporation). Standardized procedures were followed for cavity preparation, immediate dentin sealing, cavity optimization, impression-taking, onlay fabrication (SHOFU Block HC, Shofu Dental Corporation), and cementation. Restorations were evaluated at baseline, 6, 12, and 18 months using the modified USPHS criteria. Data were statistically analyzed with significance set at P  ≤ 0.05. Intergroup comparisons were assessed with Chi-squared test, while intragroup comparisons were assessed with Cochran’s Q test. Kaplan–Meier analysis and the log-rank test were used to evaluate survival rates. Results Inter- and intragroup comparisons revealed no significant differences between the two groups for most outcomes ( P  > 0.05). However, at 18 months, dual-cure resin cement exhibited significantly higher marginal discoloration than injectable resin composite ( P  = 0.038). Within the dual-cure resin cement group, a significant decline in alpha scores for marginal discoloration was observed from baseline to 18 months ( P  = 0.007). While no restorations failed (Charlie score), Kaplan–Meier survival analysis and the log-rank test demonstrated a statistically significant difference between the two groups ( P  = 0.029). Conclusions After 18 months, injectable resin composite demonstrated acceptable and comparable clinical performance to dual-cure resin cement, with the added benefit of reduced marginal discoloration. Clinical relevance Injectable resin composites offer a viable alternative to dual-cure resin cements for luting indirect restorations with enhanced esthetic outcomes. Trial Registration https://clinicaltrials.gov/ , (NCT05954156), 20-07-2023.

Objective. The aim of this study was to compare to fracture resistance test of inlay restorations prepared using direct inlay technique (Gradia® Direct Composite) and Indirect Restoration System® (Gradia Indirect Composite) and CAD/CAD system (Vita Enamic® Block). Study Design. 48 noncarious extracted maxillary second primary molars were randomly divided into 4 groups with 12 in each group. All the teeth were prepared based on inlay class II preparations except for the control group. Other groups were restored with Gradia Direct Composite, Gradia Indirect Composite, and Vita Enamic Block, respectively. All restorations were cemented self-adhesive dual cure resin (3M Espe, RelyX™ Unicem Aplicap). A fracture test was performed using a compressive load. Results were analyzed using one-way analysis of variance and Duncan’s post hoc multiple comparison tests (α=0.05). Results. Vita Enamic Block and Gradia Indirect Composite showed significantly higher fracture resistance than Gradia Direct Composite (p<0.05). There was no significant difference fracture resistance between Vita Enamic Block and Gradia Indirect Composite (p>0.05). All restorations tested led to a significant reduction in fracture resistance (p<0.05). Conclusion. In inlay restorations, Indirect Restoration Systems and CAD/CAM systems were applied successfully together with the self-adhesive dual cure resin cements in primary molars.

Background Dental caries is a common disease and affects many adults worldwide. Inlay or onlay restoration is widely used to treat the resulting tooth substance loss. Two esthetic materials can be used to manufacture an inlay/onlay restoration of the tooth: ceramic or composite. Here, we present the protocol of a multicenter randomized controlled trial (RCT) comparing the clinical efficacy of both materials for tooth restoration. Other objectives are analysis of overall quality, wear, restoration survival and prognosis. Methods The CEramic and COmposite Inlays Assessment (CECOIA) trial is an open-label, parallel-group, multicenter RCT involving two hospitals and five private practices. In all, 400 patients will be included. Inclusion criteria are adults who need an inlay/onlay restoration for one tooth (that can be isolated with use of a dental dam and has at least one intact cusp), can tolerate restorative procedures and do not have severe bruxism, periodontal or carious disease or poor oral hygiene. The decayed tissue will be evicted, the cavity will be prepared for receiving an inlay/onlay and the patient will be randomized by use of a centralized web-based interface to receive: 1) a ceramic or 2) composite inlay or onlay. Treatment allocation will be balanced (1:1). The inlay/onlay will be adhesively luted. Follow-up will be for 2 years and may be extended; two independent examiners will perform the evaluations. The primary outcome measure will be the score obtained with use of the consensus instrument of the Fédération Dentaire Internationale (FDI) World Dental Federation. Secondary outcomes include this instrument’s items, inlay/onlay wear, overall quality and survival of the inlay/onlay. Data will be analyzed by a statistician blinded to treatments and an adjusted ordinal logistic regression model will be used to compare the efficacy of both materials. Discussion For clinicians, the CECOIA trial results may help with evidence-based recommendations concerning the choice of materials for inlay/onlay restoration. For patients, the results may lead to improvement in long-term restoration. For researchers, the results may provide ideas for further research concerning inlay/onlay materials and prognosis. This trial is funded by a grant from the French Ministry of Health. Trial registration ClinicalTrials.gov Identifier: NCT01724827

The dimensional accuracy of digitally processed inlays is often questioned because of inherent manufacturing inconsistencies associated with computer-aided design and manufacturing (CAD/CAM). This study aimed to compare the absolute marginal discrepancy (AMD), marginal gap (MG), internal gap (IG), and overall discrepancy (OD) of three-dimensional (3D) printed, milled and conventional inlays. Forty resin dies were 3D-printed from a class II mesiococclusodistal preparation on a typodont and randomly distributed into four groups of 10 each. Optical impressions were taken for three groups to fabricate CAD/CAM inlays: Group PVC, 3D printed VarseoSmile Crownplus; Group PVT, 3D printed VarseoSmile TriniQ; and Group MVE, milled using Vita Enamic. For Group CGP (control), CGP was conventionally fabricated using Gradia Plus. These inlays were stabilized on dies and subjected to cone‒beam computed tomography to measure discrepancies in mesiodistal and buccolingual sectional images. All the discrepancies differed significantly among the groups (one-way ANOVA, P  > 0.05). The mean OD was significantly greater in the MVE than in the PVT and CGP; the mean AMD and MG were significantly greater in the PVC than in the PVT (Tukey test, P  > 0.05). Compared with the other groups, the 3D-printed inlays, especially the VarseoSmile TriniQ, presented a closer marginal and internal fit.

Key Points In general a significant decrease in marginal accuracy should be taken into consideration for partial coverage restorations after adhesive cementation. Adhesive luted partial coverage restorations appear to have a moderate increase in marginal gap width under masticatory ageing. The introduced new preparation designs fulfil the technical demands to fabricate accurate fitting all ceramic partial coverage restorations. Objectives To determine the influence of the preparation design and the dimensions of all-ceramic partial coverage restorations (PCR) on the marginal accuracy before and after masticatory simulation. Methods In this in vitro study 80 extracted human maxillary molars were restored with MOD inlay restorations and four different modified PCR restorations using a new press ceramic IPS e.max® Press (IPS e.max® Press VP 1989). The teeth were divided into five groups of 16 specimens each and prepared as follows: Group A received an MOD inlay preparation and Group B, C, D and E received modified PCR. The restorations were adhesively luted and exposed to a mastication simulator. The discrepancies of the marginal fit were examined on epoxy replicas before and after luting as well as after masticatory simulation at 200× magnification. Results The mean (geometrical) [95% confidence limits] marginal gap decreased from Group A to E before cementation (A-83[77-90]μm, B-68[65-70]μm, C-59[55-64]μm, D-56[52-61]μm, E-50[45-55]μm). Group A had significantly higher marginal gap values than group B (p = 0.017) and the other groups (p<0.0001). After cementation the marginal accuracy was recorded as following: A-103[93-114]μm, B-101[94-108]μm, C-93[89-98]μm, D-102[98-105]μm and E-99[96-102]μm. Cementation increased the marginal gap in groups B-E significantly (p<0.00001), not significantly in group A (p = 0.059). Artificial ageing (A-116[106-127]μm, B-114[109-120]μm, C-106[103-110]μm, D-109[100-118]μm and E-109[105-112]μm) led to further significant decrease of marginal accuracy in Group B (p = 0.029) and C (p = 0.026) only. After cementation and masticatory simulation of the ceramic restorations, the marginal gap values of Groups A, B, C, D and E did not significantly differ from each other (p = 1.00). Conclusions The result of this in vitro study showed that IPS e.max® Press can be used to fabricate all-ceramic inlays and PCR which meet the requirements in terms of a clinically acceptable marginal gap, irrespective of the preparation design used. However, the preparation design and dimensions of the restorations appeared to affect the initial marginal fit and flowing off of luting material during the cementation process. The factors responsible for these findings require further substantiation.

Objective To evaluate the effect of deep margin elevation (DME) and immediate dentin sealing (IDS) on the fracture strength of premolars restored with lithium disilicate inlay restorations. Materials and Methods Standard MOD inlays with proximal box preparations extending 3 mm apical to the cementoenamel junction were prepared on forty sound premolars (n = 10) randomly divided into four groups: inlays without DME and without IDS (G1); inlays without DME but with IDS (G2); inlays with DME but without IDS (G3); and inlays with both techniques applied (G4). Composite resin was applied incrementally to elevate the proximal cervical margin coronally to the cementoenamel junction. For immediate dentin sealing, bonding agent was applied immediately after tooth preparation. All teeth were restored with lithium disilicate inlays and, after adhesive resin cementation, specimens were thermomechanically aged for 500 cycles at 5°–55°C and then subjected to load failure testing. Failure loads and locations were recorded and analyzed using one‐ and two‐way ANOVA with Tukey's post‐hoc testing (α = 0.05). Failure modes were analyzed using descriptive statistics. Results The mean fracture loads were 565.76 ± 233.22 N, 978.47 ± 394.2 N, 974.31 ± 334.7 N, and 1108.21 ± 292.41 N for G1, G2, G3, and G4, respectively. Deep margin elevation (p = 0.011) and immediate dentin sealing (p = 0.010) were associated with significantly increased fracture loads. Fracture loads were significantly lower for G1 teeth than for G2‐G4 teeth, but there were no significant differences between G2, G3, and G4. G1 teeth showed 50% catastrophic and non‐catastrophic failures, which increased to 60% for G2 and decreased to 20% for G3 teeth. Samples with both seals and elevation (G4) had a 60% catastrophic failure rate. Conclusions When applied individually or together, deep margin elevation and immediate dentin sealing significantly increase the fracture strength of premolars restored with indirect lithium disilicate inlays. Clinical Implications In the challenging setting of margin elevation, studies on the effects of immediate dentin sealing have generally been limited to evaluating marginal integrity and bond strength. The findings of this In Vitro study suggest that both deep margin elevation and immediate dentin sealing protocols are likely to improve clinical outcomes of indirect lithium disilicate inlay restorations and may be considered viable options in clinical practice.

The aim of this study was to evaluate the accuracy of two intraoral scanners used in the dental office. A molar fixed in a typodont was prepared for a ceramic onlay. The preparation was scanned using a high-resolution scanner (reference scanner) and saved as stereolithography (STL) format. The prepared resin molar was scanned again using the intraoral scanners, and all the scans were saved as well in STL format. All STL files were compared using metrology software (Geomagic Control X). Overlapping the meshes allowed the assessment of the scans in terms of trueness and precision. Based on the results of this study, the differences of trueness and precision between the intraoral scanners were minimal.

Context Cranioplasty is a frequently performed procedure that uses a variety of reconstruction materials and techniques. In this technical note, we present refinements of computer-aided design–computer-aided manufacturing inlay cranioplasty. Objective, design, and setting In an attempt to decrease complications related to polyether-ether-ketone (PEEK) cranioplasty, we gradually made changes to implant design and cranioplasty techniques. These changes include under-contouring of the implant and the use of segmented plates for large defects, microplate fixation for small temporal defects, temporal shell implants to reconstruct the temporalis muscle, and perforations to facilitate the drainage of blood and cerebrospinal fluid and serve as fixation points. Results From June 2016 to June 2017, 18 patients underwent cranioplasty, and a total of 31 PEEK and titanium implants were inserted. All implants were successful. Conclusions These changes to implant design and cranioplasty techniques facilitate the insertion and fixation of patient-specific cranial implants and improve esthetic outcomes.

The aim of this study was to evaluate the marginal adaptation of CEREC ceramic inlays, CEREC composite inlays and direct composite restorations in unbeveled proximal slot cavities under artificial aging conditions. Two groups of each restoration type were prepared (n = 6), one group with a self-etch adhesive, the other group with H(3)PO(4) enamel etching before the self-etch adhesive application. Replicas were generated before and after long-term thermo-mechanical loading under dentinal fluid simulation and margins were evaluated at x200 magnification in the scanning electron miscroscope (SEM). Statistically, significant differences were found before and after loading with respect to the percentages of \"continuous margins\", the direct composite filling with H(3)PO(4) enamel etching giving the lowest percentages of \"continuous margins\" after loading (p < 0.05). The highest percentage of \"continuous margin\" was attained by composite inlays without H(3)PO(4) enamel etching. However, these results were not significantly different from ceramic inlays after stressing. Polymerization shrinkage is still one critical property of composite restorative materials. The marginal adaptation of indirect adhesive proximal slot restorations without enamel bevels both fabricated out of composite and ceramic is better than that of directly placed composite restorations.