IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54

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IP Indian Journal of Conservative and Endodontics

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Case Report
Indirect composite inlay restoration: A case report

Linda Maria Jose1, *, Basil Jose1 , Justline Jose1 , Kessiya Babu1

1 Dept. of Conservative Dentistry and Endodontics, St. Gregorios Dental College, Chelad, Kerala, India

ARTICLE INFO ABSTRACT

Article history: In several deterioration cases , composite competes with amalgams, metallic and ceramic inlays. In
Received 26-02-2022 relatively small cavities of posterior teeth, utility of direct composite restorations is restricted due to its
Accepted 02-03-2022 polymerisation stresses. A much-appreciated alterative to ceramics in posterior teeth is indirect composite.
Available online 31-03-2022 Due to recent technological advancements in composite materials and bonding techniques, its use escalates
steadily. Touati and Mormann introduced the first generation of indirect resins composite in early 1980s.
Although there is a successful accomplishment in direct composite restoration, the use of composite
Keywords: restoration with indirect or extra-oral method remains ambiguous. In this article, we will inquire into
Indirect Composite Inlay composite systems used at the laboratory for indirect restoration in a clinical ground.
Grandio SO Inlay System
Voco This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
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1. Introduction with ceramic inlays, composite resin restorations have the

advantage to be more user-friendly and less expensive. 4
Direct composite restoration causes polymerization
When compared to direct composites, indirect composite
shrinkage and it has lower fracture toughness. So
resins have an upper hand in aesthetics, colour stability and
we tried indirect composite restoration. Owing to the
reduced postoperative sensitivity. 5 Moreover, it is easier for
advancement of adhesive technologies and restorative
indirect restorations to achieve anatomic morphology and
materials, approaches and treatment plans for restoring
ideal proximal contacts.
posterior teeth have been impressively improved. 1 Inspite
Another advantage suggested is better integrity of the
of the fact that amalgam and gold have illustrated
tooth/restoration interface which can result in increased
persistent clinical success and biocompatibility, novel
longevity and reduced marginal leakage. 1,6
tooth-coloured restorations are dynamically supplanting
Elimination of polymerization shrinkage would be a
metal restorations not only for aesthetic reasons but also
major factor in the reduction of microleakage. Three
for more conservative preparations. 2 In light of biology,
techniques have been suggested to reduce the effects of this
mechanics, function, and aesthetics, a harmonious and
shrinkage:
successful restorative result could be accomplished with
these natural-looking restoration materials, such as resin
1. (Use of an incremental packing technique.
composite and ceramics. 3
2. (The ’waxing up’ of a restoration in composite in the
According to various clinical performance studies, Inlays
mouth and polymerization extra orally.
have an upper hand over direct fillings when dealing
3. The complete extra-oral fabrication of a composite
with fracture and porosity / crack formation. Comparing
inlay which is then placed using a resin cement. 7,8
* Corresponding author. In addition, polymerization shrinkage, is limited to
E-mail address: [email protected] (L. M. Jose). that of the thin luting cement layer, as it takes place

https://doi.org/10.18231/j.ijce.2022.010
2581-9534/© 2022 Innovative Publication, All rights reserved. 49
50 Jose et al. / IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54

extraorally. 9

The aim of the present investigation was to study the clinical

performance of composite resin inlays using the indirect
inlay technique. This report presents a case involving the
restoration of an extensive cavity of the upper left first
premolar through an indirect composite technique and
follow-up of the clinical outcome afterwards.

2. Case Presentation
A 19-year-old female student visited the department of
Conservative dentistry and Endodontics, St. Gregorios
Dental College, Chelad with the chief complaint of decay
in the upper left back tooth region. She noticed the decay
since 2 months and was asymptomatic. Clinical examination
Fig. 3: IOPA of 24
revealed Class II dental caries of the upper left first premolar
without any gingival inflammation .The pulp vitality test
was normal with no symptoms or signs.
her aesthetic and financial concerns, and further possibility
of root canal treatment. A written informed consent was
obtained before the treatment, and patient gave permission
for the related pictures and radiographs to be published
before submission.
At the next appointment, caries was removed by low-
speed carbide burs and sharpened spoon excavator under
rubber dam isolation. The class II cavity was prepared,
bevels and flares were placed.

Fig. 1: Preoperative photograph of maxillary left second premolar

Radiographic examination revealed an occlusal and

mesial decay in proximity to the pulp horn while no obvious
abnormal apical findings were noted.

Fig. 4: Photograph of class 2 inlay cavity preparation

Fig. 2: Bitewing radiograph of maxillary and mandibular

posteriors, Light body impression material was injected onto the
prepared tooth after removal of the rubber dam. Putty
After oral hygiene reinforcement, we discussed with impression material was loaded onto the impression tray and
the patient that composite inlay might be a choice for maxillary arch impression was made.
 Jose et al. / IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54 51

Fig. 5: Impression of prepared tooth

2.1. Laboratory procedures

A fast-setting silicone die material (GrandioSO Inlay
System, Voco, Cuxhaven, Germany) was injected into the
impression. Lower arch alginate impression was made and
cast was poured in dental stone to check the occlusion.

Fig. 7: Shows photograph of fast-setting silicone die material

(GrandioSO Inlay System, Voco, Cuxhaven, Germany).

Fig. 6:

Die material was removed carefully without any

distortion and the inlay restoration was fabricated
incrementally with a light-cured composite resin (shades
B3) and each layer was polymerized for 20 s with a
light-emitting diode curing with light irradiance of 1000
mW/cm2 .
For sculpting the occlusal morphology, we determined
the cusps and marginal ridges by referring to the existing
morphology of neighbouring teeth. In addition, the cast
of the lower arch was used for adjusting the occlusion.
After finishing and polymerization, the composite inlay was Fig. 8: Shows photograph of dental impression mixing and
removed from the silicone die and cured from the intaglio dispenser gun.
surface for 40s.
52 Jose et al. / IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54

Fig. 12: Positive replica of prepared tooth and adjacent tooth

Fig. 9: Application of separating medium on the impression of
prepared tooth.

Fig. 13: Placing of composite restorative material on the prepared

Fig. 10: Mixing of impression material tooth

Fig. 11: Placing of modelling silicone onto the impression. Fig. 14: Light curing of composite.
 Jose et al. / IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54 53

The occlusal contacts were adjusted and checked with

articulating paper. Finally, the restoration was finished by
fine-grained diamond burs and polished by abrasive. At
the two weeks recall, the restoration still maintained its
aesthetic and chewing function.

Fig. 15: Polishing of the composite restoration.

Fig. 17: Photograph showing acid etching of the prepared class 2

inlay cavity on 24.

Fig. 16: Finished and polished class 2 inlaycomposite restoration

on prepared die.
Fig. 18: Postoperativephotograph of 24 after placement of class 2
inlay composite restoration.

Then, the inlay was tried in and the fitness was checked.
Before cementation, the intaglio surface of restoration was
3. Discussion
conditioned with 37.5% phosphoric acid gel for 15 s.
After the etchant gel was rinsed, the composite inlay was The resin composite inlay technique is a venture to
rinsed with water for 15 seconds. Moreover, the tooth was overcome the main drawback of polymerization shrinkage
selectively etched with 37.5% phosphoric acid gel for 15s, of the direct resin composite restoration. 10 Indirect inlays
rinsed with water spray, and air dried. The self-etching were made under dental school conditions, which is far
adhesive and dual-cured luting composite were used for different from a busy private practice. This should be noted
final cementation. Polymerization was performed for 20s in mind when evaluating the results. An indirect restoration
per surface is more complimentary for restoring the morphology and
54 Jose et al. / IP Indian Journal of Conservative and Endodontics 2022;7(1):49–54

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The authors declare that there is no conflict of interest.

Author biography
6. Source of Funding
Linda Maria Jose, House Surgeon
None.
Basil Jose, House Surgeon
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doi:10.3390/dj6040054. 2022;7(1):49-54.