CATEGORY 78 AUSTRALASIAN DENTIST CLINICAL Introduction In the evolving landscape of aesthetic dentistry, the shift towards minimally invasive techniques and the utilisation of advanced materials like lithium disilicate has revolutionised the way we approach restorative treatments. Indirect posterior dentistry, in particular, offers significant potential for achieving outstanding aesthetic and functional outcomes while preserving tooth structure. As we continue to integrate high strength glass ceramic materials like lithium disilicate into our posterior quadrant dentistry and full mouth rehabilitations, it’s crucial to understand the high-level strategies for planning these cases—ensuring both longevity and a natural appearance for our patients. The Changing Paradigm: From Luted to Bonded Ceramics Historically, the use of ceramics in restorative dentistry primarily involved luted materials that required traditional cementation techniques. These materials often demanded greater tooth reduction and more invasive procedures to accommodate the restoration. Studies show that up to 9% of patients that receive full coverage crowns develop pulpal disease (Yavorek et al 2020, Ptak et al 2023). However, the introduction of high strength glass ceramics, such as, lithium disilicate has fundamentally shifted this paradigm. Unlike its predecessors, lithium disilicate is chemically bonded to the tooth structure, reducing the need for aggressive preparation while increasing the strength and durability of the restoration. The benefits of bonded ceramics over luted ceramics are profound. Bonding offers superior retention, significantly reducing the likelihood of restoration dislodgement and enhancing the mechanical strength of the final restoration. In situations where there is any concern about cuspal integrity, cuspal coverage with lithium disilicate via this chemical bond also helps distribute occlusal forces more evenly across the tooth, contributing to better long-term stability and reduced risk of tooth fracture. This advancement allows for a more conservative approach, preserving as much natural tooth structure as possible, while still achieving the strength and aesthetic results that modern patients demand. Aesthetic and Functional Strategies for Indirect Quadrant Dentistry When planning an indirect restoration in a quadrant, it’s critical to understand the various options available and choose the most appropriate approach based on both aesthetic goals and occlusal considerations. Lithium disilicate provides a versatile solution for a range of indirect restorations, but choosing between a traditional inlay, onlay, tabletop, crownlays, veneerlays, and full coverage crowns can significantly impact the overall outcome. Below, we discuss the differences and benefits of each approach. 1. Tabletops (Overlay): u Aesthetic Enhancement: Lithium disilicate’s superior translucency makes it an excellent choice for improving the aesthetic appearance of the tooth without compromising strength. u Conservative Approach: Almost always avoids the need for a full coverage crown. Ideal Cases: Tabletops are most suitable for cases with intact marginal ridges but have functional damage from a crack. This is also suitable for cases with occlusal erosion. 2. Crownlays: Indirect Posterior Dentistry Using Lithium Disilicate: High-Level Strategies for Optimal Planning Dr. Andrew See By Dr. Andrew See BDS Hons (Syd), FRACDS, MSc(Lond), PGDipDentImplantology, FCGDENT(UK), FICOI, MFDS RCSEng Aesthetic Dentist and Educator, Founder of Dental Mastery Academy A tabletop restoration involves the placement of a thin ceramic layer that covers all the occlusal surface of a posterior tooth. This minimally invasive option is particularly effective in cases where the tooth’s underlying structure is largely intact, but there are aesthetic or functional concerns with the occlusal surface. Benefits: u Minimal Tooth Reduction: Tabletops require very little removal of healthy tooth structure, which is ideal for preserving tooth vitality. Crownlays combine elements of both a traditional inlay/onlays and tabletop design, covering part of the tooth structure while preserving more enamel. This option is ideal for teeth that have moderate structural loss but still retain enough sound tooth tissue to avoid the need for a full coverage crown. Benefits: u More Coverage with Less Reduction: Compared to traditional full crowns, crownlays cover a larger surface area but require less tooth preparation. u Improved forced distribution: Lithium disilicate’s high flexural strength is able to absorb the occlusal forces rather
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