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Indirect Resin Systems
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Question #1: Do indirect resin systems cause less wear on opposing natural teeth?

Answer: Most indirect resins are filled with fine filler particles, as well as their direct composite counterparts, and wear natural teeth less than porcelains. However, newer low fusing porcelains approach these low wear rates.


Question #2: Should fibers be placed in all resin restorations?

Answer: No, fibers are only useful in increasing flexural strength. In clinical situations where smaller restorations will mainly undergo compressive forces, as an inlay or a conservative onlay, fibers are less likely to have much clinical benefit.


Question #3: When is it important to use fibers?

Answer: In larger restorations. Full posterior crowns and bridges are the most in need of fiber reinforcement to improve flexural strength. In addition, with inlays and onlays where large portions of the marginal ridge are involved and the composite is extended from the gingival floor fibers could help reduce marginal ridge fractures. Marginal ridge fractures are the primary cause of failure in both composite and ceramic restorations.


Question #4: Are fiber splints as strong as the time tested wire splints?
Answer: It is not known. Fiber requires more space than wire but fibers are easier to mask. Lingual splints and circumferential splints have very different dynamics and are difficult to compare. Lingual splints are completely retained by adhesives and circumferential splints have a large amount of mechanical retention.


Question #5: Which one of the indirect resin systems is best?

Answer: It will take over ten years of clinical use to determine this. Clinical performance depends on many often unforeseen factors. It is hoped newer systems will perform much better than previous indirect resin systems. Most direct composites last over 8 years. To justify the use of indirect composites the patient should expect a considerably longer life span.


Question #6: Which of the fiber systems is the best?

Answer: None, the placement and adapation to the restoration is far more important than the fiber used. Whichever fiber the technician can most easily use is preferred.


Question #7: Does the improved fit of indirect resins affect longevity?

Answer: Marginal wash out of indirect composites compared to ceramic inlays, which usually have a poorer fit, will be less since marginal wash out is usually half of the marginal width. However, this may not be clinically significant since it is not a primary cause of failure.
Cohesive failures may be slightly improved by a better fit if the restoration flexs more due to the lower stiffness of the luting cement.


Question #8: Is there any place for these systems?

Answer: Presently they are best reserved for provisionals. Despite their widespread use there are few places in dentistry that we know of where they offer the patient better service than existing restorative systems.


Question #9: Are single component bonding agents any good?

Answer: With bonding materials, ease is not necessarily better. In fact, the reliability of a material after each use is much more important than the advertised bond strength.


Question #10: How much bond strength do you need?

Answer: Enough to make the restoration successful. Most bonding systems give you enough strength to keep the restorative material in place. The critical part of a restoration's success is the method of placement. If placement technique is poor, no bonding material will be adequate. If placement is good almost all major brands will be successful.
A problem in dentistry is that great attention is given to the material when the critical area for success is technique.


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