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Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 277-281

Why ceramic? When you can use composite. Indirect restoration of tooth in a more biomimetic way using heat treated direct resin composite

Department of Conservative and Endodontic Dentistry, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India

Date of Submission17-Mar-2021
Date of Acceptance16-Jul-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Bhavika Bhavsar
Department of Conservative and Endodontic Dentistry, RKDF Dental College and Research Centre, Bhopal - 462 026, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrntruhs.jdrntruhs_35_21

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Direct resin composites have a greater degree of conversion, physical properties, color, and resistance to abrasion when heat treated. So, it is best suited for indirect use as heat-treated direct resin using oven, autoclave or porcelain furnace, or microwave. We have chosen direct resin composite as a suitable material and heat-treated it for endo crown fabrication or aesthetic indirect restoration. The reason for such technique is supported by various research studies, and case reports available have shown positive results, and it is also considered as a biomimetic method.

Keywords: Direct resin composite, endo crown, fractured teeth, heat treatment, inlay, onlay, endodontically treated teeth

How to cite this article:
Bhavsar B, Neilalung K, Vaz M. Why ceramic? When you can use composite. Indirect restoration of tooth in a more biomimetic way using heat treated direct resin composite. J NTR Univ Health Sci 2021;10:277-81

How to cite this URL:
Bhavsar B, Neilalung K, Vaz M. Why ceramic? When you can use composite. Indirect restoration of tooth in a more biomimetic way using heat treated direct resin composite. J NTR Univ Health Sci [serial online] 2021 [cited 2023 Feb 7];10:277-81. Available from: https://www.jdrntruhs.org/text.asp?2021/10/4/277/339819

  Introduction Top

After glass ionomer cement was introduced which was named man-made dentin, dental composite has been introduced to overcome the weakness of glass ionomer cement. Direct resin composites have a greater degree of conversion, physical properties, color, and n abrasion resistance when heat treated.[1] Thus, such post treatment of direct resin using oven, autoclave or porcelain furnace or microwave, allows it to be used for indirect restoration.[2]

  Case Report Top

Case 1

A 21-year-old female patient with a chief complaint of food lodgment diagnosed with dental caries in mesio-occlusal surface with 38 tooth number was planned for indirect pulp capping followed by heat-treated direct resin composite onlay treatment.

Case 2

A 30-year-old male patient with a chief complaint of food lodgment was diagnosed with proximal caries with 26 tooth number and was treated with heat-treated direct resin composite inlay.

Case 3

A 57-year-old female patient with a chief complaint of old restoration was diagnosed withasymptomatic irreversible pulpitis with normal peri-radicular tissue with 36 tooth number and managed with root canal treatment and heat-treated direct resin composite endo crown.

All the procedures are explained in [Figure 1], [Figure 2], and, [Figure 3] respectively. All the patients who reported to the Department of Conservative Dentistry and Endodontics were evaluated if they required such indirect restorations and selected for the treatment. The procedures were explained, and their consent was obtained. The treatments were done in the same department. Reflectys- Itena (Paris, France) a direct resin composite, Tetric n Bond Universal, Ivoclar (Schaan, Principality of Liechtenstein), a bonding agent, Itena Total C-Ram by Itena (Paris, France), a luting agent, were the materials used. The autoclave machine was used at 120°C for 14 min for heat treatment.
Figure 1: Case report of restoration of 38 tooth number using heat treated direct resin composite partial onlay. (a and b): pre-operative. (c-e): Indirect pulp caping using calcium hydroxide. (f) working cast and fabrication of partial onlay using a direct resin composite. (h): try in. (i) post heat treatment and adhesive applied. (j-l): post cementation and post-operative

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Figure 2: Case report of restoration of 26 tooth number using heat treated direct resin composite inlay. (a and b): pre-operative. (c-f): cavity preparation and working cast after impression taking. (g and h): inlay fabricated & tryin. (i and j): inlay post heat treatment. (ka and l): post inlay cementation

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Figure 3: Case report of restoration of 36 tooth number using heat treated direct resin composite endo-crown. (a and b): pre-operative. (c-f): Root canal treatment done, cavity preparation followed by working cast. (g-j): endo crown fabricated and try-in. (k and l): etching and bonding post heat treatment of endo-crown. (m and n): tooth isolated using Teflon tape and luting agent added. (o-t): Post cementation

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  Discussion Top

Teeth require root canal treatment generally due to extensive tooth loss structure as a result of dental disease. The remaining healthy tooth structure of endodontically treated tooth plays an important role by providing good adhesion, marginal seal, strength, and support for final restoration which results in a final restored tooth that can resist fracture and also prevent the need for endodontic retreatment. The final step of treatment is often considered full crown but it requires aggressive reduction of tooth structure.[3] Minimal invasive treatment has been widely advocated. The literature along with research results showed great advantages due to minimal tissue removal, keeping intact the pulp-dentinal complex and periodontium. This along with advances in adhesive and restorative materials restore both function and aesthetics which predict greater durability and prognosis.[4] Esthetically, tooth-color restorations such as ceramic inlays, onlays, or endo crowns exist. However, direct resin composite– and indirect resin composite–based inlays, onlays, or endo crown are also gaining popularity. Dental ceramic restoration has a good performance and durability record in the research literature, but it is far from perfect. Disadvantages of dental ceramics exist, such as high cost, difficulty in repair, brittleness, prone to fracture, and ability to wear with opposing tooth's surface and most importantly it demands certain tooth preparation design that does not allow maximum conservation of tooth structure when maximum preservation of the remaining tooth structure is required.[5] And that is the reason why our treatment plan included direct resin composite with heat treatment instead of ceramic. We have chosen endo crown with heat-treated composite rather than a full crown because the endo crown technique has been described as “monoblock porcelain technique” as mentioned earlier in the 1990s[6] but in later years because of limitations of ceramics, endo crown fabrication by either direct or indirect resin composite has gained positive attention. Although, a total crown with a cast metal core could also be used. However, endo crown is favorable for all molars, particularly those with clinically low crowns, calcified root canals, or narrow canals, and requires lesser tooth reduction for tooth preparation. The only preparation is to get a wide and stable surface resisting the compressive stresses that are frequent in molars. The stress generated is lower than in teeth with full crowns.[7] Unlike full crown preparation that requires tooth reduction of the whole occlusal, external peripheral (axial, buccal, and mesial) walls, an endo crown preparation requires only occlusal and less aggressive internal wall preparation. For these reasons, the endo crown was the choice taken. We have chosen inlay and onlay and not the crown or direct resin restoration in case 1 and 2, the amount of tooth structure lost due to caries and fracture, respectively has shown the inter cusp distance and involvement of a functional cusp and has been justified according to the recommendations given in the literature.

We have chosen heat-treated direct resin composite as a suitable material for restoring both as endocrown or indirect restoration of inlay and onlay as various researches have shown positive benefits as a biomimetic material. According to Loza-Herrero, et al.[8] monomer conversion occurred higher up to 6 h after light cure confirming the reduction in the amount of residual monomers increasing the strength. Bagis, Rueggeberg[9] did immediate post-light cure heating for 7 min, at 50, 75, 100, and 123°C and found 75°C and above resulted in the lowest amount of residual monomers. This concept is supported by the study where the direct composite resin is better after heat treatment than the indirect resin composite.[10] This less residual monomer leads to better color stability, overall physical properties improvement which lead to being favorable choice of material for such restoration of tooth structure loss.

  Conclusion Top

In the literature, already vast data exist, conservative restoration of endodontically treated tooth serves a higher fracture resistance and is more conservative. According to Phillips and numerous studies, the physical properties of ceramic-based materials do have very good and in fact best results. However, it has some limitations such as specific cavity design, cost, repair, and its tendency to abrade opposing teeth, and more importantly very vast difference when compared to the physical properties of normal dentition. Whereas, composite already has physical properties almost comparable to normal dental tissues. With minimal cavity preparation, new advances in composites, and additional heat treatment open a new pathway alternative to ceramic.


The authors are very grateful to the participants who contributed a big role in completing this case. No financial support was received from any source. However, the authors are grateful to the institution for the permission and for providing the necessities for performing these treatments successfully.

Patient's consent

The patient's informed written consent was taken in all the cases presented.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Availability of data and material

The data used in this study are available and will be provided by the corresponding author on a reasonable request.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Terry DA, Touati B. Clinical considerations for aesthetic laboratory-fabricated inlay/onlay restorations: A review. Pract Proced Aesthet Dent 2001;13:51-4.  Back to cited text no. 1
Peutzfeldt A, Asmussen E. The effect of postcuring on quantity of remaining double bonds, mechanical properties, and in vitro wear of two resin composites. J Dent 2000;28:447-52.  Back to cited text no. 2
Dogui H, Abdelmalek F, Amor A, Douki N. Endocrown: An alternative approach for restoring endodontically treated molars with large coronal destruction. Case Rep Dent 2018;2018. doi: 10.1155/2018/1581952.  Back to cited text no. 3
Mackenzie, L., Banerjee, A. Minimally invasive direct restorations: A practical guide. Br Dent J 2017;223:163-71.  Back to cited text no. 4
Azeem RA, Sureshbabu NM. Clinical performance of direct versus indirect composite restorations in posterior teeth: A systematic review. J Conserv Dent 2018;21:2-9.  Back to cited text no. 5
[PUBMED]  [Full text]  
Oswal N, Chandak M, Oswal R, Saoji M. Management of endodontically treated teeth with endocrown. J Datta Meghe Inst Med Sci Univ. 2018;13:60-2.  Back to cited text no. 6
Dejak B, Młotkowski A. 3D-finite element analysis of molars restored with endocrowns and posts during masticatory simulation. Dent Mater 2013;29:e309-17.  Back to cited text no. 7
Loza-Herrero MA, Rueggeberg FA, Caughman WF, Schuster GS, Lefebvre CA, Gardner FM. Effect of heating delay on conversion and strength of a post-cured resin composite. J Dent Res 1998;77:426-31.  Back to cited text no. 8
Bagis YH, Rueggeberg FA. The effect of post-cure heating on residual, unreacted monomer in a coXmmercial resin composite. Dent Mater 2000;16:244-7.  Back to cited text no. 9
Miyazaki Caroline Lumi, Medeiros Igor Studart, Santana Ivone Lima, Matos Jivaldo do Rosário, Rodrigues Filho Leonardo Eloy. Heat treatment of a direct composite resin: Influence on flexural strength. Braz Oral Res 2009;23:241-7.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3]


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