Indirect Restorations

Selecting the appropriate direct restoration to meet the needs of the patient and the individual tooth depends on a large variety of factors. Each material has different physical properties, and different advantages and disadvantages as a result.

The weight of scientific evidence is that all of these materials are safe and effective for their intended use when properly placed in the appropriate clinical situation.

Dental Insurance may provide coverage for the least expensive material than can be used, whether or not it is the best material recommended by the dentist after discussing this with the patient. Patients, in consultation with their dentist, should be free to choose the most appropriate among them for their particular needs, and individual desires.

Crowns ("caps") and Fixed Partial Dentures ("bridgework") are restorations that are placed over one or more teeth after they are suitably reshaped. Crowns and Fixed Bridgework may be made out of the same materials that are used for indirect fillings.

The following chart illustrates some common considerations your dentist takes into account when determining which material is best for a particular tooth needing an indirect restoration. The list is by no means complete.

Comparison of Indirect Restorative Dental Materials

FACTORS	COMPOSITES (Indirect)	ALL-PORCELAIN (ceramic)	PORCELAIN Fused to METAL	GOLD ALLOYS (high noble)	BASE METAL ALLOYS (non-noble)
General Description	A mixture of tiny glass filler particles and acrylic resin that forms a solid tooth-colored restoration. Laboratory processing increases strength compared to direct composites cured in the mouth.	Porcelain, ceramic or glass-like fillings and crowns.	Porcelain is fused to an underlying metal structure to provide strength to a filling, crown or bridge.	Alloy of gold, copper and other metals resulting in a strong, effective filling, crown or bridge.	Alloys of non-noble metals with silver appearance resulting in high strength crowns and bridges.
Principal Uses	Esthetic dental fillings and veneers	Esthetic and Strong dental fillings, inlays, onlays, crowns & veneers.	Inlays, onlays, crowns and fixed bridges	Inlays, onlays, crowns & fixed bridges.	Crowns, fixed bridges & partial dentures.
Leakage and Recurrent Decay	Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond.	Leakage very low if properly bonded to underlying tooth structure. Recurrent decay depends on maintenance of the tooth-material bond.	The commonly used methods used for placement provide a good seal against leakage. The incidence of recurrent decay is similar to other restorative procedures.
Durability	Fair to Good in small-to-moderate size restorations, if not subject to biting forces.	Excellent durability, very strong yet able to withstand biting forces well.	Very strong and durable.	Very strong and durable, but lower quality alloys may have poor corrosion resistance.
Dentist's Cavity Preparation Considerations	Strength depends on adequate composite resin thickness, requires moderate tooth reduction during preparation (1 to 2 mm).	Strength depends on adequate porcelain thickness, requires more tooth reduction during preparation. Usually more conservative than a crown & may eliminate need to crown a tooth.	Including both porcelain and metal creates a stronger restoration than porcelain alone; more tooth reduction is required (1.5 to 2 mm).	The relative high strength of metals in thin sections requires the least amount of healthy tooth structure removal.
Clinical Considerations	These are multiple step procedures requiring highly accurate clinical and laboratory processing. Some restorations require at least two visits, others require multiple appointments.
Resistance to Wear	Moderately resistant, but less so than silver amalgam alloy.	Highly resistant to wear. Inferior grades of porcelain can rapidly wear opposing teeth in some situations.	Highly resistant to wear, but porcelain can rapidly wear opposing teeth in some situations	Resistant to wear and gentle to opposing teeth.	Resistant to wear and gentle to opposing teeth.
Resistance to Fracture	Moderate resistance to fracture in high-load restorations, some what better than direct composite restorations.	Excellent strength if properly bonded to underlying tooth structure. Fracture is uncommon.	Excellent resistance to fracture.	Highly resistant to fracture.
Biocompatibility	Reasonably well tolerated. Material may release estrogen-like chemicals, but clinical significance is unknown.	Very well tolerated.	Very well tolerated if high quality noble metal used. Low quality base metals may can cause allergic reactions.	Very well tolerated.	Well tolerated, but some patients may show allergenic sensitivity to base metals.
Post-Placement Sensitivity	Sensitivity, if present, is usually not material specific.
Post-Placement Sensitivity	Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth.	Sensitivity is rare when proper placement of quality materials is done.	Low thermal conductivity reduces the likelihood of discomfort from hot and cold.	High thermal conductivity may result in early post-placement discomfort from hot and cold.
Esthetics	Mimics natural tooth color and translucency, but can be subject to staining and discoloration over time.	Excellent esthetics, color and translucency which can very closely match natural tooth appearance.	Excellent Esthetics, color & translucency. Porcelain can very closely match natural tooth appearance, but metal may diminish translucency if placement not well done.	Metal colors do not mimic natural tooth coloration or translucency.
Relative Cost to Patient	Moderate; actual cost of fillings depends on size and technique. Generally requires at least two office visits and laboratory services.	Higher; requires at least two office visits and laboratory services.	Higher; requires at least two office visits and laboratory services.	Higher; requires at least two office visits and laboratory services.
Average Number of Visits To Complete	Two or more visits for indirect inlays, onlays, veneers and crowns.	Minimum of two; matching esthetics of teeth may require more visits.	Minimum of two; matching esthetics of teeth may require more visits.	Minimum of two

Indirect Restorations ("laboratory made restorations")

Comparison of Indirect Restorative Dental Materials