Abstract：
For restoring extensive cavities in severely damaged or decayed posterior teeth, especially those with thin walls, indirect restorations are recommended rather than direct fillings. Regarding indirect restorations for inlays and onlays, composite resin-based CAD/CAM materials are considered to have several advantages over ceramics such as easy manufacturing, lower cost, and simpler repairability. A case is presented in this article in which the treatment plan and protocol combine multiple evidence-based clinical techniques such as immediate dentin sealing (IDS), cavity design optimization (CDO), and cervical margin relocation (CMR). For CDO and CMR, two different types of flowable composite resins with different viscosities were used. Restoring such extensively damaged teeth using a defect-oriented adhesive technique is considered a challenge both in terms of the preservation of healthy tooth structure and the proper isolation for adhesive luting. The IDS technique was used to enhance the bonding to the remaining dentin, while CDO was performed to avoid unnecessary removal of vital tooth structure, for example, undercuts. The deep subgingival margins were elevated using the CMR technique to facilitate the impression taking and a contamination-free luting of the final restoration. Combining the aforementioned techniques enabled a defect-oriented, minimally invasive restoration of a severely decayed tooth. The aim of this article is to present those techniques in a simplified way through a clinical case as a step-by-step guide for the practitioner.
摘要：
为了修复严重受损或腐烂的后牙中的大量空洞，尤其是那些薄壁的，建议使用间接修复，而不是直接填充。关于嵌体和嵌体的间接修复，基于复合树脂的CAD/CAM材料被认为比陶瓷有几个优点，例如易于制造，更低的成本,和更简单的可修复性。本文提出了一个案例，其中治疗计划和协议结合了多种基于证据的临床技术，例如立即牙本质密封（IDS），腔设计优化(CDO)，和宫颈边缘重新定位（CMR）。对于CDO和CMR，使用了两种不同类型的具有不同粘度的可流动复合树脂。在保持健康的牙齿结构和适当的粘合剂隔离方面，使用面向缺陷的粘合剂技术修复这种广泛受损的牙齿被认为是一个挑战。IDS技术用于增强与剩余牙本质的结合，而CDO是为了避免不必要的切除重要的牙齿结构，例如,底切。使用CMR技术提高了深龈下边缘，以促进印象的获取和最终修复的无污染。结合上述技术实现了面向缺陷的，严重龋齿的微创修复。本文的目的是通过临床案例以简化的方式呈现这些技术，作为从业者的分步指南。
