Abstract：
OBJECTIVE: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient.
METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices.
RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent.
CONCLUSIONS: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.
METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices.
RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent.
CONCLUSIONS: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.
摘要：
目的：本病例报告介绍了一种直接复合反向注射技术，该技术使用双层透明微型索引，并通过数字工作流程制造，以恢复13岁患者的广泛的后咬合腔。
方法：在右下颌第一磨牙进行根管治疗并在左下颌第一磨牙逐步挖除深龋后，广泛的咬合修复体使用CAD软件进行数字化设计，数字蜡是3D打印的。由硬的外部塑料层和弹性的内部有机硅层组成的双层透明小索引由3D打印的铸件制备。使用6％的次氯酸钠溶液将粘合表面脱蛋白，和抗氧化剂（ClearfilDCActivator；KurarayNoritake）用于改善两步自蚀粘合剂（ClearfilSEBond2；KurarayNoritake）的牙本质粘合耐久性。随后，将高度填充的通用阴影可流动树脂复合材料（RC）逐渐放入空腔中。要创建最终的咬合形态，通过双层索引的开口反向注入相同的RC。
结果：工作流程是可行的，并使用注射技术有效地恢复了咬合腔。不需要咬合雕刻和形态调整，导致更少的椅子时间。在1年的随访中，临床结局良好.
结论：具有双层清晰迷你索引的注射技术将数字蜡像精确地转换为大型，最终修复。精确的形态学和缩短的椅子时间提高了患者的满意度，但以多次访问为代价。
方法：在右下颌第一磨牙进行根管治疗并在左下颌第一磨牙逐步挖除深龋后，广泛的咬合修复体使用CAD软件进行数字化设计，数字蜡是3D打印的。由硬的外部塑料层和弹性的内部有机硅层组成的双层透明小索引由3D打印的铸件制备。使用6％的次氯酸钠溶液将粘合表面脱蛋白，和抗氧化剂（ClearfilDCActivator；KurarayNoritake）用于改善两步自蚀粘合剂（ClearfilSEBond2；KurarayNoritake）的牙本质粘合耐久性。随后，将高度填充的通用阴影可流动树脂复合材料（RC）逐渐放入空腔中。要创建最终的咬合形态，通过双层索引的开口反向注入相同的RC。
结果：工作流程是可行的，并使用注射技术有效地恢复了咬合腔。不需要咬合雕刻和形态调整，导致更少的椅子时间。在1年的随访中，临床结局良好.
结论：具有双层清晰迷你索引的注射技术将数字蜡像精确地转换为大型，最终修复。精确的形态学和缩短的椅子时间提高了患者的满意度，但以多次访问为代价。
