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Evidence-based concepts and procedures for bonded inlays and onlays. Part III. A case series with long-term clinical results and follow-up

This third article in this series (Part III) aims to presentnew clinical results and long-term follow-up of resin composite inlays andonlays using the modern clinical concepts presented in the Part I and Part IIarticles. These revised protocols have contributed to eliminating the mostfrequent difficulties related to the preparation, isolation, impression taking,and cementation of tooth-colored inlays and onlays. This clinical reportpresents a series of 25 cases of indirect or semidirect inlays and onlays (intra-and extraoral techniques) made of microhybrid and nanohybrid composites with 6-to 21-year follow-ups. The restoration performance was assessed throughclinical examination, intraoral radiographs, and clinical photographs. Theoverall clinical assessment aimed to confirm the absence (success) or presence(failure) of decay or restoration fracture, while the restoration quality was judgedon intraoral photographs. The restoration status with regard to margins,anatomy, and color was assessed using three quality scores (A = ideal, B =satisfactory, C = insufficient). Descriptive statistics were used to evaluatethe possible impact of composite structure (microhybrid or nanohybrid) orobservation time on restoration quality. Over this medium- to long-termobservation period, no clinical failure was reported. Only a few restorations (mainlythose made of conventional inhomogeneous nanohybrid) presented discretemarginal discoloration (n = 4) or occlusal anatomy change due to wear (n = 7).This first clinical survey with long-term follow-up supports the application ofthe aforementioned clinical concepts, which thus far have only been validatedby in vitro studies.


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