Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

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Principles of 
indirect restoration
INTRODUCTION AND INDICATIONS
An indirect restoration is any restoration that is fabricated extra-
orally. Although there are a few techniques that allow indirect
restorations to be constructed at the chairside, the vast majority of
indirect restorations are constructed in a dental laboratory. An indir-
ect restoration will be then luted/cemented into/onto the tooth, in
contrast with plastic restorative materials, which are packed directly
into a preparation. As indirect restorations are rigid, in order to place
them within or on the tooth they obviously require a preparation that
is non-undercut (Fig. 5.1).
Indirect restorations may be broadly split into categories: intra-
coronal restorations that fit within the contours of a tooth (e.g. inlays,
cast intra-radicular posts); extra-coronal restorations that cover the
outer surface of a tooth to recreate the anatomic contours (e.g. full or
Fig. 5.1
Non-undercut preparation for indirect restoration (crown).
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Chapter 5
partial coverage crowns, veneers); and also those in-between restora-
tions that cover part or all of the external surface of a tooth to recreate
form and may also fit within the tooth (e.g. cuspal coverage inlay/
onlay) (Fig. 5.2).
General indications
In general terms, indirect restorations are of benefit in the following
situations:
• Large cavities/preparations – when correct anatomical form 
is difficult or impossible to reproduce with a directly placed
restoration.
• When the remaining tooth structure is compromised and at risk of
fracture (e.g. after root-canal treatment).
• When the restoration would be of such a size that alternative,
stronger/more wear resistant materials are required (than those
available for use as a directly placed restoration).
• Restoration of severely broken down or worn teeth.
• When the tooth has been prepared with instruments manufactured
with matching pre-formed components (e.g. posts, inlay inserts).
Fig. 5.2
Various types of indirect restoration. (a) Inlay, (b) onlay.
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Large cavities
Although teeth with large cavities involving multiple missing cusps
may be restored with direct restorative materials, it is very difficult
and technically demanding and errors often occur. Use of a direct
restoration in this situation cannot always establish the contact point,
and food packing and periodontal disease may result. In addition,
recreation of correct occlusal morphology is very difficult with 
large, compound restorations. The use of an indirect restoration, such
as an inlay will largely avoid these problems.