Controlling contacts and contours using preformed ceramic inserts

Current adhesive techniques and materials that seal both enamel and dentin have revolutionized modern restorative dentistry. Unfortunately, the durability problems associated with direct polymeric materials of the past have not been adequately solved. Nevertheless, when cost and esthetics form part of the treatment decision process, patients presenting with Class 2 defects are most often provided with a direct restorative option. Direct composite resin restorations are fraught with problems largely related to the mechanical stresses that accompany polymerization shrinkage. A partial solution is to incorporate prefabricated ceramic inserts into the substance of the composite resin, thereby decreasing the volume of directly cured restorative material and effectively reducing the magnitude of the polymerization stresses. SONICSYS approx is a unique addition to the restorative continuum that takes the insert strategy one step further by using specifically shaped sonically driven diamond-coated preparation tips to adjust the cavity form to fit presized ceramic proximal inlays. The SONICSYS approx system represents a technique intermediate between a direct resin composite and a laboratory fabricated inlay. This article describes the background of this development, and the components and application of the system. In addition, within the presentation of a case study, operative innovations are introduced that improve interfacial integrity and allow for the conveyance of predictable contacts and proper physiological contour.