Yes, you have read the title correct. I DID get Chris Orr on the Podcast…the silver lining of lockdown?!
I am very excited to share this episode with you – Composite vs Ceramic, Direct vs Indirect.
I have placed hundreds of humongous composites in my career that in hindsight should have been indirect restorations – I share the challenges that I faced in my journey and I am sure many of you will be able to resonate with it.
An extremely insightful episode with Dr Chris Orr (whom I refer to as ‘the Rockstar Dentist’ and I share the story WHY I give him this name)
Is there a place for inlays?
At what point does a composite become a ceramic (or read: direct becomes indirect)
Is there a place for composite onlays?
Does the parafunctional status of a patient influence the choice of restoration?
Is eMax acceptable for 2nd molars?
Dual cure cement vs light cure cement for onlays?
How do you decide which cusps to cover? What kind of join is best to the tooth?
Pressed eMax vs CAD/CAM eMax?
What does Chris Orr think about BOPT/Vertipreps?
As promised in the episode, if you are waiting for announcements of Advanced Dental Seminar courses by Dr Chris Orr – check out their ADS Facebook page
Jaz: Well the next question then is: Composite Onlays – do they have a place in Restorative Dentistry? I mean… I’ll put my hands up say I placed quite a few in my NHS days, not so many now. My default is lithium disilicate. But is there a role for Composite Onlays in Restorative Dentistry? (Indirect)
Chris: Now, when we talked a little bit earlier on direct versus indirect, I chose my words carefully to say that the direct techniques are more conservative than indirect, not to say composite will always be more conservative and ceramic, because I’m not a big fan of composite onlays having done lots of them in 15-20 odd years ago.
A couple of problems with them. Number one, they are less conservative than today’s ceramic. Typically, for composite you need minimum 2.0mm of occlusal clearance to make it durable enough to have some chance of surviving. And that’s a lot more to take off than, for example with most ceramics, lithium disilicate, you need one millimetre as a minimum – Second molars you might go to 1.5mm.
On the first premolar, you might even get less, 0.7 millimetres. But let’s say 1.0mm for the sake of comparison, gone half a millimetre. So from the point of view of conservation, NO – composite doesn’t win from the point of view of longevity.
When we’re talking about onlays to patients, the conversation is along the lines of ‘this tooth, classically would need a crown’. ‘A crown involves cutting a little bit away from all the way around the teeth a little bit off the top, I’m gonna make it a little cap, called a crown that fits over the top and protects what is left of the tooth from breakage’ and so on. The usual conversation with the patient, ‘but the problem with the crown, it involves cutting away a lot of the healthy tooth is remaining. So an Onlay does the same job as a crown, only more conservatively’. We know again, from the literature that some of the survival rates that crowns versus onlays over a 15 year period… it’s pretty much the same within a couple of percentage points. So I think it’s a reasonable thing to say to the patients that are normally is ‘kind of like an extended filling – it extends over the biting parts of the tooth’ (and hopefully you’re pointing this out on the screen while you’re telling them). ‘It covers over those things, it stops them from breaking it binds what’s left of the tooth together, does the same job as crowns only more conservatively.
The other thing… I have a huge collection of pictures of composite onlays that have failed, broken, debonded etc and they’re all done by me…when I switched to ceramic, those problems went away.