8184  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.

Dentine Replacement with Biodentine Under Class II

Composite Inlay: A Case Report

Lora Mishra1, Pratayee Basu2, Sumit Dash1, Naomi Ranjan Singh3, Rini Behera3

Professor1, Post Graduate Trainee2, Senior Lecturer3, Department of Conservative Dentistry & Endodontics,
Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Abstract
Biodentin is a bioactive cement with dentin-like mechanical properties, which can be used as a dentine
substitute for both crown and root. It also helps in the remineralization of dentine along with maintenance
of pulp vitality. This advocated to be used in various clinical applications, such as root perforations,
apexification, resorptions, retrograde fillings, pulp capping procedures, and dentine replacement. Indirect
laboratory-processed composite systems present an esthetic alternative for intracoronal posterior restorations
and provide esthetic results that may also reinforce tooth structure. Additional clinical benefits include exact
marginal integrity, wear resistance similar to enamel, wear compatibility with opposing natural dentition,
optimal esthetics, ideal proximal contacts, and excellent anatomic morphology.

Keywords:  Calcium Silicate Cement, Caries,, Composite Inlays, Remaining Dentinal Thickness.

Introduction direct composite restoration since the contraction of the

inlay takes place outside the oral cavity.5 Biodentine is
The caries attack proportion is the highest maxillary
a new generation silicate cement which is bioactive like
and mandibular permanent first molars, followed by
mineral trioxide but has superior handling properties and
second molars. The interproximal surface of molar are
strength. It is an adequate dentine replacement and pulp
highly susceptible to dental caries and often get unnoticed
protecting material.6 This paper presents the clinical
in the usual dental inspection.1 One suspects Class II
cases in which Biodentine was placed to replace the
caries (Fig 1) only when the patient complains of food
lost dentine during caries and cavity prep, followed by
lodgement, sensitivity or noticeable frank cavitation seen
indirect composite inlays
in the marginal ridge area.2 There is various material
available for the restoration of such defects. The most Case Report: A 37-year-old male patient was
popular direct restorative material preferred for Class referred to the Postgraduate Clinic of Conservative
II was Silver Amalgam.2 Due to its metallic colour and Dentistry and Endodontics (Institute of Dental Sciences
mercury hazards associated with it along with phasing and Hospital, Bhubaneswar). The patient complained of
out of this material worldwide, there is a sudden surge in dislodged restoration and gave a history of restoration
the use of other restorative materials.3 done four years back. Patient’s had a non-contributory
medical history. Intra-oral examination revealed mesio
Aesthetic restorations for posterior teeth are in
occlusal caries concerning 46. Clinical inspection and
current demand by patients worldwide. Composite
radiographic evaluation revealed secondary caries
restoration is among one of the choices preferred by most
approximating pulp. The pulp sensibility for 46 revealeda
of the dentist.4 Nevertheless, one of the drawbacks of
positive response to it.
composite restoration is that it undergoes polymerization
shrinkage, which leads to microleakage and in short span The patient had uncontrolled ropy saliva, and even
leas to deterioration of the restoration. Indirect composite after the placement of high evacuation suction and
inlay was introduced to overcome these pitfalls of direct isolation device, it was challenging to do the direct
restorations. The composite inlay has an advantage over restoration. Therefore we settled to restore the tooth with
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8185
indirect composite inlay. Subsequently,the patient’s
consent was taken to restore the tooth with indirect
composite resin inlay.

The secondary caries was excavated at a slow

speed using round carbide bur and spoon excavator.
The weakened and unsupported enamel was removed.
Ensuring the principles of tooth preparation to receive
inlay, the cavity preparation was done. The cavity walls
had divergent walls, rounded internal line angles and
cavosurface configuration with butt joint. The walls of
the cavity smoothened using finishingbur (Fig 2). As
the axial wall was approximating the pulp chamber, a
protective dentine replacement was done with Biodentin.
After the final tooth preparation, the cavity was cleaned
and dried. With the polyvinylsiloxane material (Aquasil/
Dentsply)impression was made using both heavy body
putty and light body together.. Subsequently, a direct
provisional restoration was placed using temporary
light-cured resin-based cement (Cool Temp, Coltene). Figure 1. Class II caries
The positive replica of this impression taken was made
using die stone. An appropriate shade of the restoration
was selected using the Vitapan shade guide, and the
casts and with selected shade image was delivered to the
laboratory(Dent Care) for the fabrication of the inlay.

After 1-week patient visited again for a second

appointment. The provisional restoration was taken out,
and the cavity was disinfected with 2% chlorhexidine
The cavity was selectively etched with 37% phosphoric
acid, the adhesive (Universal Bond, 3M ESPE)was
applied and light-cured (Bluephase, Ivoclar) on the
tooth, and the same adhesive was applied on the silanated
(Monobond S Ivoclar) internal aspect of composite inlay
without being polymerized. Then the cementation was
carried out by applying a thin layer of dual-cure Resin Figure 2. Class II inlay cavity preparation.
Modified Glass Ionomer Cement (Fuji, GC). The resin
luting cement was light-cured (Blue Phase Ivoclar)
through the restoration from both, palatal and buccal
side of restoration. The excess resin luting cement from
the interproximal area was removed using a dental floss.
The finishing and polishing were done using a composite
finishing kit (Ivoclar). Post final finishing and polishing,
the occlusion was evaluated. (Figure 3) The patient
was informed about the limitation of the technique and
was asked to maintain a regular maintenance visit. A
radiograph was taken after 6 months during follow up
visits to evaluate the restoration (Figure 4).

Figure 3. Cemented Composite Inlay

8186  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
Like all indirect restoration, IRC results in less
chair-time for the patient and minimizes the finishing
and polishing time. Furthermore, it is effortless to
make proximal contacts using indirect restorations. An
essential advantage of using this indirect restoration
method is increased surface hardness, resistance to
compression, reduced risk of fractures and cracks in the
internal structure of the material.6

One of the primary purposes of restoration is to

establish and replicate occlusal anatomy and proximal
contacts of the tooth. Indirect composite restoration
can achieve all that and hence should be considered as
restorative material of choice when the tooth can not be
isolated, inaccessible areas, limited mouth opening and
when the patient cannot sit for a long time during direct
restoration.8

Conflict of Interests: None

Ethical Permission: Approved

Funding: Nil

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