Clinical Cases and Chairside

Time to intervene: preserving a compromised molar with a hybrid-ceramic partial restoration

Case by Jotautas Kaktys, DDS

When molar teeth are structurally compromised, showing cracks and leaking restorations, symptoms often appear only after substantial progression of decay. This severe damage frequently results in extensive removal of tooth structure. Continuous monitoring and timely intervention are therefore essential, enabling minimally invasive treatment that improves both prognosis and longevity. In such cases, indirect restorations using hybrid ceramics can offer an optimal balance between preservation and durability.

CASE EXAMPLE

A 38-year-old patient presented for a routine check-up without pain or sensitivity. Examination of the mandibular right first molar (tooth #46, FDI notation) revealed extensive distal deterioration of a large composite restoration, with visible cracks and marginal leakage.

After discussing the findings with the patient, the risk of future complications was clearly outlined. Given the extent of the restoration, an indirect replacement approach was recommended. Although conventional ceramic was considered the premium option, a monolithic milled hybrid ceramic (KATANA™ AVENCIA™ Block 2, Kuraray Noritake Dental Inc.) was ultimately selected as a suitable and cost-effective solution for the indicated partial onlay restoration. The clinical workflow is described below.

Fig. 1. Initial clinical situation.

Fig. 2. The affected tooth captured from different angles to show all compromised areas.

Fig. 3. Tooth after preparation for a hybrid ceramic restoration with intact parts of the previous restorations left in place.

Fig. 4. Pre-preparation scan of the upper and lower right quadrants, which allows us to copy and then improve the existing anatomy. Scanner: iTero Lumina, Align Technology.

Fig. 5. Evaluation of the original occlusal contacts, facilitating restoration design with proper occlusion, which will reduce the manual adjustments necessary at delivery.

Fig. 6. Detailed occlusal analysis.

Fig. 7. Scan taken after tooth preparation.

Fig. 8. Margins are well defined and perfectly visible in the black-and-white view of the software.

Fig. 9. Rubber dam placed and surface sandblasted for adhesive cementation of the produced partial restoration in the shade A3.

Fig. 10. Surfaces are clean and matte, reactivated for bonding.

Fig. 11. Cementation with universal adhesive and heated composite. Clean-up is amazingly easy after cooling down. The adjacent tooth is protected with PTFE tape for simplified interproximal cleaning.

Fig. 12. Excess removed and cusps overlaid, while the buccal restoration is merely resealed.

Fig. 13. Occlusal view of the restoration immediately after final polishing and rubber dam removal. At this moment, the restoration might appear too dark or too transparent due to dehydration of surrounding dental tissues.

Fig. 14. Treatment outcome after eight months. A smooth optical integration is obtained after rehydration of the tooth structure.

Fig. 15. Occlusal view of the restoration eight months after treatment. The restoration is almost indistinguishable from the surrounding tooth structure, with smooth, seamless margins.

CONCLUSION

Timely intervention in asymptomatic but compromised teeth enables minimally invasive treatment and supports long-term tooth preservation. Hybrid ceramic partial restorations represent an effective and pragmatic restorative option in such cases.

Special thanks to dental technician Tautvilas Kaktys (my twin brother) and the dental laboratory RiCreo for their outstanding laboratory support and craftsmanship.