Indirect restoration in composite resin: a clinical report of self-adhesive cementation in deproteinized dentin

Direct restorations in composite resin represent the most common method of dental rehabilitation. However, the posterior region has some complications and limitations to perform this technique: polymerization contraction, postoperative sensitivity, adhesive failures, wear.1 These drawbacks become more critical when rehabilitation occurs in heavily destroyed teeth, situations in which the indirect technique is the most indicated.2 The cases with great structural impairment, which previously were only solved with invasive prosthetic treatments and of high cost, today can be solved perfectly with minimally invasive techniques. In this sense, the latest generation composite resins can be used indirectly, thus facilitating access to people who cannot afford the laboratorial costs.3 In general, indirect resinous restorations have a number of advantages, such as: greater longevity when compared to direct restorations; possibilities for repair; adjustment and intra-buccal polishing.4 These indirect composite restorations are a great alternative for large restorations of posterior teeth. The scientific literature has evidenced numerous reports of clinical success cases when using this technique.5−9 Another aspect to be considered corresponds to the annulment of the nutritive pulp support after the endodontic treatment, a common situation in the teeth with indication for indirect restorations. This condition may result in a weakened dentin protein framework in which the performance of conventional adhesive techniques could culminate in early bond failure due to the susceptibility of this collagen fiber network. To overcome this limitation, some studies have pointed to dentin deproteinization as one of the possible strategies for the optimization of adhesion, especially when the self-adhesive cements are used, which do not require previous dental pre-treatment, simplifying the cementation steps.10−12 With the development of resin-based cements, the limited mechanical properties and relatively high solubility in the oral environment presented by traditional cements, such as polycarboxylate, zinc phosphate and zinc oxide eugenol, are being softened.13 Clinical reports involving the dissolution of dentinal collagen fibers in association with adhesive cementation, which demonstrates the importance of a detailed description of the clinical stages, aiming at greater dissemination to the scientific community. The aim of this study was to describe, through a case report, the steps for the preparation of an indirect restoration in composite resin, performed on an endodontically treated tooth, using contemporary union techniques (deproteinization+self-adhesive cementation).