Scientific Online Resource System

Scripta Scientifica Medicinae Dentalis

Marginal adaptation of ceramic inlays—an in vitro study

Sabina Keremedchieva, Stefan Peev, Ivaylo Parushev


Introduction: Class II approximal defects are very common in the clinical practice, in many cases extending subgingivally and beyond the cementoenamel junction (CEJ). For large defects in the posterior region, indirect ceramic restorations provide a better solution than direct composite restorations.

Aim: The aim of this experimental in vitro study is to compare the marginal adaptation of hybrid ceramic and lithium disilicate inlays, fabricated using classic and hybrid technique and cemented with two different types of dental cements.

Materials and Methods: Forty extracted human molars and premolars were randomly divided into 8 groups and class II cavities (medio-oclusal or disto-oclusal) with the same dimensions were prepared. Hybrid ceramic and lithium disilicate inlays were fabricated according to the manufacturer’s instructions. The marginal gap after cementation was measured using a microscope at 40x magnification.  

Results: The lowest cement thickness was registered for Group 4—lithium disilicate inlays, classic technique, cemented with composite cement, closely followed by Group 3—hybrid ceramic inlays, classic technique, cemented with composite cement. The highest mean cement thickness values were registered for Group 1—hybrid ceramic inlays, classic technique, cemented with glass ionomer cement, followed by Group 5—hybrid ceramic inlays, hybrid technique, cemented with glass ionomer cement.

Conclusion: Under the limitations of this experimental in vitro study, we can conclude the following: lithium disilicate and hybrid ceramic inlays cemented with composite cement have better marginal adaptation than the ones cemented with glass ionomer cement. Lithium disilicate restorations and inlays without cervical margin relocation (classic technique) have a slightly better marginal fit than hybrid ceramic inlays and restorations with hybrid technique. For a more detailed insight, microleakage evaluation should also be carried out.


hybrid ceramic; lithium disilicate; ceramic inlays; marginal fit; marginal adaptation

Full Text


Ritter AV, Baratieri LN. Ceramic restorations for posterior teeth: guidelines for the clinician. J Esthet Dent. 1999;11:72–86.

Bueno AL, Arrais CA, Jorge AC, Reis AF, Amaral CM. Light-activation through indirect ceramic restorations: does the overexposure compensate for the attenuation in light intensity during resin cement polymerization? J Appl Oral Sci. 2011;19(1):22-7. doi: 10.1590/s1678-77572011000100006.

Bustamante-Hernández N, Montiel-Company JM, Bellot-Arcís C, Mañes-Ferrer JF, Solá-Ruíz MF, Agustín-Panadero R, et al. Clinical Behavior of Ceramic, Hybrid and Composite Onlays. A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(20):7582. doi: 10.3390/ijerph17207582.

Warreth A, Elkareimi Y. All-ceramic restorations: A review of the literature. Saudi Dent J. 2020;32(8):365-72. doi: 10.1016/j.sdentj.2020.05.004.

Nirmala S, G SG, Kumar K N, Chukka RR, Reddy N. Ceramic Onlay: A Case Report. Cureus. 2022;14(12):e32641. doi: 10.7759/cureus.32641.

Zarone F, Di Mauro MI, Ausiello P, Ruggiero G, Sorrentino R. Current status on lithium disilicate and zirconia: a narrative review. BMC Oral Health. 2019;19(1):134. doi: 10.1186/s12903-019-0838-x.

Jurado CA, Amarillas-Gastelum C, Afrashtehfar KI, Argueta-Figueroa L, Fischer NG, Alshabib A. Ceramic and composite polishing systems for milled lithium disilicate restorative materials: a 2D and 3D comparative in vitro study. Materials (Basel). 2022;15(15):5402. doi: 10.3390/ma15155402.

Jorquera G, Mahn E, Sanchez JP, Berrera S, Prado MJ, Bernasconi V. Hybrid ceramics in dentistry: a literature review. J Clin Res Dent 2018;1(2):1-5.

Goujat A, Abouelleil H, Colon P, Jeannin C, Pradelle N, Seux D, Grosgogeat B. Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic review of in vitro studies. J Prosthet Dent. 2019;121(4):590-7.e3. doi: 10.1016/j.prosdent.2018.06.006.

Bresser RA, van de Geer L, Gerdolle D, Schepke U, Cune MS, Gresnigt MMM. Influence of deep margin elevation and preparation design on the fracture strength of indirectly restored molars. J Mech Behav Biomed Mater. 2020;110:103950. doi: 10.1016/j.jmbbm.2020.103950.

Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: A literature review. J Prosthodont Res. 2018;62(3):273-80. doi: 10.1016/j.jpor.2017.09.005.

Aldakheel M, Aldosary K, Alnafissah S, Alaamer R, Alqahtani A, Almuhtab N. Deep margin elevation: current concepts and clinical considerations: a review. Medicina (Kaunas). 2022;58(10):1482. doi: 10.3390/medicina58101482.

Rocca GT, Rizcalla N, Krejci I, Dietschi D. Evidence-based concepts and procedures for bonded inlays and onlays. Part II. Guidelines for cavity preparation and restoration fabrication. Int J Esthet Dent. 2015;10(3):392–413.

Dietschi D, Spreafico R. Evidence-based concepts and procedures for bonded inlays and onlays. Part I. Historical perspectives and clinical rationale for a biosubstitutive approach. Int J Esthet Dent. 2015;10(2):210–27.

Kielbassa AM, Philipp F. Restoring proximal cavities of molars using the proximal box elevation technique: systematic review and report of a case. Quintessence Int. 2015;46(9):751–64. doi: 10.3290/j.qi.a34459.

Magne P, Spreafico R. Deep margin elevation: a paradigm shift. Am J Esthet Dent. 2012;2(2):86–96.

Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esthet Dent. 2010;5(1):50–76.

Najet AM, Sawsan K, Saida Z, Kamel BS. In vitro comparison of Biodentine and Riva LC interfaces with cervical dentin and Filtek Z350 in posterior class II open sandwich restorations. SRM J Res Dent Sci. 2021;11:178-84.

Roulet JF. Marginal integrity: clinical significance. J Dent. 1994;22 Suppl 1:S9-12. doi: 10.1016/0300-5712(94)90164-3.

Holmes JR, Bayne SC, Holland GA, Sulik WD. Considerations in measurement of marginal fit. J Prosthet Dent. 1989;62(4):405-8. doi: 10.1016/0022-3913(89)90170-4.

Soares CJ, Faria-E-Silva AL, Rodrigues MP, Vilela ABF, Pfeifer CS, Tantbirojn D, et al. Polymerization shrinkage stress of composite resins and resin cements - What do we need to know? Braz Oral Res. 2017;31(suppl 1):e62. doi: 10.1590/1807-3107BOR-2017.vol31.0062.

Zarrati S, Mahboub F. Marginal adaptation of indirect composite, glass-ceramic inlays and direct composite: an in vitro evaluation. J Dent (Tehran). 2010;7(2):77-83.

Dietschi D, Scampa U, Campanile G, Holz J. Marginal adaptation and seal of direct and indirect class II composite resin restorations: an in vitro evaluation. Quintessence Int. 1995;26(2):127–38.



About The Authors

Sabina Keremedchieva
Medical University of Varna,

Department of Periodontology and Dental Implantology, Faculty of Dental Medicine

Stefan Peev
Medical University of Varna

Department of Periodontology and Dental Implantology, Faculty of Dental Medicine

Ivaylo Parushev
Medical University of Varna

Department of Clinical Medical Sciences, Faculty of Dental Medicine

Font Size