I see this type of thing a lot, and when I do, I go for the ceramic onlay. I knw some people would say “not on a 2nd molar”, but most ceramic failures are due to a bonding problem. You obviously can acheive a dry field, since the remaining tooth is supragingival and you have a rubber dam in place. I have tons of these out there in Empress 1 up to 11 years old, but I have recently switched to Authentic pressed porcelain due to some positive feedback on the material from my lab. They say it’s stonger than empress. Back to the prep, I would take down the buccal cusp also, make sure that bothe M and D contacts are broken, and bond te ceramic to the acre of dentin and enamel that you have left. I would temporize with some fermit or triad molded and locked between the adjacent teeth, tell the patient that he or she is off the hook for flossing for the next couple of weeks, and then bond that baby in at the delivery appointment. It works great, and the tissue stays much healthier around the ceramic due to the undetectable supragingival margins.

Hey Glenn – – That was a nice recovery from a not so pretty clinical situation. In all of the porcelain onlays that i have done, i have seen them debond from time to time. My thoughts are that there was decay left there from the previous prep, which, of course, would compromise the bond. There are many factors I am sure that you know that will cause bond failures, namely improper porcelain etch, silanation, bonding technique, contaminated tooth surface, improper isolation, occlusion, prep design… the list goes on. A failure that I see more often is the failure of large core buildups bonded entirely to dentin. Although I think that the pins will help hold the core in place, you are still left with the situation where you have to now put your crown margin another 2 mm beyond the buildup ideally to be on sound tooth structure, which most likely paces your margin on cementum and quite subgingival. I guess the laser will help with getting your impression, but the sulcus will never be as healthy long term as it would be if you went with the onlay to start. I am not going to say that I haven’t redone work that failed, but I am comfortable with the success that I see with bonded full coverage porcelain onlays.
Did Dr. Tay say anything about the self etching bonding agents such as simplicity or I-bond?

Hi Glenn,

I don’t talk much about my bonding experiences since there are so many Gurus out there that speak reasonably well on the subject.

I started bonding DICOR to the dentin and enamel in 1985 using total etch.  Learned from Ray Bertolotti.  

I stopped using pins at that time too.

I learned on my own and with Ray’s help (John Kanca wasn’t anywhere around then) how to get those suckers to stick and stay without decay.  Now I bond Empress to anything that ins’t deep sub-gingival, even second molars.  “Deep anatomy” and occlusion are key.  

If not a bonded Empress, then a PFM or FGC with a long bevel and no BU at all.

I have never been impressed with SE and don’t use it without a TE or laser etch technique thrown in.

Bob