Seating small all porcelain restorations, inlays and onlays, can be very challenging. I find they are difficult to hold and maneuver in and out of the mouth, even if I use the placement tools. In my hands this challenge gets larger exponentially during the cementation process due to the presence of the resin cement. Now the restoration are not just small and delicate, they are slippery.
I have been known, more than once I have to admit, of loosing my grip on an inlay or onlay and having to retrieve it from the floor, or worse the patient’s mouth!! These embarrassing educational moments have influenced my technique. One of the worst consequences would be for the patient to swallow the restoration before we have a chance to seat it. Thankfully this has never happened to me, but I have lived through a few close calls. Isolation is the key to preventing this. I won’t be choosy on what type you use, but block the back of the mouth so that small porcelain items can not disappear, and can easily be retrieved. A simple trick of unfolding a 2 x 2 and draping it int he back of the mouth as a barrier will save you lots of heartache.
Utilizing a tool to carry these restorations back and forth has been a lifesaver for me. Optrastick by Ivoclar is a device designed specifically for this purpose. The sticky end is placed against the restoration, and now you have a handle that can be easily removed when you need to. I also learned how to make my own handle from another dentist recently. He simply takes a microbrush, places the fuzzy end on the occlusal table of the restoration after dipping it in a little dentin adhesive and then cures it. Of course you can only do this on the glazed surfaces of the porcelain and have to be very careful to not have the dentin adhesive run over to the intaglio surface.
The last component of my system is managing the resin cement. The classic approach is to place the cement against the intaglio surface of the restoration, carry it to the mouth loaded with cement and then seat. I still follow this protocol with full coverage, but I do not with inlays and onlays. For these small partial coverage restorations, I place the resin cement directly against the prepared tooth. Then using a microbrush I paint the resin cement, making sure to adequately cover all the prepared surfaces. Lastly I carry the restoration to the mouth and seat to place. This step has not only reduced my stress, but made these appointments much more enjoyable as I dreaded trying to manipulate the restoration once it was slippery.