Influence of Proximal-Cervical Undermined Enamel Areas on Marginal Quality and Enamel Integrity of Laboratory and CAD/CAM Ceramic Inlays and Partial Crowns

(1) The aim of this in vitro study was to investigate the handling of proximal-cervical undermined enamel margins on the adhesive performance of differently fabricated and differently cemented ceramic inlays and partial crowns (2) Methods: 192 extracted third molars received MOD (<i>n</i> = 96) and partial crown (<i>n</i> = 96) preparations. A mesial 2 × 2 × 4 mm cervical groove was created in dentin to simulate a deeper (dentin) caries excavation. This dentin groove was either left (G/groove), filled with composite (F/filling), or completely removed (D/dentin). Distal proximal boxes did not receive a groove and served as controls within the same tooth. Labside (e.max Press) restorations additionally went through a temporary phase. Labside and chairside (e.max CAD) inlays and partial crowns were then adhesively luted with Syntac/Variolink Esthetic (SV) or Adhese Universal/Variolink Esthetic (AV). Initially, and again after thermomechanical loading (TML: 1 million cycles at 50 N, 25,000 thermocycles at 5 °C/55 °C), specimens were molded and the resulting 24 groups of epoxy replicas (<i>n</i> = 8) were gold-sputtered and examined for marginal gaps using scanning electron microscopy (200× magnification). Light microscopy (10× magnification) was used to measure proximal cervical crack propagation in adjacent enamel. (3) Results: Regardless of the adhesive system, D groups generally showed significantly lower marginal quality (79-88%; <i>p</i> < 0.05), with the universal adhesive performing better than the multi-step adhesive system (<i>p</i> < 0.05). Subgroups G and F were similar in marginal quality (94-98%; <i>p</i> > 0.05) and not worse than the controls (<i>p</i> > 0.05) regardless of the adhesive system, but showed less cracking in F than in G (<i>p</i> < 0.05). In general, fewer cracks were observed in chairside CAD/CAM restorations than in laboratory-fabricated restorations (<i>p</i> < 0.05). Partial crowns showed better marginal quality (96-98%) and less cracking than inlays (<i>p</i> < 0.05). (4) Conclusions: If the dentin level is lower than the enamel level in ceramic preparations after caries excavation in the proximal box, the resulting undermined enamel should not be removed. In terms of enamel integrity, partial crowns outperformed inlays.