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Operative 2 > Inlay, Onlay, Veneer > Flashcards

Inlay, Onlay, Veneer Flashcards

1
Q

Indirect restorations
(3)

A
  • Restoration is fabricated outside of the mouth * indirectly
  • Dental impression is taken of the prepared tooth,
    then sent to lab or milled in-office
  • Includes inlays and onlays, crowns, bridges,
    and veneers
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2
Q

When margin exceeds 2/3 of the distance between central groove and cusp tip

A

MUST CAP WEAK CUSPS

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3
Q

When margins end ½ distance between central groove and cusp tip

A

CONSIDER CAPPING WEAK CUSPS

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4
Q

INLAY
(2)

A
  • indirect restoration that is placed within the cusp tips of a
    tooth
  • offers no protection of the cusp from occlusal forces
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5
Q

Inlays are used for
(2)

A

*Teeth with minimal caries and strong buccal and lingual cusps
*Acceptable (normal) occlusion

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6
Q

ONLAY
(3)

A
  • indirect restoration that covers one or more cusps, extending
    through and beyond the cusp tip to the facial/lingual and proximal
    slopes of the covered cusps
  • incorporates the principles and advantages of both intracoronal
    and extracoronal indirect restorations
  • occlusion in all functional positions is supported by restorative
    material rather than tooth structure
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7
Q

Indications for Onlays
(3)

A

*Large carious lesions or existing defective
restorations
*Cracked Teeth
*Endodontically treated teeth

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8
Q

When should we use an Onlay instead of an Inlay?
(4)

A

*When the bucco-lingual width of the cavity preparation is
* 1/2 way between central groove and cusp tip - consider
onlaying the cusp
* 2/3 way between central groove and cusp tip - should
onlay the cusp
*Where the cusps are undermined after caries removal
*Where the occlusion of the tooth must be altered

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9
Q

Crown

A
  • indirect restoration that fully covers the occlusal
    surface of a tooth and uses the external walls for
    retention
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10
Q

Why Do we do Inlays and Onlays ?
(5)

A

*Preference over amalgam
*Conserve tooth structure
- Compared to full coverage crown
*Esthetics
*Removable Prosthodontic abutment
- Can better control rest seats and guide planes

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11
Q

Disadvantages of Indirect
Restorations
(3)

A

*Expense
*Requires 2 appointments if sent to a lab
*Impression needed
- either digital or with impression material

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12
Q

Advantages of Indirect
Restorations
(3)

A

*Strength of materials
*Conservation tooth structure
*Better control of restoration’s contours

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13
Q

Principles to follow
(2)

A
  • No undercuts; passive fit
  • No sharp line angles
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14
Q

Advantages of indirect gold

A

*Strength
* will not fracture
*Wear resistance
* will support contact and occlusion
*Will maintain smooth surface (no tarnish or corrosion)
Better control of contact and contour Especially for large proximal caries where an amalgam would not restore contact and contours
*Potential for greater longevity
*Conserves cementum and periodontal attachment versus restoring with a crown

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15
Q

Contraindications

A

*Facial or lingual caries or previous restorations
*Crown is better to restore multiple surfaces
*Need to compare the margin length with that of a crown in
some instances
*Patients with a high caries rate

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16
Q

MO Gold Inlay

A

Divergence Short walls should have a 2° divergence
* Long walls can have a 5-7° divergence
Bevel occlusal
* axial pulpal line angle
* gingival wall
*No sharp line angles

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17
Q

Prep criteria -
Occlusal Internal Form – — mm deep

A

2.0

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18
Q

Inlay Preparation

A

*Dovetail
* Prevents distal displacement
*NO reverse S
* Prep is more straight and angled
* Gold has strength at edge (amalgam does not)

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19
Q

Inlay Preparation
* Adequate proximal clearance
* — mm
* Smooth proximal walls
* Bevels:
* — mm at occlusal
* — mm at gingival
* — line angles

A

0.5mm
1.0mm
1.0mm
Axiopulpal

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20
Q

Bur Dimensions
(4)

A

*Know your bur dimensions
*Both lengths and widths
*Measure with a periodontal probe
*Use the bur as a guide when
preparing the tooth

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21
Q

Clinical procedure
*Occlusal depth is — mm
*Isthmus must be at least — mm wide
* decreases chance of fracture of restorative material
*No undercuts
*Pulpal walls = smooth & flat
*Facial, lingual and gingival margins should clear contacts by at least — mm

A

1.5 - 2.0
2.0
0.5

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22
Q

Clinical procedure*Facial and lingual walls must DIVERGE
*Need passive insertion and — than a 2-5 degree taper
* restoration — to preparation walls

A

greater
BONDS

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23
Q

Clearance-

A

the amount of
space between the teeth

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24
Q

Reduction-

A

the amount of
tooth structure removed

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25
Q

Depth cuts
— mm on lingual – functional cusp
— mm on facial

A

1.5
1.0

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26
Q

Principles for Gold Onlays
*Cover both facial and lingual cusps of
maxillary and mandibular teeth
* Minimum of — mm of gold to cover cusps supporting
occlusion; — mm for cusps not supporting occlusion
* Reverse bevel of — mm on cusps supporting occlusion; — mm on cusps not supporting occlusion

A

1.5
1.0
1-2
1/2

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27
Q

Exception for cuspal coverage –
maxillary tooth
*Exception for esthetics on maxillary teeth
(2)

A
  • Do not cover the facial cusp of maxillary molar or premolar if supported
    by strong tooth structure
  • Modified “esthetic” coverage of facial cusp if weak
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28
Q

Indications

A

*Esthetics - areas of esthetic importance for the patient
*Large defects or previous restorations
*Wide labiolingual missing tooth structure
*Teeth that require cuspal coverage
*Contours of large restorations are more easily developed in the
lab
*Indirect materials are more durable than direct for replacing
occlusion and contacts

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29
Q

Contraindications

A
  • Ceramics can fracture if they don’t have sufficient bulk or
    are under excessive stress
  • e.g. - in bruxers and clenchers
  • Inability to maintain a dry field
  • Deep subgingival preparations - difficult to get an
    impression, difficult to finish, difficult to get good bonding
30
Q

Advantages

A

*Improved physical properties
*Wear resistance
* porcelain wears opposing teeth the most and has the most resistance to wear
* porcelain> lab processed composite > direct resin composites in order of causes most wear and wears the least to causes least wear and wears the most
*Reduced polymerization shrinkage
* all shrinkage occurs in the laboratory, the only material that can shrink is the resin
composite cement which is used during cementation

31
Q

Disadvantages

A

Increased cost and time Require two patient appointments and a lab bill
*Technique sensitivity - devotion to detail a must
*Ceramics (Porcelains) are brittle
*Ceramics wear opposing dentition and restorations
*Low potential for repair
*Difficult try in and delivery

32
Q

Clinical procedure

A

*Remove old restorations
*Excavate all caries
*Undercuts are blocked out with a glass ionomer liner /base or resin composite
* Want rounded internal line angles – use round end bur e.g.. 245
* All line and point angles, internal and external should be rounded to avoid stress concentrators

33
Q

Porcelain onlays
*— reduction over functional cusps
*— reduction over non functional cusps
*Bulk of Porcelain at margins – NO BEVEL
*Smooth internal line angles
*No ferrule margins
*Ceramic retention based on SURFACE AREA
*Not opposing walls

A

2.0mm
1.5mm

34
Q

Clinical procedure
*Need adequate thickness for strength of restorative materials
*Need well defined margins
*All margins should have a — degree butt joint cavosurface angle
* to ensure marginal strength of the restoration
*No external bevels

A

90

35
Q

Provisional Considerations
*Use —free cement
*Eugenol interferes with bonding
*Or, if you must use cement containing eugenol,
important to pumice tooth well to remove eugenol

A

eugenol

36
Q

Try-in and cementation
*Occlusal evaluation and adjustments are delayed until

A

after
cementation because of the fragility of porcelain restorations
*Marginal gaps are larger than gold inlays and onlay margins

37
Q

Silanation

A

*This step often completed by the lab
* You need to make sure, if not, do it yourself chairside
*Porcelain is acid etched with hydrofluoric acid and then silanated before
cementation with a resin cement

38
Q

Instrumentation for Finishing and Polishing
Ceramics

A

*Medium to fine grit diamond instrument
*30-fluted carbide burs
*Rubber, abrasive impregnated porcelain polishing points
*Diamond polishing paste
* Do not want any scratches or rough spots on the porcelain or it will wear enamel
severely

39
Q

3M Lava Ultimate
(4)

A
  • 3M calls it a Resin Nano Ceramic
  • Made primarily of Silinated Silica and
    Zirconia nanomers
  • Highly Polishable
  • Easy to use clinically
40
Q

Vita Enamic
(3)

A
  • Porous Sintered Ceramic structure
    infused with a polymer
  • Highly Polishable
  • Easy to use clinically
41
Q

Vita Porcelain
(3)

A
  • Highly esthetic
  • Mostly used in Anterior applications now
  • Flexural Strength 154 MPa +/- 15 MPa
42
Q

Ivoclar Empress
(4)

A

*Leucite helps strengthen ceramic and can
act as a crack deflector
*Highly Esthetic
*Flexural Strength 160 MPa
*Leucite glass ceramic

43
Q

Ivoclar e.max
(5)

A

*Lithium Disilicate Ceramic
*Starts in an intermediate phase and must
be crystalized
*Flexural Strength 360 MPa
*Shortened firing cycle may cause loss of
strength and color shift
*Multiple applications

44
Q

Veneer definition-

A

a thin covering
* Often to hide the under layer

45
Q

Veneers
*Types
(2)

A
  • Indirect
  • Most commonly Feldspathic Porcelain or Lithium Disilicate
  • Direct
  • Composite
46
Q

Indications for Veneers

A
  • Intrinsic Discoloration
  • Tetracycline staining
  • Fluorosis
  • Extrinsic Staining
  • Coffee
  • Smoking
  • Wine
  • Wear Patterns
  • Poor Restorations
  • Diastema Closure
  • Rotated and Misaligned Teeth
47
Q

Contraindications

A

*Severely Malpositioned teeth
* Ortho may be indicated
*Denuded Dentin
*Unavailable Enamel
*Poor Oral Hygiene
Beware of highly fluoridated teeth Issues with bonding
*No primary teeth!
*Adolescents
*Pregnancy
*Oral Habits
* Bruxism
Picture From DVM360.com

48
Q

Porcelain Veneers
Indications

A

*Good Oral Hygiene
*Good Periodontal Health
*Poor Esthetics - Something that is going to be improved
*Proper Patient Psychology
*Caries Free
*Met Dental Needs
*INFORMED CONSENT / REASONABLE EXPECTATIONS

49
Q

Advantages of Porcelain Veneers

A

Esthetics – excellent
Color – porcelain is best tooth substitute
Bond strength – high to enamel
Periodontal health – not detrimental to it
Low wear and abrasion of porcelain restorations

50
Q

Disadvantages of Porcelain Veneers

A

Time- Multiple appointment
Cost compared to composite veneers – ($100-150/unit)
Some tooth preparation. Must have adequate room.
Requires laboratory involvement and fee

51
Q

Alternate Treatment

A

*Bleaching for discoloration
*Microabrasion and macroabrasion
*Direct composite veneers
* Microfill composite resin polishes best
*PFM/Porcelain jacket crown
*ORTHODONTICS

52
Q

Advantages of Composite (Direct) Veneers

A
  • Mask discolorations on a tooth
  • Less cost to patient
  • Usually one appointment
  • Can correct simple tooth rotation and diastema easily
53
Q

Disadvantages of Composite (Direct) Veneers

A

*Susceptible to Wear
*Margin Fracture and Stain
*Discoloration

54
Q

Composite Veneer Procedure
Window Preparation

A
  • Most often recommended
  • Remove only enough tooth structure to achieve optimal
    contours with final restoration
  • Incisal edge remains intact
  • Intra-enamel preparation* necessary to provide space for materials to achieve maximum esthetics
  • removes outer, fluoride-rich layer of enamel (resistant to etching)
  • roughens surface for improved bonding
  • establishes definite finish line
55
Q

Composite Veneer Procedure
Incisal Lapping Preparation

A
  • Preparation includes incisal edge
  • Indicated when tooth needs to be lengthened or an incisal defect
    is present and needs to be corrected
56
Q

Some clinicians do minimal tooth preparation
which may result in — (bulky) veneers

A

overcontoured

57
Q

Microabrasion
(2)

A
  • Involves use of acidic and abrasive agents applied to enamel surface
  • 37% phosphoric acid and pumice or 6% hydrochloric acid and silica
58
Q

Macroabrasion
(3)

A
  • Removal of enamel defect with bur
  • 12 fluted carbide or diamond finishing bur, followed by 30 fluted carbide finishing bur
  • Polished with rubber point
59
Q

Porcelain Veneer Procedure
DIAGNOSTIC WAX UP !!!!
Very important to see

A

what can be
done for both you and the patient

60
Q

Porcelain Veneer Procedure
PREP GUIDE

A

Made from wax up, tells you how much
reduction is needed to get ideal from
wax up

61
Q

Porcelain Veneer Procedure
Minimal Prep needed for veneers
Try to keep prep in — for optimal bond strength

A

enamel

62
Q

Tooth Preparation
*MINIMAL PREP VENEERS

A
  • When minimal shade or shape change is desired
  • 0.3mm chamfer at margin or slightly subgingival
  • Thickness is 0.5-0.7mm on labial surface
  • 1.5mm at incisal reduction
  • 1-2mm reduction acceptable
  • 90 degree butt joint is best
  • Materials
  • e.max (pressed monolithic ceramic)
  • Empress (pressed ceramic)
  • Feldspathic porcelain (etched porcelain)
63
Q

Tooth Preparation
*MODERATE PREP VENEERS

A
  • Moderate alignment corrections, up to 3 step change in chroma or value, diastema correction <1mm
  • 0.3mm chamfer at margin or slightly subgingival
  • Thickness is 0.8-1.0mm on labial surface
  • 1.5mm at incisal reduction
  • 1-2mm reduction acceptable
  • 90 degree butt joint is best
  • Materials
  • e.max (pressed layered ceramic)
  • Empress (pressed ceramic)
  • Feldspathic layered porcelain (etched porcelain)
64
Q

Tooth Preparation
(4)

A

– Gingival
* Terminates at the gingival crest or 0.3-0.5 sub-gingivally for esthetics
* When severely discolored enamel is present, a reduction greater than 0.5 mm may be required
* When the tooth is in lingual version, little or no reduction is necessary
* Your diagnostic wax up will guide you in the amount of reduction needed by the way of the prep guide.

65
Q

Tooth Preparation
Contour the — amount necessary
according to the material that you are using to
restore the teeth

A

minimum

66
Q

Summary of Incisal Margins
*Minimum — mm reduction for material bulk
*or — reduction of incisal if lengthening incisal edge
*Rounded at all line angles
*Butt shoulder on incisal
*No undercut between lingual and gingival

A

1.0 -2.0
NO

67
Q

Tooth Preparation
Why no lingual margin?
(4)

A

Seating issuesLingual margin failure from inadequate porcelain thicknessPorcelain needs bulk when loadedIncisal butt margin preferred

68
Q

Tooth Preparation
(2)

A

*Margins should be well-defined
*Provide a definite finish line for
technician

69
Q

Porcelain Veneer Procedure
* — with a temporary material
* such as Dentsply Integrity
* Use — as matrix to fabricate provisionals

A

Provisionalize
wax up

70
Q

Veneer Insertion

A

Remove provisional and clean prep with
nonfluoridated pumice
Clean interproximal lightly with finishing strip
*Isolate with rubber dam and sometimes
retraction cord
*Etch teeth with 37% Phosphoric Acid
* if in enamel for 30 seconds
* if in dentin for 15 seconds
*Place bonding agent
* Use bonding agent recommended for your
composite cement
*Tack cure in order to clean cement from margin
Remove excess cement very carefully much more difficult to remove excess cement
*Following removal of excess cement, LIGHT CURE full amount
of time
* From buccal and lingual

71
Q

Veneer Insertion
Polish and Check Occlusion
(3)

A

*Adjust occlusion after veneers have been
bonded
* fracture more likely otherwise
* use diamond bur and water spray

72
Q

CAUTION
DO NOT — veneers when polishing
Excess heat may cause degradation of cement bond

A

OVERHEAT

Operative 2 (12 decks)

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