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Intermediate restorative skills (Den 305) > Inlays and onlays > Flashcards

Inlays and onlays Flashcards

1
Q

Inlay definition

A

intracoronal restorations made indirectly to

strengthen and repair decayed or damaged posterior teeth

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2
Q

Onlay definition

A

similar to inlay but extends over weakened cusps to provide extra protection

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3
Q

Indications for onlays and inlays

A 
As an alternative to amalgam
-concerns for amalgam toxicity
-lichen planus
When resin composite is not
indicated
-size of cavity
-previously failed composite restorations
-aesthetic considerations..
When a long-lasting aesthetic result
is aimed
A conservative type of indirect restoration
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4
Q

Indications for inlays

A
  • Low caries rate
  • Small MO or DO cavities in molars and premolars
  • Conservative MOD in molars
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5
Q

Indications for onlays

A

• Teeth with larger restorations, but sound buccal and lingual walls

  • endodontically treated teeth
  • wider MODs
  • MODs in premolars
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6
Q

Contraindications

A

• Patients with poor OH
• Not suitable for patients with excessive
occlusal loading i.e. bruxism

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7
Q

Materials

A

Gold
Ceramic (pts choice)
Resin composite (mainly USA)

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8
Q

Advantages (of gold)

A 
• Conservative
• Marginal integrity
• Good wear characteristics
• Corrosion resistance
• Relative ease of handling
• Excellent physical and mechanical
characteristics
• Excellent survival rates (25 – 40 years)
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9
Q

Considerations for gold inlays and onlays

A

• Cost
• Technique sensitivity – clinical and laboratory
• Poor aesthetics
• Wedge effect of inlay
• Other materials were researched
• Ceramics and resin composites were suggested
as alternatives

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10
Q

Introduction to adhesive technologies

A 
• Introduction of acid etch technique –
Buonocore 1955
• Mile`stone in development of adhesive
dentistry
• Resin composite a viable alternative to
amalgam
• But still a few problems….
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11
Q

Advantages to adhesive technologies

A 
• Extre`mely aesthetic restorations
• Stronger and more stable material (no wear;
discolouration)
• Resin composite used luting is displaced by an
inert body…
• Marginal leakage due to polymerisation
shrinkage is minimal
• Conservative ceramic restorations
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12
Q

Considerations for adhesive technologies

A

• Ceramic is a fragile material – needs to be handled with
care
• Sensitive technique:
-intraoral adjustment is contraindicated until the restoration is bonded
-after bonding adjustments can compromise aesthetics
-when bonded certain stages are required to guarantee the result
• Bonding indirect composite still remains an unsolved
problem
• Wear of the luting agent can lead to marginal gaps and
secondary caries
• Longer treatment: indirect restorations – 2 visits are
required unless chairside CAD/CAM used
• Cost

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13
Q

Ceramic types

A
  • Feldspathic glass ceramic
  • Leucite reinforced ceramic
  • Lithium disilicate ceramic
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14
Q

Indirect resin composite types

A
  • Hybrid composite
  • Ceromers
  • Ceramic optimized resins
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15
Q

General rules for preparation technique

A

• Box shaped cavities
• Divergent walls to allow path of insertion
• No undercuts
• Limit path of insertion
• Resistance to occlusal forces
• Specific guidelines apply for gold or ceramic/
composite inlays and onlays

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16
Q

Gold inlay prep

A
  • 2mm occlusal reduction
  • Proximal box 1mm width
  • Isthmus 1/3 of intercuspal width
17
Q

Gold onlay prep

A
  • Intracoronal preparation same as inlay
  • 1.5 – 2mm cuspal reduction
  • 1mm occlusal shoulder
18
Q

Stress distribution

A

Wedging stresses
produced by inlays by
photoelastic analysis
**

19
Q

Preparation for ceramic inlay

A

• Similar to gold inlay but no bevels
• Box shaped cavity
• Parallel and slightly divergent walls
• Round internal line angles
• 90 degree CSA
• 2mm deep occlusally
• No grooves or slots are needed as the
restoration will be bonded
• Beveled finishing lines can create thin areas of
ceramic which may fracture during cementation
• Remember to check occlusal contacts
• Outline of cavity should avoid occlusal contacts
to avoid unnecessary loading on margins that
could lead to deterioration of cement and
marginal openings

20
Q

Preparation for ceramic onlay

A

• Same as onlay
• One or more cusps also prepared
• Different preparation guidelines for cusp
reduction

21
Q

Points not to forget about prep technique

A

• To check the occlusal contacts
• The outline of the cavity should avoid occlusal
contacts
• That is to avoid unnecessary load to the margins
that could lead to deterioration of cement and
marginal openings
• Undercuts can be blocked with GIC, RMGIC,
resin composite

22
Q

Armamentarium

A 
• Basic dental setup for
restorative procedures
• Burs: medium grit tapered and
straight diamond burs
• Special bur kits exist on the
market that will give box
shaped cavities
• Retraction cord and packer or
gingival retraction paste (e.g.
Expasyl)
• Provisional material e.g.
Systemp, Protemp
23
Q

Temporisation types

A

Direct or indirect

24
Q

Direct temporisation

A 
• Composite based
temporary material e.g.
Systemp
• Use as other temp filling
materials
• Shape with flat plastic
instruments
• No impression required
• No temp cement
25
Q

Indirect temporisation

A 
• Pre-operative impression
required or
• Lab made vacuform shell
• Self curing acrylic
material
• Composite based acrylic
material e.g. Protemp
• TempBond NE to cement
(no eugenol)
26
Q

Cementation

A

• When adhesive cement is used it should be performed under rubber dam
• High viscosity resin composite material can also
be used for cementation
• The thickness of the ceramic should not be
>2mm as adequate curing of the material cannot
be guaranteed
• Colour of inlay can also affect the setting of the
material and may need to increase light curing
for darker shades

27
Q

Gold cementation

A
  • traditional cements: GIC, zinc phosphate

- resin cements: Panavia, Rely X

28
Q

Cementation for aesthetic inlays onlays

A

Resin luting agents preferred over traditional cements
Self cured or dual cured resin composite cement
Compomers contra indicated due to expansion –> fracture of ceramic

29
Q

Glass ceramic

A

• Fitting surface must be treated with HF acid or
sandblasting
• Coating of fitting surface with a silane coupling
agent
• Resin cement for the cementation
• A bond between ceramic and tooth is created
• Effectively the restoration and tooth will act as
one piece

30
Q

Composite

A

• Roughening of fitting surface with diamond burs
or sandblasting is NOT sufficient
• Resin cement for cementation
However…
• Bond of composite cement to composite inlays
still exist as unsolved problem
• Clinical studies have shown failure of composite
– composite bond (60% marginal opening in 6
months)

31
Q

Failure

A

Bulk fracture***

Intermediate restorative skills (Den 305) (16 decks)

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