Inlays and Onlays

Question 1

what are indirect restorations?

Answer 1

Restorations made outside the mouth in a lab.

Question 2

name examples of indirect restorations. (5)

Answer 2

Crowns 
Post and cores 
Brides work 
Inlays/onlays 
Veneers

Question 3

what are inlays?

Answer 3

Intracoronal restorations made in a lab - Like fillings made outside the mouth

Question 4

what types of inlay materials are available? (4)

Answer 4

Gold
Composite
Porcelain
Ceramic

Question 5

when are inlays used? (4)

Answer 5

Used for occlusal or DO/MO

Narrow MOD only - use onlay for normal MODS

Used to replace failing direct restorations (placed once/twice)

Can use as minor bridge retainers - not recommended

in those with low caries risk

Question 6

what teeth are inlays used on?

Answer 6

molars & premolars

Question 7

what are the advantages of inlays?

Answer 7

• Can use better materials
• Precisely fitted to margins
  = Increased longevity

Question 8

what are the disadvantages of inlays? (2)

Answer 8

Take longer to create

Increased cost

Question 9

describe the tooth preparation required fir inlays. (8)

Answer 9

flat pulpal floor

retentive features; isthmus, dovetails and grooves

rounded internal line angles

shoulder/chamfer margins

clear contact points - interproximal and occlusal

no undercuts

4-6 degree taper on walls

proximal box if required

Question 10

what is the difference between an inlay and an onlay?

Answer 10

Similar but onlays have cuspal coverage

Question 11

what are onlays? (3)

Answer 11

Extra-coronal restorations made in a lab.

They are similar to inlays only they have cusp coverage.

Less destructive alternative to crowns

Question 12

when are onlays used? (1) give examples (4)

Answer 12

When there is substantial tooth loss - esp lost cusps - with little/weak remaining tooth structure

Tooth wear cases
Fractured cusps
Root treated teeth
Replace failed direct restorations

Question 13

what types of onlay materials are available? (4)

Answer 13

Gold
Compose
Porcelain
Ceramic

Question 14

when are onlays used instead of amalgam? (2)

Answer 14

when;

Higher strength materials required
There is significant reshaping of the tooth required

Question 15

when is it recommended that you check occlusion and adjust occlsuion in a ceramic onlay?

Answer 15

Ceramic onlays are weak before cementation

So cement them then check the occlusion.
Adjust occlusion once the Onlay is cemented

Question 16

describe the tooth preparation required for onlays.

Answer 16

significant cusp reduction

flat pulpal floor

retentive features; isthmus,

shoulder/chamfer margins

rounded internal line angles

clear contact points - interproximal and occlusal

no undercuts

4-6 degree taper on walls

proximal box if required

Question 17

list the clinical stages for the 1st indirect restoration appointment. (7)

Answer 17

Give LA (if tooth is vital)

Made reduction template

Take and impression for the temporary

Carry out tooth preparation

Make the temporary

Take impressions, bite registration and record shade

Cement the temporary

Question 18

list the clinical stages for the 2nd indirect restoration appointment. (6)

Answer 18

Remove the temporary

Isolate, clean and dry the prepared tooth

Try in, assess fit, adapt and check occlusion

Address any problems now

Cement

Make minor adjustments

Question 19

what are the alternative to inlays/onlays? (3)

Answer 19

Large direct restorations using amalgam, composite or GI

Crowns - Full crowns, 3/4 crowns (gold)

Extraction

Question 20

list the types of materials used in veneers. (3)

Answer 20

Porcelain,

Composite

Gold
(Gold palatal veneers for wear cases.)

Question 21

what are the indicators for use of veneers? (7)

Answer 21

Improve aesthetics

Change teeth shape/contour

Correct peg shaped laterals

Reduce proximal spaces

Align labial surfaces of outstanding teeth

Mask enamel defects - hyperplasia/flurosis

Mask discolouration

Question 22

what are contraindications for veneers? (8)

Answer 22

Poor OH

High caries rate

High lip lines

Gingival recession

Root exposures

If extensive prep is required - aim to bond veneers to enamel (have to bond to dentine = crowns)

Rotated, overlapping might require extensive prep = crowns better option

Extensive tooth surface loss = dentine exposed (want to bond veneers to enamel)

Heavy occlusal contact = likely to fracture

Question 23

describe the tooth preparation required for veneers. (3)

Answer 23

cervical reduction = 0.3mm within enamel

midfacial reduction = 0.5mm within enamel

incisal reduction = 1-1.5mm

Question 24

name the types of incisal edge preparations for veneers. (4)

Answer 24

Feathered incisal edge

Incisal bevel

Intra-enamel window

Overlapped incised edge

Question 25

list the clinical stages for the 1st veneer appointment.

Answer 25

Give LA if required

Make putty index

Take and impression for the temporary

Carry out tooth preparation

Make the temporary

Take impressions, bite registration and record shade

Cement the temporary
(if no tooth prep required skip to taking the impressions etc)

Question 26

list the clinical stages for the 2nd veneer appointment.

Answer 26

Remove the temporary

Isolate, clean and dry the prepared tooth

Try in, assess fit, adapt and check occlusion
Address any problems now

Cement

Question 27

what are alternatives to veneers? (6)

Answer 27

Spot bonded composite
No treatment 
Bleaching/tooth whitening 
Micro-abrasion 
Direct composite restorations 
Crowns