Inlays, Onlays and Veneers Flashcards
What are the clinical stages of indirect restorations?
Preparation
Temporisation
Impressions and occlusal records
Cementation
What are inlays?
Intra-coronal restorations made in the lab
A filling made outside the mouth
What are the different types of inlays?
Gold
Composite
Porcelain
When are inlays used?
Occlusal cavities
Occlusal/interproximal cavities
Replace failed direct restorations
Minor bridge retainers - no longer recommended
What are indications of using inlays?
Premolars or molars
Occlusal restorations
Mesio-occlusal or disto-occlusal restorations
MOD - if kept narrow - if not consider onlay
Low caries rate
What are the advantages of inlays?
Superior materials and margins
Won’t deteriorate over time
What are the disadvantages of inlays?
Time
Cost
What tools are needed for inlay preparation?
Handpiece
Burs
Enamel hatchets
Biangle chisel
Gingival margin trimmers
What should be written on an inlay/onlay lab card?
Lab prescription - pour impressions
Mount casts - articulator, waxbite, occlusal record, facebow
Construct restoration - Tooth (FDI), material, thickness, shade, characteristics
What are onlays?
Extra-coronal restorations made in lab
Like inlays but with cuspal coverage - heights of cusps need to be reduced during preparation
What are the types of onlays?
Gold
Composite
Porcelain
What are the indications of using onlays?
Sufficient occlusal tooth substance loss - buccal and/or palatal/lingual cusps remaining
Remaining tooth substance weakened - caries, pre-existing large restoration - MODs with wide isthmuses
When should cast metal inlays and onlays be used over amalgam?
Higher strength needed
Significant tooth recontouring required
What are the uses of onlays?
Tooth wear cases - increase OVD
Fractured cusps
Restoration of root treated teeth
Replace failed direct restorations
Minor bridge retainers (not recommended)
A less destructive alternative to crowns
What happens in the first appointment for inlays and onlays?
LA (if no RCT)
Make reduction template
Impression for temporary
Tooth preparation
Make temporary
Impressions, bite registration and record shade
Cement temporary
What happens in the second appointment for inlays and onlays?
Remove temporary
Isolate, clean and dry prepared tooth
Try in, assess fit, adaption, occlusion etc
If not happy to cement, address problems
Cement
Minor occlusal adjustments if needed
What are alternatives to inlays and onlays?
Large direct restorations
Crowns:
3/4 crown - gold
Full crown - GSC, MCC, PJC
Extraction
What is a laminate veneer?
A thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin
What are the types of veneers?
Ceramic
Composite
Gold
What are the indications for veneers?
To improve aesthetics
Change teeth shape and /or contour
Correct peg-shaped laterals
Reduce or close proximal spaces and diastemas
Align labial surfaces of instanding teeth
Enamel defects and discolouration
What are the contraindications to veneers?
Poor OH
High caries rate - and unsound restorations
Gingival recession
Root exposure
High lip lines
Labially positionedm severely rotated and overlapping teeth
Extensive TSL/insufficient bonding area
Heavy occlusal contacts
Severe discolouration
What should be written on a lab card for veneers?
Pour impressions
Mount casts - articulator waxbite occlusal record, facebow
Construct restoration - tooth (FDI), material, thickness, characteristics, shade, translucency
What adhesives are used for inlays, onlays and veneers?
NX3 (Nexus)
ABC
RelyX Unicem
How should excess adhesive be removed?
When cement is not yet set
Microbrushes
What happens in the first appointment for veneers if tooth preparation is required?
LA if necessary
Make putty index
Impression for temporary
Tooth preparation
Make temporary
Impressions, bite reg and record shade
Cement temporary if necessary
What happens in the first appointment for veneers if tooth preparation is not required?
Impressions, bite reg and record shade
Cement temporary if necessary
What happens in the second appointment for veneers?
Remove temporary if proved
Isolate, clean and dry prepared tooth
Try in, assess fit, adaptation and occlusion
If not happy to cement address problems
If happy to cement, then cement
What are alternates to veneers?
No treatment
Micro-abrasion
Penetrative resin restorations eg - ICON
Direct composite restorations
Crowns
