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Operative Dentistry > Inlays, Onlays and Veneers > Flashcards

Inlays, Onlays and Veneers Flashcards

1
Q

What are the parts of the pre-operative assessment?

A

Special Investigations
◦ Radiographs
◦ Caries
◦ Periodontal condition
◦ Peri-radicular/Peri-apicallesions
◦ Previous RCT
◦ Quality
◦ Sensibility testing
◦ Ethyl chloride
◦ Electric pulp test (EPT)
◦ Mounted study models
◦ Semi- or fully adjustable articulator
◦ Diagnostic wax-up
◦ Aesthetics
◦ Occlusion
◦ Communication with patient and lab ◦ Achievability

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2
Q

What are the conventional clinical stages of indirect restorations?

A
  1. Preparation
  2. Temporisation
  3. Impressions and occlusal records
  4. Cementation
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3
Q

How can indirect restorations be done chairside and what is a disadvantage?

A

CAD-CAM
◦ Restorations milled from block of ceramic
◦ Quick with no temporary needed

However may not be very accurate

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4
Q

What are inlays and what are the different materials?

A

intra-coronal restorations made in lab

materials
- gold
- composite
- porcelain

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5
Q

What are the uses of inlays?

A
  • Occlusal cavities
  • Occlusal/interproximal cavities
  • Replace failed direct restorations
  • Minor bridge retainers (no longer recommended
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6
Q

What type of prep is used for a gold inlay and what type of prep is used for a ceramic inlay?

A

gold - rounded
ceramic - square

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7
Q

Indications for inlays?

A

◦ Premolars or molars
◦ Occlusal restorations
◦ Mesio-occlusal or disto-occlusal restoration
◦ MOD
◦ If kept narrow
◦ If not – consider onlay
◦ Low caries rate

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8
Q

Advantages Vs Disadvantages of Inlays

compared to direct restorations

A

Advantages (vs direct restorations)
◦ Superior materials and margins
◦ Won’t deteriorate over time

Disadvantages
◦ Time
◦ Cost
◦ Fractures (ceramic)

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9
Q

What is the inlay prep for ceramic?

isthmus, depth, chamfer, CSAM

A
  • 1.5-2mm isthmus width
  • 1.5mm depth
  • 1mm (min) shoulder or chamfer margin
  • Butt-joint cavosurface margins (No bevels)
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10
Q

What is the inlay prep for gold?

isthmus, depth, chamfer, CSAM

A
  • 1mm isthmus width
  • 1.5mm depth
  • 0.5mm chamfer margin
  • 15-20 o bevel upper 1/3 of isthmus wall
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11
Q

What are general prep features inlays may have?

A
  • Occlusal key/Dovetail
  • Grooves (internal retention features)
    (proximal buccal and lingual/palatal axial walls gingival floor).
  • No undercuts
  • Flat pulpal floor
  • Margins clear of occlusal contact points
  • ## Rounded line angles
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12
Q

What materials are usually used for the temporary restoration?

alternatives (less common too)

A

pre-op putty
protemp

less common;
kalzinol (ZOE)
clip (composite based)
GI

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13
Q

How are impressions taken?

time scale for lab

A

Take impressions and occlusal records ◦ Send to lab for restoration fabrication
◦ 2 weeks (typically)

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14
Q

What should the lab prescription include?

A

Lab prescription

Pour impressions

Mount casts
◦ Articulator
◦ Waxbite
◦ Occlusal record – e.g. JetBite, wax bite
◦ Facebow

Construct restoration
◦ Tooth (FDI notation)
◦ Material
◦ Thickness
◦ Shade
◦ Characteristics

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15
Q

What should you not do when the ceramic inlays/onlays are not cemented?

A

do not check occlusion
they may fracture

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16
Q

What are the adhesive systems used for cementing ceramic inlays/inlays?

3

A

◦ NX3 (Nexus) - main
◦ ABC
◦ RelyX Unicem self adhesive resin cement- Self etching, self priming resin based adhesive system

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17
Q

What are the adhesive systems used for cementing gold inlays/onlays?

3

A

◦ AquaCem - main
◦ Panavia
◦ RMGI (RelyX)

18
Q

What are inlays and what are the different materials?

A

Extra-coronal restorations made in lab Like inlays but with cuspal coverage
Height of cusps need to be reduced during preparation

◦ Gold
◦ Composite
◦ Porcelain

19
Q

What are indications of onlays?

A

◦ 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

20
Q

When are cast metal inlays/onlays preferred to amalgam?

A

◦ Higher strength needed
◦ Significant tooth recontouring required

21
Q

What are the uses of onlays?

A

◦ Tooth wear cases
◦ Increase OVD
◦ Fractured cusps
◦ Restoration of root treated teeth
◦ Replace failed direct restorations
◦ Minor bridge retainers (not recommended)

(less destructive than crowns)

22
Q

What is the onlay prep for porcelain?

working/ non cusp reduction, margin , csam

A
  • Non working cusp – 1.5mm reduction
  • Working cusp – 2mm reduction
  • 1mm shoulder or chamfer
23
Q

What is the onlay prep for gold?

working/ non cusp reduction, margin , csam

A
  • Non working cusp – 0.5mm reduction
  • Working cusp – 1mm reduction
    1. 5mm chamfer
  • 15-20o bevel upper 1/3 of isthmus wall
24
Q

What are all the steps of the 1st appointment for inlays/onlays?

7

A
  1. LA (if no RCT)
  2. Make reduction template
  3. Impression for temporary
  4. Tooth preparation
  5. Make temporary
  6. Impressions, bite reg, record shade
  7. Cement temporary
25
Q

What are all the steps of the 2nd appointment for inlays/onlays?

5

A
  1. Remove temporary
  2. Isolate, clean and dry prepared tooth
  3. Try-in, assess fit, adaptation, occlusion
  4. Cement
  5. Minor occlusal adjustments
26
Q

What are inlays/onlays alternatives?

A

Large direct restorations
◦ Amalgam
◦ Composite
◦ GI
Crowns
◦ 3⁄4 crown
◦ Gold
◦ Full crown
◦ Gold shell crown (GSC)
◦ Metal-ceramic (MCC)
◦ Porcelain (PJC)
Extraction

27
Q

What are veneers (PLV) and what are the types?

A

A laminate veneer is a thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin.

Types
◦ Ceramic
◦ Composite
◦ Gold

28
Q

Indications of veneers?

A

improve aesthetics
change teeth shape and contour
correct peg-shape laterals
reduce/ close proximal spaces and diastemas
align labial surfaces of instanding teeth
enamel defects
discolouration (intrinsic/extrinsic)

29
Q

What are examples of intrinsic discolouration veneers can fix?

A
  • Non-vital teeth
  • Ageing
  • Trauma
  • Medications (tetracycline)
  • Fluorosis
  • Hypoplasia or hypomineralisation
  • Amelogenesis imperfecta
  • Erosion and abrasion
30
Q

What is an example of extrinsic discolouration veneers can fix?

A
  • Staining not amenable to bleaching
31
Q

What are contraindications of veneers?

A

◦ Poor OH
◦ High caries rate
◦ Interproximal caries and/or unsound restorations
◦ Gingival recession
◦ Root exposure
◦ High lip lines
◦ If extensive prep needed (>50% of surface area no longer in enamel)
◦ Consider alternatives – PJC, DBCs MCCs
◦ Labially positioned, severely rotated and overlapping teeth
◦ Extensive TSL/insufficient bonding area
◦ Heavy occlusal contacts
◦ Severe discolouration

32
Q

What are the operative preps for veneers/

A

Putty index and Depth cuts

Cervical reduction
* 0.3mm
* Slight chamfer margin
* Within enamel
* Supragingival or slightly subgingival

Midfacial reduction
* 0.5mm
* Within enamel

Incisal reduction
* 1-1.5mm with bevel

33
Q

What are the types of veneer preps?

A

a) Feathered incisal edge
b) Incisal bevel
c) Intra-enamel (window)
d) Overlapped incisal edge

34
Q

What is the gurel technique?

A

minimial prep for veneers using pro-temp mockup

temporary veneers to assess the desired aesthetic outcome before any permanent preparation. This helps minimize unnecessary tooth reduction.

35
Q

What is the temporisation of veneers?

A

may not need temporary

If temporary restoration required:
Take impressions and occlusal records ◦ Send to lab for restoration fabrication
◦ 2 weeks
Fit temporary restoration

36
Q

What is the alternative method to protemp temporisation in veneers?

A

Spot bonded composite
◦ No etch
◦ Small spot of primer and adhesive
◦ Directly apply composite (veneer)

37
Q

What should you use when cementing with adhesive systems in veneers?

A

Matrix strip or PFTE interproximal surfaces
Remove excess
◦ When cement not set
◦ Microbrushes

38
Q

What are the steps of the 1st appointment in veneers if there is no tooth prep required?

2

A
  1. Impressions, bite reg, record shade
  2. Cement temporary (if necessary)
39
Q

What are the steps of the 1st appointment in veneers if there is tooth prep required?

7

A
  1. LA (if necessary)
  2. Make putty index
  3. Impression for temporary
  4. Tooth prep
  5. Make temp
  6. Impressions, bite reg, record shade
  7. Cement temp
40
Q

What are the steps of the 2nd appointment in veneers?

4

A
  1. Remove temporary (if provided)
  2. Isolate, clean and dry prepared tooth
  3. Try in, assess fit, adaptaion and occlusion (address problems)
  4. Cement
41
Q

What are alternatives to veneers?

A

No treatment
Micro-abrasion
Penetrative resin restorations – e.g., ICON
Direct composite restorations
Crowns

Operative Dentistry (4 decks)

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