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BDS3 Operative Dentistry > Inlays, Onlays and Veneers > Flashcards

Inlays, Onlays and Veneers Flashcards

1
Q

What is an ‘indirect’ restoration?

A
  • Restorations fabricated outside the mouth by a technician in a lab
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2
Q

What are examples of indirect restorations? (5)

A
  • Crowns
  • Post and cores
  • Bridgework
  • Inlays and onlays
  • Veneers
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3
Q

What would you include within a pre-operative assessment? (12)

A

Full history and exam:

  • CO
  • HPC
  • PMH
  • PDH
  • FH
  • SH
  • EO
  • IO
  • Oral hygiene
  • Caries, fractures (restorable?)
  • Periodontal condition
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4
Q

What special investigations might you include in a pre-operative assessment? (4)

A
  • Radiographs
  • Sensibility testing
  • Mounted study models
  • Diagnostic wax up
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5
Q

What are you looking for in radiographs in a pre-operative assessment? (5)

A
  • Caries
  • Periodontal condition
  • Peri-radicular/peri-apical lesions
  • Previous RCT
  • Quality
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6
Q

What does the diagnostic wax up allow you to do? (4)

A
  • Aesthetics
  • Occlusion
  • Communication with patient and lab
  • Achievability
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7
Q

What are the 4 conventional clinical stages for indirect restorations?

A
  1. Preparation
  2. Temporisation
  3. Impressions and occlusal records
  4. Cementation
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8
Q

What are the benefits of the CAD-CAM restorations milled from a block of ceramic? (2)

A
  • Quick

- No temporary needed

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9
Q

What is the possible negative of the CAD-CAM restorations milled from a block of ceramic?

A

There are questions over the accuracy of it

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10
Q

What is an inlay?

A

Intra coronal restoration made in lab - like a filling made outside the mouth

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11
Q

What are the different types of inlays? (4)

A
  • Gold
  • Composite
  • Porcelain
  • Ceromeric (mix of composite and porcelain)
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12
Q

What are the uses of inlays? (4)

A
  • Occlusal cavities
  • Occlusal/interproximal cavities
  • Replace failed direct restorations
  • Minor bridge retainers (not advised)
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13
Q

What are indications for inlays? (5)

A
  • Premolars and molars
  • Occlusal
  • Mesio-occlusal or disto-occlusal restoration
  • MOD (if kept narrow as if not thin would find that cusps are quite thin and so might fracture off)
  • Low caries rate (good chance of maintaining the restoration)
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14
Q

What are advantages of inlays vs direct restorations? (2)

A
  • Superior materials and margins

- Won’t deteriorate over time

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15
Q

What are disadvantages of inlays vs direct restorations? (2)

A
  • Time

- Cost

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16
Q

What tools can we use for inlay preparations? (5)

A
  • Handpiece
  • Burs
  • Enamel hatchet
  • Binangle chisel
  • Gingival margin trimmers
    (bottom 3 might use but not needed)
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17
Q

What burs are available to use for inlay preparations? (7)

A
  • No. 170L
  • No. 169L
  • Coarse-grit flame diamond
  • Flame (H4BL-010)
  • Ready made bur kits
  • Shamper bur
  • Shoulder bur
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18
Q

What are the 2 burs we would use the most for inlay preparations?

A
  • Shamper shape bur

- Shoulder bur

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19
Q

When preparing a tooth for an inlay where do we not wan the margin to be near?

A
  • Don’t want it to be near the natural contact point
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20
Q

Do we want undercuts when preparing a tooth for an inlay?

A
  • No
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21
Q

Do we want tapered walls when preparing a tooth for an inlay?

A
  • Want a slight taper (4-6 degrees)
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22
Q

What do we want the pulpal floor to be like?

A

Flat with an even depth (approx. 1.5m)

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23
Q

What do we want the line angles to be like for an inlay preparation?

A

Rounded

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24
Q

With what material would you use a shoulder bur?

A

When you are using ceramic materials

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25
Q

With what material would you use a shamper bur?

A

When you are using gold

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26
Q

If you don’t think you have enough retention in a cavity prep for an inlay what can you do?

A
  • Can cut grooves and scores into the tooth
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27
Q

Why do we want rounded internal line angles for an inlay cavity prep?

A
  • To prevent fracture of the restoration
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28
Q

What are the dimensions we want for a cavity prep for a ceramic inlay? (4)

A
  • 1.5-2mm isthmus width
  • 1.5mm depth
  • 1.5-2mm proximal box
  • 1mm (min) shoulder or chamfer margin
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29
Q

What are the dimensions we want for a cavity prep for a gold inlay? (4)

A
  • 1mm isthmus width
  • 1.5mm depth
  • 1mm proximal box (min)
  • 0.5mm chamfer margin
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30
Q

What should we do first when preparing for an inlay?

A
  • Make the temporary restoration

- do this first so if you run out of time in the session at least this is done

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31
Q

What is the temporisation and impression stage of preparing inlays? (3)

A
  • Make temporary restoration
  • Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
  • Fit temporary restoration (with protemp)
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32
Q

What are alternative temporary restorations to protemp? (4)

A

Direct temporary materials:

  • Kalzinol
  • Clip
  • GI (will have to cut GI back out and so might alter the cavity prep which is not what we want)
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33
Q

When we want an inlay to be produced, what should we write on our lab card? (3)

A

Pour impressions
- Say what type of stone you want them poured in

Mount casts

  • Articulator (which one)
  • Occlusal record e.g. jetbite, wax bite
  • Facebrow (if altering the occlusion in any way

Construct restoration

  • Tooth (FDI notation)
  • Material
  • Thickness
  • Characteristics
  • Shade
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34
Q

What is the key difference between inlays and onlays?

A
  • Onlays have cuspal coverage

- So need to do some cuspal modification for onlays

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35
Q

What is an onlay?

A

Extra-coronal restorations made in lab

- Like inlays but with cuspal coverage (height of cusps need to be reduced during restoration)

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36
Q

What are the different types of onlays? (4)

A
  • Gold
  • Composite
  • Porcelain
  • Ceromeric
37
Q

What are indications for onlays? (6)

A

Sufficient occlusal tooth substance loss
- Buccal and/or palatal/lingual cusps remaining

Remaining tooth substance weakened

  • Caries
  • Pre-existing large restorations
  • MOD’s with wide isthmuses
38
Q

When are cast inlays/onlays preferable to amalgam? (2)

A

When:

  • Higher strength needed
  • Significant tooth recontouring required
39
Q

What is the main advantage of onlays?

A
  • Less destructive alternative to crowns
40
Q

What are the uses of onlays? (5)

A
  • Tooth wear cases (increase OVD)
  • Fractured cusps
  • Restoration of root retained teeth (more likely to survive if the restoration has cuspal coverage)
  • Replace failed direct restorations
  • Minor bridge retainers (not recommended)
41
Q

What are the tools used for inlays? (5)

A
  • Handpiece
  • Burs
  • Enamel hatchets
  • Binangle chisel
  • Gingival margin trimmers
42
Q

What occlusal reduction would you want to do on a working cusp if replacing it with a porcelain onlay?

A

2mm reduction

43
Q

What occlusal reduction would you want to do on a non-working cusp if replacing it with a porcelain onlay?

A

1.5mm reduction

44
Q

What occlusal reduction would you want to do on a working cusp if replacing it with a gold onlay?

A

1mm reduction

45
Q

What occlusal reduction would you want to do on a non-working cusp if replacing it with a gold onlay?

A

0.5mm reduction

46
Q

If a proximal box is required for an onlay prep how big would it have to be for a gold onlay?

A

1mm

47
Q

If a proximal box is required for an onlay prep how big would it have to be for a ceramic onlay?

A

2mm

48
Q

What should the margin be like for a porcelain onlay preparation?

A

1mm shoulder or chamfer

49
Q

What should the margin be like for a gold onlay preparation?

A

0.5mm chamfer

50
Q

When preparing for an onlay what should we make sure the margins are clear of?

A
  • Should be clear of occlusal contact points
51
Q

When preparing for an onlay, if we are using ceramic should we have a bevel?

A
  • No

- Want to have butt-joint cavosurface margins

52
Q

When preparing for an onlay we want to ensure the margins are supra-gingival. Why is this?

A
  • So the patient can keep the margins nice and clean
53
Q

If preparing a tooth for a gold onlay do we want a bevelled margin?

A

Yes, want 15-20 degrees bevel in the upper 1/3 of isthmus wall

And want 4-6 degrees tapered wall on other margins

54
Q

For an onlay preparation do we want undercuts?

A
  • No
55
Q

For an onlay preparation what do we want the internal line angles to be like?

A
  • Want them to be rounded
56
Q

What is the procedure for temporisation and impression of an onlay? (3)

A
  • Make temporary restoration
  • Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
  • Fit temporary restoration
57
Q

When we want an onlay to be produces, what should we include in the lab card? (3)

A

Pour impressions
- Say what type of stone you want them poured in

Mount casts

  • Articulator (which one)
  • Occlusal record e.g. jetbite, wax bite
  • Facebrow (if altering the occlusion in any way

Construct restoration

  • Tooth (FDI notation)
  • Material
  • Thickness
  • Characteristics
  • Shade
58
Q

What do we need to be careful of prior to cementing a ceramic onlay?

A
  • They are weak when not cemented

- Be very careful if checking the occlusion as they might fracture

59
Q

What are the different adhesive systems used for ceramic onlays? (3)

A
  • NX3 (Nexus)
  • ABC
  • RelyX Unicem self adhesive resin cement - self etching, self priming resin based adhesive system
60
Q

What are the different adhesive systems used for gold onlays? (3)

A
  • AquaCem (GI)
  • Panavia (composite with 10-MDP)
  • RMGI (RelyX)
61
Q

What would be included within the first appointment for inlay/onlay prep? (7)

A
  • LA (if no RCT)
  • Make reduction template
  • Impression for temporary
  • Tooth preparation
  • Make temporary
  • Impressions, bite registration and record shade
  • Cement temporary
62
Q

What would be included within the second appointment for inlay/onlay prep? (6)

A
  • Remove temporary
  • Isolate, clean and dry prepared tooth
  • Try-in, assess fit, adaptation, occlusion etc
  • If happy to cement: cement -> minor occlusal adjustments (if required)
  • If not happy to cement: address problems
63
Q

What are alternatives to inlays/onlays?

A

Large direct restorations:

  • Amalgam
  • Composite
  • GI

Crowns:

  • 3/4 crown - gold
  • Full crown (gold shell crown, metal-ceramic, porcelain)

Extraction

64
Q

What are 2 names for veneers?

A
  • Porcelain laminate veneer

- Laminate veneer

65
Q

What is a laminate veneer?

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
66
Q

What are the 3 different types of veneer?

A
  • Ceramic
  • Composite
  • Gold
67
Q

What kind of veneer are ceramic and composite usually used for?

A
  • Usually used for labial veneers
68
Q

What kind of veneer is gold usually used for?

A

Palatal veneers - can be used in tooth wear cases

69
Q

What are indications for veneers? (5)

A
  • Improved aesthetics
  • Change teeth shape and/or contour
  • Correct peg-shaped laterals
  • Reduce or close proximal spaces and diastemas
  • Align labial surfaces of in standing teeth
70
Q

Why might veneers be indicated for teeth with discoloration? (long answer)

A
  • Enamel defects
Discolouration:
Intrinsic:
- Non-vital teeth 
- Ageing 
- Trauma 
- Medications (tetracycline) 
- Fluorosis 
- Hypoplasia or hypo mineralisation 
- Amelogenesis imperfects 
- Erosion and abrasion

Extrinsic:
- Staining not amenable to bleaching

71
Q

What are contraindications for veneers? (10)

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)
  • Labially positioned, severely rotated and overlapping teeth
  • Extensive TSL/insufficient bonding area
  • Heavy occlusal contacts
  • Severe discoloration
72
Q

What preparation is required for porcelain laminate veneers? (2)

A

Use:

  • Putty index
  • Depth cuts
73
Q

What cervical reduction needs to be done for veneer preparation? (3)

A
  • 0.3mm
  • Slight chamfer margin
  • Within enamel
  • Supragingival or slightly subgingival
74
Q

What midfacial reduction needs to be done for veneer preparation? (2)

A
  • 0.5mm

- Within enamel

75
Q

What incisal reduction needs to be done for veneer preparation?

A

1-1.5mm

76
Q

What is a depth cut bur used for?

A
  • Used for veneer preparation
  • Makes 0.5mm grooves into the tooth
  • Gives you a guide to be as conservative as you can
77
Q

What are the 4 types of veneer preparation?

A
  • Feathered incisal edge
  • Incisal bevel
  • Intra-enamel (window)
  • Overlapped incisal edge
78
Q

What is the veneer preparation type dictated by?

A
  • Dictated by the patients occlusion
  • Don’t want patient to be biting on the edge of the margin as it will just fracture
  • Also need to bear in mind aesthetics - some patients might have a stained incisal edge so need to overlap this
79
Q

What is the name of the technique for minimal preparation for veneers?

A
  • Gurel technique
80
Q

Explain the Gurel technique?

A
  • Impression has been taken and wax up done
  • Then a putty index was taken
  • The space between the teeth and the putty index tells you how much porcelain you are going to put and how much tooth prep you need
  • Then take the index and fill the spaces up - put it in the patients mouth and once it sets it gives a mock up of the veneers in the patients mouth
  • Then prepare ideal tooth prep through the mock up - will preserve tooth tissue in areas you don’t need to cut
81
Q

What is the process for temporising and impressions for veneers? (4)

A
  • May not need temporary
  • Make temporary restoration (if need it)
  • Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
  • Fit temporary restoration
  • Alternative - spot bond composite
  • No etch
  • Small spot of primer and adhesive
  • Directly apply composite (veneer)
82
Q

When preparing for veneers, what should we include in the lab prescription (3)

A

Pour impressions
- Say what type of stone you want them poured in

Mount casts

  • Articulator (which one)
  • Occlusal record e.g. jetbite, wax bite
  • Facebrow (if altering the occlusion in any way

Construct restoration

  • Tooth (FDI notation)
  • Material
  • Thickness
  • Characteristics
  • Shade
  • Translucency
83
Q

What might we use to cement veneers? (3)

A
  • NX3 (Nexus)
  • ABC
  • RelyX Unicem

Want to be using a composite based resin cement

84
Q

What is included in the process of cementing veneers? (2)

A
  • Matrix strip or PTFE in interproximal surfaces to stop you from cementing all of the teeth together

Remove excess:

  • When cement not set
  • Micro-brushes
85
Q

What would the first appointment be like for veneers if no tooth prep is required? (3)

A
  • No tooth prep required
  • Impressions, bite registration and record shade
  • Cement temporary (if necessary)
86
Q

What would the first appointment be like for veneers if tooth prep is required? (8)

A
  • Tooth prep required
  • LA (if necessary)
  • Make putty index
  • Impression for temporary
  • Tooth preparation
  • Make temporary
  • Impressions, bite registration and record shade
  • Cement temporary (if necessary)
87
Q

What would the second appointment be like for veneers ? (5)

A
  • Remove temporary (if provided)
  • Isolate, clean and dry prepared tooth
  • Try in, assess fit, adaptation and occlusion
  • If happy to cement then cement
  • If not happy to cement then address the problems
88
Q

What are the possible alternatives to veneers? (5)

A
  • No treatment
  • Bleaching/tooth whitening
  • Micro-abrasion
  • Direct composite restorations
  • Crowns

BDS3 Operative Dentistry (3 decks)

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