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BDS3 - Operative Dentistry > Inlays, Onlays and Veneers > Flashcards

Inlays, Onlays and Veneers Flashcards

1
Q

what are indirect restorations

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

what are some examples of indirect restorations

A
  • crowns
  • posts and cores
  • bridgework
  • inlays and onlays
  • veneers
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3
Q

what is included in a pre-operative assessment

A
  • full history and exam
  • complaining of
  • history of presenting complaint
  • past medical history
  • past dental history
  • family medical history
  • social history
  • extra-oral examination
  • intra-oral examination
  • special investigations
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4
Q

what is included within the intra-oral examination

A
  • oral hygiene
  • caries
  • fractures
  • periodontal conditions
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5
Q

what are some examples of special investigations

A
  • radiographs
  • sensibility testing
  • mounted study models
  • diagnostic wax-up
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6
Q

what are radiographs used for

A
  • caries
  • periodontal condition
  • peri-radicular/peri-apical lesions
  • previous RCT
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7
Q

what are examples of sensibility testing

A
  • ethyl chloride

- electric pulp test (EPT)

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8
Q

what are diagnostic wax-ups used for

A
  • aesthetics
  • occlusion
  • communication with patient and lab
  • achievability
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9
Q

what are the 4 main conventional clinical stages for inlays, onlays and veneers

A
  • preparation
  • temporisation
  • impressions and occlusal record
  • cementation
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10
Q

how are chair side indirect restorations carried out

A
  • use CAD-CAM which sends impression to milling machine
  • restorations milled (cut) from block of ceramic
  • quick
  • no temporary restoration is needed = can have a single appointment
  • BUT there are questions over its accuracy
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11
Q

what are inlays

A
  • intracoronal restorations made in the lab

- like a filling made outside the mouth

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12
Q

what are the different types of inlays

A
  • gold
  • porcelain
  • composite
  • ceromeric
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13
Q

what are inlays used for

A
  • occlusal cavities
  • occlusal/interproximal cavities
  • replace failed direct restorations
  • minor bridge retainers (not advised)
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14
Q

what the indications to use inlays

A
  • premolar or molars (don’t really do on anterior)
  • occlusal
  • messy-oclusal or ditto-occlusal restoration
  • MOD
  • low caries rate
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15
Q

why do you need to keep and MOD cavity narrow for an inlay

A
  • if wide then cusps all thin and if you put an inlay in it will cause wedging which could then lead to fracture of the inlay
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16
Q

what are the advantages of inlays

A
  • superior
  • superior materials and margins
  • won’t deteriorate over time
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17
Q

what are the disadvantages of inlays

A
  • time

- cost

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18
Q

what tools do you need for inlays

A
  • handpiece
  • burs
  • enamel hatchets
  • binangle chisel
  • gingival margin trimmers
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19
Q

what different burs are used for inlays

A
  • No. 170L
  • No. 169L
  • coarse-grit flame diamond
  • flame
  • ready-made bur kits
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20
Q

what are the 2 main shaped burs to use for inlays

A
  • chamfer = rounded

- shoulder = more square

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21
Q

when is a chamfer bur used

A
  • can use for metals, or on palatal aspect for a metal ceramic crown, but would use shoulder for whenever ceramic as you need it at the margin
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22
Q

when is a shoulder bur used

A
  • gives a thicker preparation which is better for ceramic
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23
Q

what are the measurements for an inlay preparation for ceramic

A
  • 1.5-2mm isthmus width
  • 1.5mm depth
  • 1.5-2mm proximal box
  • 1mm shoulder or chamfer margin
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24
Q

what are the measurements for an inlay preparation for gold

A
  • 1mm isthmus
  • 1.5mm depth
  • 1mm proximal box
  • 0.5mm chamfer margin
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25
Q

why can you decrease the preparation for gold

A
  • because it is stronger
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26
Q

what are the key components to an inlay preparation

A
  • margins clear of occlusal contact points
  • no undercuts
  • 4-6 degrees tapered walls
  • clear of adjacent contact points
  • rounded internal line angles
  • flat pulpal floor with even depth
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27
Q

why do you not want undercuts

A
  • won’t be able to get inlay back in
  • if they haven’t been blocked out by the lab then the base of the restoration is wider than the cavity and it won’t go in
  • if the lab does block them out then you get a wider gap between tooth and restoration
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28
Q

why do you want a slight later of the cavity walls by 4-6 degrees

A
  • so the restoration will slide in

- if it is more than this then it will reduce retention

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29
Q

what material can you create a bevel for an inlay

A
  • gold
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30
Q

why can’t you create a bevel for ceramic inlays

A
  • the lab will then prepare an area with an overlap

- the overlap area will be brittle and will just break

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31
Q

why do you want the margins of the inlay clear of the occlusal contact points

A
  • because if the contact area is constantly subjected to force where the restoration and tooth join then they will fail
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32
Q

how can you improve the retention for an inlay

A
  • grooves

- dovetail/key

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33
Q

why is it important to get the temporary impression done

A
  • in case you can’t get the finished one done
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34
Q

what are some materials used for temporary inlay

A
  • pro-temp
  • polycarbonate
  • composite in some cases
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35
Q

what are some alternative direct temporary materials

A
  • Kalzinol = ZOE based, don’t get as good a bond
  • Clip =composite based
  • GI = not great
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36
Q

why is GI not great for a temporary restoration material

A
  • sticks well with teeth

- so when we have to cut it back out, we could end up modifying the cavity preparation

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37
Q

what is included in the lab prescription card

A
  • pour impression and what stone you want study model in
  • mount casts and on what articulator
  • construct restoration = tooth FDI, material, thickness, characteristics, shade
38
Q

what are onlays

A
  • extra-coronal restorations made in the lab
  • like inlays but with cusp coverage
  • height of cusps need to be reduced during preparation
39
Q

what are the different types of onlays

A
  • gold
  • composite
  • porcelain
  • ceroemeric
40
Q

what is ceromeric

A
  • cross between porcelain and composite
41
Q

what are the indications for doing an onlay

A
  • sufficient occlusal tooth substance loss
  • remaining tooth substance weakened from caries, or a large pre-existing restoration
  • tooth loss involving cusps
  • loss of a lot of tooth structure
42
Q

why are inlays and onlays preferable to amalgam

A
  • higher strength needed

- significant tooth recontouring required

43
Q

what are onlays used for

A
  • tooth wear case
  • fractured cusps
  • restoration of root treated teeth
  • replace failed direct restoration
  • minor bridge retainers = not recommended
  • easier to recontour tooth outside patients mouth
44
Q

why are onlays good

A
  • less destructive alternative to crowns
45
Q

what are the tools needed for onlays

A
  • handpiece
  • burs
  • enamel hatchets
  • binangle chisel
  • gingival margin trimmers
46
Q

what are the burs used for onlays

A
  • No. 170L
  • No.169L
  • corase-grit flame diamond
  • flame (H4BL-101)
47
Q

what are the measurements for preparation for an onlay for porcelain

A
  • occlusal reductions = 1.5mm on non-working cusps and 2mm reduction on working
  • 1.5-2mm proximal box
  • 1mm shoulder or chamfer margin
  • 1.5mm isthmus width
48
Q

what are the measurements for preparation for an onlay for gold

A
  • non working cusp reduction of 0.5mm, working cusp 1mm
  • 1mm proximal box
  • 0.5mm chamfer margin
  • less than 1.5mm isthmus width
  • 15-20 degrees bevel on upper 1/3 of isthmus wall
49
Q

what are the important features of an onlay preparation

A
  • margins clear of occlusal contact point
  • 4-6 degrees tapered walls
  • proximal box
  • no undercuts
  • cusp reduction
  • rounded internal line angles
  • shoulder or chamfer margins
  • flat pulpal floor at an even depth =1.5mm
50
Q

what is the problem with ceramic onlays

A
  • they are weak when not cemented
  • so can’t check occlusion as they will fracture
  • need to fit them in then adjust occlusion
51
Q

what are the adhesive systems for ceramic onlays

A
  • NX3 (nexus)
  • ABC
  • RelX Unicem self-adhesive resin cement
52
Q

what is the most commonly used adhesive system for ceramic onlays

A
  • NX3 = Nexus
53
Q

what are the materials used for cementation of gold onlays

A
  • Aquacem (GI)
  • Panavia (composite with 10-MDP)
  • RMGI (RelyX)
54
Q

what is good about gold onlays

A
  • can check occlusion before cementation as gold is stronger than ceramic
55
Q

what is the most commonly used material for cementation of gold onlays

A
  • Aquacem = GI
56
Q

what does 10-MDP allow

A
  • allows metals to stick to teeth a bit better

- usually used for bridgework

57
Q

what do you do in the 1st appointment for inlays/onlays

A
  • LA (if not RCT)
  • made reduction template
  • impression for temporary
  • tooth preparation
  • make temporary
  • impressions, bite registration and record shade
  • cement temporary
58
Q

what do you do in the 2nd visit for inlays/onlays

A
  • remove temporary
  • isolate, clean and dry prepared tooth
  • try in, assess fit, adaptation, occlusion etc.
  • cement if happy
  • minor occlusal adjustments ( if needed
59
Q

what are the alternatives to inlays and onlays

A
  • large direct restorations = amalgam, composite, GI
  • crowns
  • extraction
60
Q

what different types of crowns do you get

A
  • 3/4 crown = gold

- full crown = gold shell crown, metal ceramic crown, porcelain

61
Q

what are the different names for veneers

A
  • porcelain laminate veneer (PLV)

- laminate veneer

62
Q

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
63
Q

what are the different types of veneers-

A
  • ceramic = for labial
  • composite = for labial
  • gold = for palatal, good for tooth wear cases
64
Q

what is the most common veneer

A
  • porcelain
65
Q

what are the indications for a veneer

A
  • improve aesthetics
  • change teeth shape and/or contours
  • correct peg-shaped laterals
  • reduce or close proximal spaces and diastema
  • align labial surfaces of in standing teeth
  • enamel defects
66
Q

what are the intrinsic causes of enamel discolouration

A
  • non-vital teeth
  • ageing
  • trauma
  • medications = tetracycline
  • fluorosis
  • hypoplasia or hypo mineralisation
  • amelogeneiss imperfecta
  • erosion and abrasions
67
Q

what are the extrinsic causes of enamel discolouration

A
  • staining not amenable to bleaching
68
Q

what are the contraindications of veneers

A
  • poor OH
  • high caries rate
  • gingival recession
  • root exposure
  • high lip lines = not always a contra-indication
  • if extensive prep is needed (>50%)
  • labially positioned, severely rotated and overlapping teeth
  • insufficient bonding area
  • heavy occlusal contacts
  • severe discolouration
69
Q

why are high lip lines sometimes a contraindication

A
  • tend to see the margins of their teeth a bit more

- so if treatment is not done well, then can sometimes look very obvious

70
Q

what are alternatives to do if there is extensive prep needed of more than 50% of surface area no linger in enamel

A
  • PJC, DBC’s, MCC’s
71
Q

what do veneers rely on to bond to

A
  • enamel

- if there is not a lot of enamel then they wouldn’t last very long

72
Q

what are the preparations needed for veneers

A
  • none
  • want to keep preparation as minimal as possible
  • preparation required for PLV
  • cervical reduction of 0.3mm within enamel with chamfer
  • mid facial reduction of 0.5mm within enamel
  • incisal reduction of 1-1.5mm
73
Q

what is a depth cut bur

A
  • used for veneers
  • prescribed to a particular thickness
  • 0.5mm for veneers
  • makes grooves into tooth
  • you can then reduce the rest of the tooth to that level
  • gives you a guide on how far to cut to be as conservative as possible
74
Q

what might you have to do for preparation for high lip line patients

A
  • might need to go sublingual or right up to gingival margin
  • would need to warn patient that they could get recessions it is is placed sub gingival
75
Q

where do you need to bevel the tooth from for veneer

A
  • from mid aspect of tooth to incisal edge
76
Q

what are the different types of veneer preparations

A
  • featured incisal edge
  • incisal bevel
  • intra-enamel
  • overlapping incisal edge
77
Q

how is the choice of veneer prep decided

A
  • by the occlusion and aesthetics
  • don’t want patient biting at the edge where the veneer meets the tooth as that will cause it to fall off
  • some patients have a discoloured incisal edge
78
Q

what is the Gurel technique for veneer preparation

A
  • minimal prep
  • take impression first
  • diagnostic wax-up of what veneers should look like and take putty index of it
  • fill spaces for teeth with pro-temp and put in patient’s mouth
  • that gives a mock-up of veneers in mouth
  • allows you to check everything
  • whilst you keep mock-up in mouth, then prepare ideal veneer preparation through mock-up
79
Q

why do you often not need temporary restoration for veneers-

A
  • because you have only cut in the enamel so should be fine
80
Q

what can you do for patient if their tooth is feeling sensitive after veneer prep

A
  • place prime and bond and cure that
  • make temporary restoration = same as for crowns and inlays
  • spot bonded composite
81
Q

what is spot bonded composite

A
  • divide tooth into 9
  • not etch
  • small spot of primer and adhesive in centre of tooth
  • directly apply composite
  • build composite veneer directly in patients mouth
  • will stick to tooth better in centre of tooth but will hold elsewhere
  • should last for couple weeks until veneers are back from lab
  • then just use a probe and flick them off
82
Q

what is different to include on a lab prescription that is not included in inlays and onlays

A
  • translucency
83
Q

what different translucencies of veneers can you get

A
  • very opaque to use in severe discolouration teeth

- translucent so that the natural colour of the patients tooth shines through to give more natural appearance

84
Q

what materials are used to cement veneers

A
  • NX3 (Nexus)
  • ABC
  • RelyX Unicem
85
Q

how are veneers cemented

A
  • place cement in veneer
  • remove excess before cement has set with micro brushes
  • composite based resin cement
  • use matrix strips or PTFE tape
86
Q

why do you use matrix strips or PTFE tape when placing veneers

A
  • because we are usually putting a lot of veneers in at once
  • want to avoid cement smear everywhere and teeth sticking together
  • place these at interproximal surfaces
87
Q

what is done in the first appointment for veneers if tooth prep is needed

A
  • LA
  • make putty index
  • impression for temporary
  • tooth preparation
  • make temporary
  • impressions, bite registration and record shade
  • cement temporary if needed
88
Q

what is done in the first appointment for veneers if tooth prep is not needed

A
  • impressions, bite registration and record shade

- cement temporary of needed

89
Q

what is done in the second appointment for veneers-

A
  • remove temporary
  • isolate, clean and dry prepared tooth
  • try-in, assess fit, adaptation and occlusion
  • cement if happy
90
Q

what are some alternatives to veneers-

A
  • no treatment
  • bleaching/tooth whitening
  • micro-abrasion
  • direct composite restorations
  • crowns

BDS3 - Operative Dentistry (7 decks)

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