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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
why can you decrease the preparation for gold
- because it is stronger
26
what are the key components to an inlay preparation
- 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
27
why do you not want undercuts
- 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
28
why do you want a slight later of the cavity walls by 4-6 degrees
- so the restoration will slide in | - if it is more than this then it will reduce retention
29
what material can you create a bevel for an inlay
- gold
30
why can't you create a bevel for ceramic inlays
- the lab will then prepare an area with an overlap | - the overlap area will be brittle and will just break
31
why do you want the margins of the inlay clear of the occlusal contact points
- because if the contact area is constantly subjected to force where the restoration and tooth join then they will fail
32
how can you improve the retention for an inlay
- grooves | - dovetail/key
33
why is it important to get the temporary impression done
- in case you can't get the finished one done
34
what are some materials used for temporary inlay
- pro-temp - polycarbonate - composite in some cases
35
what are some alternative direct temporary materials
- Kalzinol = ZOE based, don't get as good a bond - Clip =composite based - GI = not great
36
why is GI not great for a temporary restoration material
- sticks well with teeth | - so when we have to cut it back out, we could end up modifying the cavity preparation
37
what is included in the lab prescription card
- 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
what are onlays
- extra-coronal restorations made in the lab - like inlays but with cusp coverage - height of cusps need to be reduced during preparation
39
what are the different types of onlays
- gold - composite - porcelain - ceroemeric
40
what is ceromeric
- cross between porcelain and composite
41
what are the indications for doing an onlay
- 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
why are inlays and onlays preferable to amalgam
- higher strength needed | - significant tooth recontouring required
43
what are onlays used for
- 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
why are onlays good
- less destructive alternative to crowns
45
what are the tools needed for onlays
- handpiece - burs - enamel hatchets - binangle chisel - gingival margin trimmers
46
what are the burs used for onlays
- No. 170L - No.169L - corase-grit flame diamond - flame (H4BL-101)
47
what are the measurements for preparation for an onlay for porcelain
- 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
what are the measurements for preparation for an onlay for gold
- 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
what are the important features of an onlay preparation
- 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
what is the problem with ceramic onlays
- they are weak when not cemented - so can't check occlusion as they will fracture - need to fit them in then adjust occlusion
51
what are the adhesive systems for ceramic onlays
- NX3 (nexus) - ABC - RelX Unicem self-adhesive resin cement
52
what is the most commonly used adhesive system for ceramic onlays
- NX3 = Nexus
53
what are the materials used for cementation of gold onlays
- Aquacem (GI) - Panavia (composite with 10-MDP) - RMGI (RelyX)
54
what is good about gold onlays
- can check occlusion before cementation as gold is stronger than ceramic
55
what is the most commonly used material for cementation of gold onlays
- Aquacem = GI
56
what does 10-MDP allow
- allows metals to stick to teeth a bit better | - usually used for bridgework
57
what do you do in the 1st appointment for inlays/onlays
- LA (if not RCT) - made reduction template - impression for temporary - tooth preparation - make temporary - impressions, bite registration and record shade - cement temporary
58
what do you do in the 2nd visit for inlays/onlays
- remove temporary - isolate, clean and dry prepared tooth - try in, assess fit, adaptation, occlusion etc. - cement if happy - minor occlusal adjustments ( if needed
59
what are the alternatives to inlays and onlays
- large direct restorations = amalgam, composite, GI - crowns - extraction
60
what different types of crowns do you get
- 3/4 crown = gold | - full crown = gold shell crown, metal ceramic crown, porcelain
61
what are the different names for veneers
- porcelain laminate veneer (PLV) | - laminate veneer
62
what is a laminate veneer
- thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin
63
what are the different types of veneers-
- ceramic = for labial - composite = for labial - gold = for palatal, good for tooth wear cases
64
what is the most common veneer
- porcelain
65
what are the indications for a veneer
- 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
what are the intrinsic causes of enamel discolouration
- non-vital teeth - ageing - trauma - medications = tetracycline - fluorosis - hypoplasia or hypo mineralisation - amelogeneiss imperfecta - erosion and abrasions
67
what are the extrinsic causes of enamel discolouration
- staining not amenable to bleaching
68
what are the contraindications of veneers
- 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
why are high lip lines sometimes a contraindication
- 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
what are alternatives to do if there is extensive prep needed of more than 50% of surface area no linger in enamel
- PJC, DBC's, MCC's
71
what do veneers rely on to bond to
- enamel | - if there is not a lot of enamel then they wouldn't last very long
72
what are the preparations needed for veneers
- 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
what is a depth cut bur
- 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
what might you have to do for preparation for high lip line patients
- 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
where do you need to bevel the tooth from for veneer
- from mid aspect of tooth to incisal edge
76
what are the different types of veneer preparations
- featured incisal edge - incisal bevel - intra-enamel - overlapping incisal edge
77
how is the choice of veneer prep decided
- 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
what is the Gurel technique for veneer preparation
- 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
why do you often not need temporary restoration for veneers-
- because you have only cut in the enamel so should be fine
80
what can you do for patient if their tooth is feeling sensitive after veneer prep
- place prime and bond and cure that - make temporary restoration = same as for crowns and inlays - spot bonded composite
81
what is spot bonded composite
- 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
what is different to include on a lab prescription that is not included in inlays and onlays
- translucency
83
what different translucencies of veneers can you get
- 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
what materials are used to cement veneers
- NX3 (Nexus) - ABC - RelyX Unicem
85
how are veneers cemented
- place cement in veneer - remove excess before cement has set with micro brushes - composite based resin cement - use matrix strips or PTFE tape
86
why do you use matrix strips or PTFE tape when placing veneers
- 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
what is done in the first appointment for veneers if tooth prep is needed
- LA - make putty index - impression for temporary - tooth preparation - make temporary - impressions, bite registration and record shade - cement temporary if needed
88
what is done in the first appointment for veneers if tooth prep is not needed
- impressions, bite registration and record shade | - cement temporary of needed
89
what is done in the second appointment for veneers-
- remove temporary - isolate, clean and dry prepared tooth - try-in, assess fit, adaptation and occlusion - cement if happy
90
what are some alternatives to veneers-
- no treatment - bleaching/tooth whitening - micro-abrasion - direct composite restorations - crowns

BDS3 - Operative Dentistry (7 decks)

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