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BDS3 Op Tech > Inlays, Onlays and Veneers > Flashcards

Inlays, Onlays and Veneers Flashcards

1
Q

Indirect Restorations

A

Restorations fabricated outside the mouth by a technician in a laboratory

Examples:
•	Crowns
•	Post and cores
•	Bridgework
•	Inlays and Onlays
•	Veneers
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2
Q

direct restorations

A

made by operator chairside

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3
Q

Pre operative assessment for indirect restorations

A 
Full history and exam
- CO
- HPC
- PMH
- PDH
- FM
- SH
- EO
- IO
Oral hygiene
Caries, fractures
- Restorable?
Periodontal condition
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4
Q

special investigations for indirect restorations

A

Radiographs

  • Caries
  • Periodontal condition
  • Peri-radicular/Peri-apical lesions
  • Previous RCT- Quality

Sensibility testing

  • Ethyl chloride
  • Electric pulp test (EPT)

Mounted study models
- Semi- or fully adjustable articulator

Diagnostic wax-up

  • Aesthetics
  • Occlusion – both static and dynamic when pt absent
  • Communication with patient and lab- patients can make educated decision- Show lab what you and/or patient want.
  • Achievability
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5
Q

indirect restorations conventional clinical stages (4)

A
  1. Preparation
  2. Temporisation
  3. Impressions and occlusal records
  4. Cementation
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6
Q

chair-side indirect restorations use

A

CAD-CAM computer aided design , computer aided manufacture

Restorations milled from block of ceramic
- Quick - just one visit for pt
- No conventional impression or temporary needed
???Questions over accuracy???

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7
Q

inlays

A

Intra-coronal restorations made in lab – fillings made outside the mouth

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8
Q

types of inlays (5)

A

Composite

Gold

Ceramic

Porcelain

Ceromeric – porcelain and ceramic combination

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9
Q

uses of inlays (4)

A

Occlusal cavities

Occlusal/interproximal cavities

Replace failed direct restorations

Minor bridge retainers
- not advised now

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10
Q

indications for inlays (5)

A

Premolars or molars

occlusal

mesio-occlusal or disto-occlusal restoration

MOD restoration
- If kept narrow
- If not – consider onlay
cusps would be thin, create a wedge and cause cusps to fracture off

Low caries rate

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11
Q

MOD restoration when to use inlay Vs onlay

A
  • If kept narrow
  • If not – consider onlay
    cusps would be thin, create a wedge and cause cusps to fracture off
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12
Q

advantages of inlays (2)

A

Superior materials and margins

Won’t deteriorate over time

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13
Q

disadvantages of inlays (2)

A

time

cost

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14
Q

inlay preparation - tools/armamentarium

A

Handpiece

Burs					 
- No. 170L
- No. 169L
- Coarse-grit flame diamond
- Flame (H4BL-010)
- Ready made bur kits
chamfer or shoulder burs mainly

Fine tuning

  • enamel hatchets
  • Binangle chisel
  • Gingival margin trimmers
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15
Q

inlay

pulpal floor

A

flat

even depth (approx. 1.5 mm)

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16
Q

inlay

isthmus

A

sufficient width for materials

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17
Q

inlay

Undercuts?

A

none

- need to be blocked out if they exist

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18
Q

inlay

taper?

A

slight taper

Slide in and seat with retention
- Improve path of insertion - Go in one way and out one way

Not over tapered – reduce retention

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19
Q

inlay

line angles

A

Rounded line angles – can fracture if sharp cliff edge

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20
Q

inlay preparation for ceramic/composite

A 
Isthmus: 1.5 - 2mm
1.5 mm depth
proximal box: 1.5-2mm
1mm (min) shoulder or chamfer margin 
- SHOULDER FOR CERAMIC

Margins clear of occlusal contact points

Flat pulpal floor

Even-depth

Perpendicular to path of insertion

4-6 degree Tapered walls
- No undercuts

No bevels at occlusal aspect
- (thin porcelain -> fracture)

Butt-joint cavosurface margins
- Brittle in thin section so don’t want to break

Clear of adjacent tooth contact points

(Supra-gingival) Shoulder or chamfer margin

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21
Q

inlay preparation for composite/ceramic measurements

A 
Isthmus: 1.5 - 2mm
1.5 mm depth
proximal box: 1.5-2mm
1mm (min) shoulder or chamfer margin 
- SHOULDER FOR CERAMIC
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22
Q

inlay preparation for gold

A

Isthmus: 1mm
1.5mm depth
1mm proximal box (min)
0.5 mm chamfer margin

Margins clear of occlusal contact points

Flat pulpal floor

  • Even-depth
  • Perpendicular to path of insertion

4-6 degree Tapered walls
- No undercuts

15-20 degree bevel upper 1/3 of isthmus wall

  • Stronger in thin section
  • Nicer fit

Clear of adjacent tooth contact points

  • buccal-lingual
  • apical depth

Occlusal key/Dovetail

(Supra-gingival) Shoulder or chamfer margins
- chamfer

If proximal box required – keep margins clear of adjacent tooth contact points

Consider internal accessory retention features (e.g. grooves)

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23
Q

inlay preparation gold measurements

A

Isthmus: 1mm
1.5mm depth
1mm proximal box (min)
0.5 mm chamfer margin

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24
Q

bevel

A

for gold inlay

15-20 degree bevel upper 1/3 of isthmus wall

  • Stronger in thin section
  • Nicer fit
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25
Q

tapered walls

A

for gold and ceramic/composite inlay

4-6 degree Tapered walls
- No undercuts

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26
Q

inlays - temporisation and impression

A

Make temporary restoration

Impressions and occlusal records

  • Send to lab for restoration fabrication
  • 2 weeks

Fit temporary restoration

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27
Q

alternative to inlays

A

Direct temporary materials

Kalzinol
- not recommended – decrease dentine bonding to resin based cements)

Clip

GI
- May overly bond – need to cut back out thus modifying preparation that impression is off

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28
Q

communication with lab for inlay

A 
Lab prescription
- Pour impressions – state stone 
- Mount casts
- Articulator – state type
Occlusal record – e.g. JetBite, waxbite
Facebow
Construct restoration
- Tooth (FDI notation)
- Material
- Thickness
- Characteristics
fissure patterns, staining, disguise tooth as another tooth e.g. An E as a 5, white spots, wear facelts
-Shade
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29
Q

inlay cementation for ceramic inlays

A

Weak when not cemented
- Don’t check occlusion as May fracture

Adhesive systems

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

Place matrix strips interproximally or PTFE tape over adjacent teeth

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30
Q

inlay cementation for gold inlays

A
  • AquaCem
  • Panavia
  • RMGI (RelyX)

Place matrix strips interproximally or PTFE tape over adjacent teeth

31
Q

onlays

A

Extra-coronal restorations made in lab

Like inlays but with cuspal coverage

Height of cusps need to be reduced during preparation

Less destructive alternative to crowns

32
Q

types of onlays (3)

A

Gold

Composite

Porcelain

33
Q

indications for onlays (2)

A

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

Remaining tooth substance weakened

  • Caries
  • pre-existing large restoration e.g.MODs with wide isthmuses; Thin cusps
34
Q

cast metal inlays/onlays preferable to amalgam when

A

Higher strength needed

Significant tooth recontouring required
- Easier to do outhwith pt mouth (esp wear cases

35
Q

uses of onlays (5)

A

Tooth wear cases
- Increase OVD

Fractured cusps

Restoration of root treated teeth

Replace failed direct restorations

Minor bridge retainers (not recommended)
- insufficient retention to successfully resist additional forces placed on abutment tooth by bridge

Less destructive alternative to crowns

36
Q

onlay preparation - the tools/armamentarium

A

Handpiece

Burs

  • No. 170L
  • No. 169L
  • Coarse-grit flame diamond
  • Flame (H4BL-010)

Enamel hatchets
Binangle chisel
Gingival margin trimmers

37
Q

onlay preparation measurements

porcelain

A

non working cusp: 1.5mm reduction

working cusp: 2mm reduction

Margins: 1mm shoulder/chamfer

38
Q

onlay preparation measurements

gold

A

non working cusp: 0.5mm reduction

working cusp: 1mm reduction

Margins: 0.5mm chamfer

39
Q

onlay preparation measurements

proximal box

A

if needed

1mm for gold
2mm for ceramic

40
Q

onlay preparation

ceramic/composite

A

Margins clear of occlusal contact points

4-6 degree Tapered walls
- No undercuts

Flat pulpal floor

  • Even-depth
  • Perpendicular to path of insertion

Proximal box (if required): 1mm width

Supra-gingival Shoulder or chamfer margins: 1mm

Rounded internal line angles

Occlusal reductions;

  • Non working cusp – 1.5mm reduction
  • Working cusp – 2mm reduction
41
Q

onlay preparation gold

A

Same as for composite/ceramic onlay expect:

Occlusal reductions

  • Non working cusp – 0.5mm reduction
  • Working cusp – 1mm reduction

Shoulder or chamfer margins: 0.5 mm
- Supra-gingival

Avoid cutting sound tooth tissue – use composite to block out undercuts

42
Q

undercuts in onlay

A

none

Avoid cutting sound tooth tissue – use composite to block out undercuts

43
Q

cusp reduction for onlay

A

Working cusp or non working cusp

Porcelain

  • non working – 1.5mm
  • working - 2mm

Gold

  • non – 0.5
  • Woking 1.5mm
44
Q

onlays - temporisation and impressions

A

Make temporary restoration

Take impressions and occlusal records

  • Send to lab for restoration fabrication
  • 2 weeks

Fit temporary restoration

45
Q

communication with lab for onlays

A

Lab prescription
- Pour impressions – state stone type

Mount casts
- Articulator -state type
Occlusal record – e.g. JetBite, waxbite
Facebow

Construct restoration
- Tooth (FDI notation)
- Material
- Thickness
- Characteristics
fissure patterns, staining, disguise tooth as another tooth 
e.g. An E as a 5.
- Shade
46
Q

onlay cementation - ceramic

A

Weak when not cemented
- Don’t check occlusion
May fracture

Adhesive systems

  • NX3 (Nexus) – ceramic onlays
  • ABC
  • RelyX Unicem self adhesive resin cement- Self etching, self priming resin based adhesive system

best
- NX3 (Nexus) – ceramic onlays

Place matrix strips interproximal or PTFE tape over adjacent teeth

47
Q

onlay cementation - gold

A
  • AquaCem (GI)
  • Panavia (Composite with 1—MDP) metals to stick, often with bridge
  • RMGI (RelyX)

Best
- AquaCem (GI)

Place matrix strips interproximal or PTFE tape over adjacent teeth

48
Q

inlay/onlay alternatives (3)

A

Large direct restorations

  • Amalgam
  • Composite
  • GI
Crowns
- ¾ crown
(Gold)
- Full crown
(Gold shell crown (GSC)
Metal-ceramic (MCC)
Porcelain (PJC))

Extraction

49
Q

Inlays/onlays 1st appointment

A

LA (if not RCT)

make putty index ->
impression for temporary ->
tooth preparation ->
make temporary ->

Sufficient clinical time
- impressions, bite registration and record shade

If insufficient time
- cement temporary

50
Q

inlays/onlays 2nd appointment

A

remove temporary ->

isolate, clean, dry prepared tooth ->

try in, assess fit, adaptation, occlusion etc

HAPPY -> cement
NOT HAPPY -> address issues

finally: minor occlusal adjustments (if needed)

51
Q

veneers a.k.a

A

Porcelain laminate veneer (PLV), Laminate veneer

52
Q

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.

53
Q

veneer types

A

Ceramic - labial

Composite - labial

Gold – palatal, tooth wear cases

54
Q

indications for veneers (3)

A

Improve aesthetics

Enamel defects

Discolouration – decipher cause, aid Tx

55
Q

intrinsic discolouration causes (8)

A

Non-vital teeth

Ageing

Trauma

Medications (tetracycline)

Fluorosis

Hypoplasia or hypomineralisation

Amelogenesis imperfecta

Erosion and abrasion

56
Q

extrinsic discolouration causes

A

Staining not amenable to bleaching

57
Q

aesthetic issues addressed by veneers

A

If considerable changes – use diagnostic wax ups or composite mock-ups

Change teeth shape and/or contour
- Correct peg-shaped laterals

Reduce or close proximal spaces and diastemas

Align labial surfaces of instanding teeth
- wider labial palatal direction, can charactered incisal edge

58
Q

contraindications to veneers (10)

A

Poor OH

High caries rate
- Interproximal caries and/or unsound restorations

Gingival recession

Root exposure

High lip lines – see margins more, so if Tx not great can be seen

If extensive prep needed (>50% of surface area no longer in enamel)

  • Consider alternatives – PJC, DBCs MCCs
  • Chemically bond to enamel?

Labially positioned, severely rotated and overlapping teeth

Extensive TSL/insufficient bonding area

Heavy occlusal contacts – substantial loads cause porcelain to fracture

Severe discolouration – degree of translucency

59
Q

preparation needed for veneers

A

None in some cases

Use putty index and depth cut burs

  • keep putty index
  • 0.5mm grooves into tooth then normal bur to match

If prep required:
- Incisal edge reduction (if required): 1 – 1.5mm
material dependant bevel edge
- Midfacial reduction: 0.5mm
Within enamel, sufficient porcelain thickness
- Cervical reduction: 0.3mm (thinner enamel, want to stay within enamel)
Slight chamfer margin
Within enamel
Supragingival or slightly subgingival (0.5mm)

60
Q

preparation for veneers

incisal edge reduction (if needed)

A

1 – 1.5mm

material dependant bevel edge

61
Q

preparation for veneers

Midfacial reduction

A

0.5mm

Within enamel, sufficient porcelain thickness

62
Q

Preparation for veneers

cervical reduction

A

0.3mm (thinner enamel, want to stay within enamel)

Slight chamfer margin

Within enamel
Supragingival or slightly subgingival (0.5mm

63
Q

4 veneer types

A

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

dictated by pt occlusion. Don’t want to bite on veneer – will fracture, But overlap needed for aesthetics

64
Q

minimal preparation veneer technique

A

Gurel Technique

diagnostic wax up with putty index on top
can see spaces between index and tooth
- Where porcelain goes
- assess thickness and preparation requirements

Mock up
- Fill with protemp – can check aesthetics, occlusal contact points

65
Q

veneers temporisation and impression

A

May not need temporary – as remaining in enamel
- Prime and bond cured on top can be used for minimal sensitivity

BUT if necessary…make temporary restoration

  • Take impressions and occlusal records
  • Send to lab for restoration fabrication (2 weeks)
  • Fit temporary restoration

Alternative – spot bonded composite
- No etch
- Small spot of primer and adhesive
(stick better in centre but strong enough for 2 week period and can be flicked off with prove)
- Directly apply composite to build veneer shell

66
Q

veneers communication with lab

A

Lab prescription
- Pour impressions

Mount casts
- Articulator
Occlusal record – e.g. JetBite, waxbite
Facebow

Construct restoration

  • Tooth (FDI notation)
  • Material
  • Thickness
  • Characteristics
  • Shade
  • Translucency – opaquer (severe discolouration or change shade)
67
Q

veneers cementation

A

Adhesive systems

  • NX3 (Nexus) composite based cement as porcelain based
  • ABC
  • RelyX Unicem

Matrix strip or PTFE tape - interproximal surfaces (time consuming, can damage veneer)

  • Remove excess before cement sets
  • Microbrushes/probes/floss
68
Q

veneers alternatives (4)

A

No treatment

Micro-abrasion

Direct composite restorations

Crowns

69
Q

veneer 1st appointment

A

tooth prep required?

YES

  • LA
  • make putty index
  • impression for temporary
  • make temporary

after this and if NO tooth prep needed
- impressions, bite registration and record shade

(cement temporary if needed)

70
Q

veneers 2nd appointment

A

remove temporary (if provided)

isolate, clean, dry prepared tooth

try-in, assess fit, adaptation and occlusion

HAPPY - cement
NOT HAPPY - address problems

71
Q

chamfer margins for (3)

A

metal

gold

palatal MCC

72
Q

shoulder margin for (1)

A

ceramic

73
Q

MCC crown margins

A

shoulder on labial

palatal has chamfer margin as just metal there

BDS3 Op Tech (10 decks)

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