Inlays, Onlays and Venners

Question 1

What are the conventional clinical stages of Indirect restorations?

Answer 1

• Preparation
• Temporisation
• Impressions and occlusal records
• Cementation

Question 2

What is CAD-CAM?

Answer 2

• Restorations milled from block of ceramic
• Chairside
• Quick
• No temp needed
• Accuracy questionable

Question 3

What are inlays?

Answer 3

• Intra-coronal restorations made in lab
• Essentially a filling made outside the mouth

Question 4

What are the types of inlays?

Answer 4

• Gold
• Composite
• Porcelain

Question 5

What are the uses of inlays?

Answer 5

• Occlusal cavities
• Occlusal/interproximal cavities
• Replace failed direct restorations
• Minor bridge retainers – no longer recommended

Question 6

What are the indications if inlays?

Answer 6

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

Question 7

What are the advantages of inlays vs direct restorations?

Answer 7

• Better materials and margins
• Won’t deteriorate over time

Question 8

What are the disadvantages of inlays?

Answer 8

• Time
• Cost

Question 9

What tools are needed for inlay preparations?

Answer 9

• Handpiece
• Burs
  
  • No. 170L
  • No. 169L
  • Coarse-grit flame diamond
  • Flame (H4BL-010)
• Enamel hatchets
• Binangle chisel
• Gingival margin trimmers

Question 10

What is the inlay preparation for Ceramic inlay?

Answer 10

• 1.5mm-2mm isthmus width
• 1.5mm depth
• 1mm shoulder or chamfer margin
• Occlusal key/dovetail
• Consider grooves for accessory retention

Question 11

What is the temporisation and impression stage of inlays and onlays?

Answer 11

• Make temporary restoration
• Take impressions and occlusal records
• Send to lab for restoration fabrication
• Fit temp rest

Question 12

What is the lab prescription for inlays and onlays?

Answer 12

• Pour impression
• Mount casts on articulator
• Construct restoration in
• Tooth
• Material
• Thickness
• Shade
• Characteristics

Question 13

What can you use to cement ceramic inlays and onlays?

Answer 13

• NX3 (Nexus) RMGIC

Question 14

What are onlays?

Answer 14

• Extra-coronal restorations made in lab
• Inlays with cuspal coverage essentially

Question 15

What are the types of onlays?

Answer 15

• Gold
• Composite
• Porcelain

Question 16

What are the indications for onlays?

Answer 16

• Sufficient occlusal tooth substance loss (buccal and or palatal cusps remain)
• Remaining tooth substance weakened by caries or pre existing large restoration

Question 17

When are cast metal inlays/onlay preferred to amalgam?

Answer 17

• When higher strength needed
• Significant tooth recontouring required

Question 18

What are the uses of onlays?

Answer 18

• Tooth wear cases to increase OVD
• Fractured cusps
• Restoration of root treated
• Replace failed direct restorations

Question 19

What is the onlay preparation for porcelain?

Answer 19

• Non working cusp 1.5mm reduction
• Working cusp 2mm reduction
• Proximal box if required 1mm
• 1mm shoulder or chamfer

Question 20

What does the first appointment for inlays and onlays consist of?

Answer 20

• LA if no RCT
• Make reduction template
• Impression for temp
• Tooth prep
• Make temporary
• Impressions, bite registration and record shade
• Cement temp

Question 21

What does the 2nd appointment for inlays and onlays consist of?

Answer 21

• Remove temp
• Isolate, clean and dry prepared tooth
• Try in, assess fit, adaptation and occlusion
• If happy then cement
• Minor occlusal adjustments if needed

Question 22

What are some inlay/onlay alternatives?

Answer 22

• Large direct restorations with amalgam/ composite/ GI
• Crown (either 3/4 or full crown)
• XLA

Question 23

What are veneers?

Answer 23

• Laminate veneer is a thing layer of cast ceramic that is bonded to labial or palatal surface of a tooth with resin

Question 24

What are the types of veneers?

Answer 24

• Ceramic
• Composite
• Gold

Question 25

What are some indications for veneers?

Answer 25

- Improve aesthetics - Change teeth shape and / or contour - Correct peg shaped laterals - Reduce or close proximal spaces and diastemas - Align labial surfaces of instanding teeth - Enamel defects - Discolouration

Question 26

What are some contraindications to veneers?

Answer 26

- Poor OH - High caries rate - Gingival recession - Root exposure - High lip lines - Heavy occlusal contacts - Sever discolouration

Question 27

What is the preparations for veneers if any?

Answer 27

- 0.3mm cervical reduction at slight chamfer margin either supragingival or slightly subgingival - 0.5mm midfacial reduction - 1-1.5mm incisal reduction

Question 28

What are the types of veneer preparations?

Answer 28

- Feathered incisal edge - Incisal bevel - Intra-enamel (window) - Overlapped incisal edge

Question 29

What is the temporisation and impression stage of veneers?

Answer 29

- May not need but if temp needed - Take impressions and occlusal records and send to lab for restoration fabrication - Fit temp restoration

Question 30

What is an alternative approach to veneer than temporisation?

Answer 30

- Spot bonded composite - No etch - Small spot of primer and adhesive - Directly apply composite

Question 31

What does the first appointment of veneers consist of?

Answer 31

- If tooth prep required - LA if needed - Make putty index - Impression for temp - Tooth prep - Make temp - Impressions, bite registration and record shade - Cement temp

Question 32

What does 2nd appointment of veneers consist of?

Answer 32

- Remove temp - Isolate, clean and dry prepared tooth - Try in, assess fit, adaptation and occlusion - Cement

Question 33

What are some alternatives to veneers?

Answer 33

- No treatment - Micro-abrasion - Penetrative resin restorations e.g. ICON - Direct composite restorations - Crown