Inlays, Onlays and Venners Flashcards
What are the conventional clinical stages of Indirect restorations?
- Preparation
- Temporisation
- Impressions and occlusal records
- Cementation
What is CAD-CAM?
- Restorations milled from block of ceramic
- Chairside
- Quick
- No temp needed
- Accuracy questionable
What are inlays?
- Intra-coronal restorations made in lab
- Essentially a filling made outside the mouth
What are the types of inlays?
- Gold
- Composite
- Porcelain
What are the uses of inlays?
- Occlusal cavities
- Occlusal/interproximal cavities
- Replace failed direct restorations
- Minor bridge retainers – no longer recommended
What are the indications if inlays?
- Premolars or molars
- Occlusal restorations
- Mesio-occlusal or disto-occlusal restoration
- MOD If kept narrow (If not – consider onlay)
- Low caries rate
What are the advantages of inlays vs direct restorations?
- Better materials and margins
- Won’t deteriorate over time
What are the disadvantages of inlays?
- Time
- Cost
What tools are needed for inlay preparations?
- Handpiece
- Burs
- No. 170L
- No. 169L
- Coarse-grit flame diamond
- Flame (H4BL-010)
- Enamel hatchets
- Binangle chisel
- Gingival margin trimmers
What is the inlay preparation for Ceramic inlay?
- 1.5mm-2mm isthmus width
- 1.5mm depth
- 1mm shoulder or chamfer margin
- Occlusal key/dovetail
- Consider grooves for accessory retention
What is the temporisation and impression stage of inlays and onlays?
- Make temporary restoration
- Take impressions and occlusal records
- Send to lab for restoration fabrication
- Fit temp rest
What is the lab prescription for inlays and onlays?
- Pour impression
- Mount casts on articulator
- Construct restoration in
- Tooth
- Material
- Thickness
- Shade
- Characteristics
What can you use to cement ceramic inlays and onlays?
- NX3 (Nexus) RMGIC
What are onlays?
- Extra-coronal restorations made in lab
- Inlays with cuspal coverage essentially
What are the types of onlays?
- Gold
- Composite
- Porcelain
What are the indications for onlays?
- Sufficient occlusal tooth substance loss (buccal and or palatal cusps remain)
- Remaining tooth substance weakened by caries or pre existing large restoration
When are cast metal inlays/onlay preferred to amalgam?
- When higher strength needed
- Significant tooth recontouring required
What are the uses of onlays?
- Tooth wear cases to increase OVD
- Fractured cusps
- Restoration of root treated
- Replace failed direct restorations
What is the onlay preparation for porcelain?
- Non working cusp 1.5mm reduction
- Working cusp 2mm reduction
- Proximal box if required 1mm
- 1mm shoulder or chamfer
What does the first appointment for inlays and onlays consist of?
- LA if no RCT
- Make reduction template
- Impression for temp
- Tooth prep
- Make temporary
- Impressions, bite registration and record shade
- Cement temp
What does the 2nd appointment for inlays and onlays consist of?
- Remove temp
- Isolate, clean and dry prepared tooth
- Try in, assess fit, adaptation and occlusion
- If happy then cement
- Minor occlusal adjustments if needed
What are some inlay/onlay alternatives?
- Large direct restorations with amalgam/ composite/ GI
- Crown (either 3/4 or full crown)
- XLA
What are veneers?
- Laminate veneer is a thing layer of cast ceramic that is bonded to labial or palatal surface of a tooth with resin
What are the types of veneers?
- Ceramic
- Composite
- Gold
What are some indications for veneers?
- 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
What are some contraindications to veneers?
- Poor OH
- High caries rate
- Gingival recession
- Root exposure
- High lip lines
- Heavy occlusal contacts
- Sever discolouration
What is the preparations for veneers if any?
- 0.3mm cervical reduction at slight chamfer margin either supragingival or slightly subgingival
- 0.5mm midfacial reduction
- 1-1.5mm incisal reduction
What are the types of veneer preparations?
- Feathered incisal edge
- Incisal bevel
- Intra-enamel (window)
- Overlapped incisal edge
What is the temporisation and impression stage of veneers?
- May not need but if temp needed
- Take impressions and occlusal records and send to lab for restoration fabrication
- Fit temp restoration
What is an alternative approach to veneer than temporisation?
- Spot bonded composite
- No etch
- Small spot of primer and adhesive
- Directly apply composite
What does the first appointment of veneers consist of?
- 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
What does 2nd appointment of veneers consist of?
- Remove temp
- Isolate, clean and dry prepared tooth
- Try in, assess fit, adaptation and occlusion
- Cement
What are some alternatives to veneers?
- No treatment
- Micro-abrasion
- Penetrative resin restorations e.g. ICON
- Direct composite restorations
- Crown
