Inlays, Onlays & Veneers Flashcards
What are indirect restorations
Indirect restorations are restorations that are fabricated outside of the mouth by a technician in a laboratory
What are examples of indirect restorations
○ Crowns ○ Post and cores ○ Bridgework ○ Inlays and onlays ○ Veneers
What does the full history consist of
○ Complaining of ○ History of complaint ○ Past medical history ○ Past dental history Social history
What do we look for in the intra oral exam
§ Oral hygiene
§ Caries/Fractures
□ Are these teeth restorable?
Periodontal condition
What special investigations can be carried out to get further info
radiographs
sensibility testing
mounted study models
diagnostic wax up
What is the radiograph useful for
§ Caries § Perio condition § Peri-radicular/periapical lesion § Previous RCT What is the quality?
What do we mount the study models on
Semi- or fully adjustable articulator
What is the use of the diagnostic wax up
§ Aesthetics
§ Occlusion
§ Communication with patient and lab
§ Achievability
What are the conventional stages of preparation
- Preparation
- Temporisation
- Impressions and occlusal records
Cementation
What are chair side indirect restorations
Restorations milled from block of ceramic via CADCAM
Why are chair side restorations good
§ Quickly done - can be a single appointment
§ No temporary required
§ There are questions over the accuracy compared to the conventional technique
What is an inlay
intra coronal restoration made in the lab and it is like a filling made outside of the mouth
What are different types of inlays
○ Gold
○ Composite
○ Porcelain
Ceromeric (combination of composite and porcelain)
What are the uses of inlays
○ Occlusal cavities
○ Occlusal/interproximal cavities
○ Replace failed direct restorations
○ Minor bridge retainers (old technique that is not advised anymore)
What are indications of inlays
○ For premolars or molars ○ For occlusal restorations ○ For mesio-occlusal or disto-occlusal restorations ○ MOD if kept narrow Low caries rate
Why does MOD need to be narrow for inlays
§ If it is wide it means the cusps are now thin and if you put an inlay it will create a wedge effect causing the cusps to fracture off
§ For a wide MOD consider an inlay
What is the advantage of an inlay vs direct restoration
○ Superior materials and margins
○ Wont deteriorate over time and so will hopefully last longer because of that
What are the disadvantages of an inlay
○ Time
○ Cost (better materials)
What tools are required for inlay/onlay
○ Handpiece ○ Burs ○ Enamel hatchets ○ Binangle chisel GM trimmers
What is the inlay prep for ceramic
1.5-2mm isthmus width
1.5mm depth
1.5-2mm proximal box
1mm (min) shoulder or chamfer margin
What does the prep consist of for an inlay
4-6 degree tapered walls no undercuts margins clear of occlusal contact points shoulder or chamfer supra gingival margins no bevel for ceramic but bevel for gold
What is the bevel for gold inlay
15-20 degrees bevel upper 1/3 of isthmus wall
Describe the process of temporization and impression
○ Make temporary restoration
○ Take impressions and occlusal records and send to the lab for restoration fabrication which will take around 2 weeks
○ Fit the temporary restoration
○ Alternative is using direct temporary materials
What are direct temp materials
Kalzinol
Clip
GI
What is the risk with GI
although a risk with GI is that it bonds well to the tooth so have to cut it back out which can modify prep
What do you communicate with the lab
○ Lab prescription § Pour impressions ○ Mount casts § Articulator □ Occlusal record - e.g jetbite, wax bite □ Facebow ○ Construct restoration § Tooth (FDI notation) § Material § Thickness § Characteristics § Shade
What are onlays
xtra-coronal restorations are made in the lab
They are like inlays but with cuspal coverage meaning the height of the cusps needs to be reduced during preparation
What are the types of onlays
gold
comp
porcelain
ceromeric
What are the adhesive systems for gold
□ Aqua CEM (GI)
□ Panavia (comp with 10-MDP)
□ RMGI (relyX)
What is the disadvantages of porcelain
§ Weak when not cemented
§ Do not check the occlusion or if you do have to be super gentle because it may result in fracture
What is the adhesive system for porcelain
https://us02web.zoom.us/j/86142355242?pwd=QzBLMnA0dURlK011RGYrZFEwZU5ydz09
What are indications for onlays
○ Sufficient occlusal tooth substance loss with buccal and/or palatal/lingual cusps remaining
○ Remaining tooth substance is weakened
Why may remaining tooth substance be weakened
§ Caries
§ Pre-existing large restoration
§ MODs with wide isthmuses
When are cast metal inlays/onlays preferable to amalgam
§ Higher strength is needed
§ Significant teeth recontouring is required
What are uses of onlays
§ Tooth wear cases □ Increase OVD § Fractured cusps § Restoration of root treated teeth § Replace failed direct restorations § Minor bridge retainers (not recommended) § LESS DESTRUCTIVE THAN CROWNS
For porcelain onlay what are the occlusal reductions
1.5mm for non working cusp
2mm for working cusp
For gold onlay what are the occlusal reductions
non working cusp = 0.5mm reduction
working cusp = 1mm reduction
What is the proximal box if required for onlay prep
1mm for gold, 1.5-2mm ceramic
What are the margins for an onlay
1mm shoulder or chamfer for porcelain
0.5mm chamfer for gold
What happens at first appointment for inlay onlay
- LA
- make reduction template
- impression for temp
- make temporary
- impressions, bite registration and record shade
- cement temp
What happens at the second appointment for inlay onlay
- remove temp
- isolate, clean and dry prepared tooth
- try in, assess fit, adaption, occlusion etc
- cement
- minor occlusal adjustment if needed
What are alternatives to inlays and onlays
• Large direct restorations ○ Amalgam ○ Composite ○ GI • Crowns ○ 3/4 crown § Gold ○ Full crown § Gold shell crown GSC § Metal cerramic (MCC) § Porcelain (PJC) • Extraction
What are veneers
- Also known as porcelain laminate veneers (PLV) or laminate veneer
- A laminate veneer is a thin layer of cast ceramic that is bonded to the surface of a tooth with resin
What are types of veneers
○ Ceramic
○ Composite
○ Gold
What are indications for veneers
○ Improve aesthetics (if considerable changes then use diagnostic wax ups or composite mockups
○ Change teeth shape/contour
○ Correct peg shaped laterals
○ Reduce or close proximal spaces and diastemas
○ Align labial surfaces of in standing teeth
○ Enamel defects
○ Discolouration
What are causes of discoloration
□ Non-vital teeth □ Ageing □ Trauma □ Medications (tetracycline) □ Fluorosis □ Hypoplasia or hypomineralisation □ Amelogenesis imperfecta □ Erosion and abrasion
What are contraindications for veneers
○ Poor OH
○ High caries rate
○ Gingival recession
○ Root exposure
○ High lip lines
○ If extensive prep is needed (>50% of surface enamel) then consider alternatives - PJC, DBC, MCCs
§ We want to bond to enamel so if it is into dentine then may want to look at crowns as they have a degree of chemical retention
○ Labially positioned, severely rotated and overlapping teeth
§ Would require a lot of prep so could end up in dentine
○ Extensive TSL/insufficient bonding area
○ Heavy occlusal contacts
○ Severe discoluration
What is the cervical reduction for a veneer
0.3mm
slight chamfer margin
within enamel
supra gingival or slightly sub gingival
What is the mid facial reduction for a veneer
0.5mm
within enamel
What is the incisor reduction
1-1.5mm
What are the types of veneer prep
feathered incisor edge
incisor bevel
intra-enamel window
overlapped incisor edge
What is your choice of veneer prep dictated by
• What choice you make as to which type of prep is dictated by the patients occlusion. We don’t want the patient to be biting where the veneer meets the tooth as till come off so we need to
What is the gurel technique
○ The putty index is made and shows the space between the tooth and the index. The space tells you where its going to go and some teeth are so in standing that they don’t require much preparation but some do
Fill any spaces in the index with protemp and then make the ideal veneer prep with the mockup so the tooth tissue required to be removed will be removed and you will preserve tooth tissue in areas that don’t need to be cut
What is temporization and impression for veneers
○ May not need temp ○ Make a temporary restoration ○ Take impressions and occlusal records and send to lab for fabrication (takes 2 weeks) ○ Fit temp ○ Composite temp is an alternative § No etch § Small spot of primer and adhesive § Directly apply composite
What is the lab card for veneers
○ Lab prescription § Pour impressions ○ Mount casts § Articulator □ Occlusal record - e.g jetbite, wax bite □ Facebow ○ Construct restoration § Tooth (FDI notation) § Material § Thickness § Characteristics § Shade § Translucency
What is the cementation for veneers
○ Adhesive systems
§ NX3
§ ABC
relyX unicem
What is the matrix strip for cementation
○ Matrix strip or PFTE interproximal surfaces to prevent cement flowing over adjacent teeth and bonding over it
Remove excess when the cement isnt set with a microbrush
What is the first visit for veneers
tooth prep
make temp
impressions bite registration and record shade
cement temp
What is the second visit for veneers
remove temp
isolate, clean and dry prepared tooth
try in, asses fit, adaptation and occlusion
cement and address problems
What are alternatives to veneers
○ No tx ○ Bleaching/whitening ○ Micro abrasion ○ Direct composite restorations Crowns
