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Operative Dentistry > Inlays, Onlays + Veneers > Flashcards

Inlays, Onlays + Veneers Flashcards

1
Q

What is an indirect restoration?

A

Made outside the mouth by a technician in a lab

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2
Q

Examples of indirect restorations

A
  1. Crowns
  2. Posts and cores
  3. Bridgework
  4. Inlays and onlays
  5. Veneers
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3
Q

List some examples of pre-operative assessment for an indirect restoration

A
  1. Radiographs
  2. Sensibility testing
  3. Mounted study models
  4. Diagnostic wax up
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4
Q

What can radiographs show?

A
  1. Caries
  2. Periodontal condition
  3. Peri-radicular/peri-apical lesions
  4. Previous RCT
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5
Q

Examples of sensibility testing

A
  1. Ethyl chlroide

2. EPT

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6
Q

Types of articulators

A

Semi or fully adjustable articulator

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7
Q

What can diagnostic wax up’s show? (4)

A
  1. Aesthetics
  2. Occlusion
  3. Communication with patient and lab
  4. Achievability
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8
Q

What are the conventional clinical stages of making an indirect restoration? (4)

A
  1. Preparation of the tooth
  2. Temporisation
    - Of tooth thats been prepped
  3. Impressions + occlusal records
    - To send off to lab to make the rest
  4. Cementation
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9
Q

Advantages of CAD-CAM

A
  1. Quick - single appointment

2. No temporary needed

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10
Q

Disadvantage of CAD-CAM

A

Accuracy questionable

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11
Q

What are the different types of inlays? (4)

A
  1. Gold
  2. Composite
  3. Porcelain
  4. Ceramic
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12
Q

Uses of inlays (3)

A
  1. Occlusal + interprox cavities
  2. Replacing failed direct restorations
  3. Minor bridge retainers (not advised)
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13
Q

What teeth are inlays recommended for?

A
  1. Premolars or molars
  2. Occlusal - MO/DO
  3. MOD - If kept narrow
  4. Low caries rate
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14
Q

Why would an inlay may not be the best option for an MOD?

A
  • If kept narrow
  • If its really wide then the cusps will be thin and weakened
  • This will create a wedging affect so the cusps will fracture off
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15
Q

Advantages of inlays vs direct restos (2)

A
  1. Superior materials + margins

2. Won’t deteriorate over time

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16
Q

Disadvantages of inlays vs direct restos (2)

A
  1. Time
    - longer prep
  2. Cost
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17
Q

What 2 burs are used for an inlay prep?

A
  1. Chamfer bur
    - Rounded edge creates ski slope margin around the tooth
  2. Shoulder bur
    - Square
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18
Q

Inlay prep:

Ceramic vs Gold

  1. Isthmus width
  2. Depth
  3. Proximal box
  4. Shoulder or chamfer margin
A 
CERAMIC
1.5-2mm isthmus width
1.5mm depth
1.5-2mm proximal box
1mm (min) shoulder/chamfer
GOLD 
1mm isthmus width
1.5mm depth
1mm proximal box 
0.5mm chamfer margin
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19
Q

Does ceramic require bevels?

A

No you want it square

Gold has a 20 degree bevel under 1/3rd of isthmus wall

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20
Q

Why should undercuts be avoided?

A
  • Lab will fill them with cement

- Not ideal as want least cement as possible and tighter fit

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21
Q

Whilst prepping the wall of the cavity, what degree of taper do we want?

A

4-6 degrees so the rest can slide down and fit into the tooth

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22
Q

Too much taper disadvantage

A

You can decrease retention

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23
Q

What type of material is a shoulder normally used with?

A

Ceramic materials

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24
Q

What type of material is a chamfer normally used with?

A

Gold

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25
Q

Why do we avoid bevels in ceramic inlays? (2)

A
  • Makes them brittle

- Butt joint cavosurface margins means you get a nice thickness of material in all areas of the restoration

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26
Q

Why do we use bevels in gold inlays? (2)

A
  • Gold is strong

- Nice bevel means we get a nicer fit around the restoration margins

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27
Q

Why must you be clear of the occlusal contact point?

A

Or you will get plaque accumulation or lead to secondary caries

28
Q

Whats the next steps after taking a temporary restoration for inlays/onlays + veneers? (3)

A
  1. Make temporary restoration
  2. Take the impressions + occlusal records
    - Send to lab for restoration fabrication
    - 2 weeks
  3. Fit temporary restoration
29
Q

Why should we be careful with Kalzinol?

A
  • Can decrease the condition of dentine so we don’t get as good as a bond with composite cement

Be careful if using resin based cements with Kalzinol to cement your restoration

30
Q

Communication with the lab for inlays / onlays + veneers (3)

A
  1. Lab prescription
    - Pour impressions
    - Type of stone you want them poured in
  2. Mount casts
    - Articulator (semi adjustable or fully)
    - Occlusal record (wax bite, jet bite)
    - Facebow (if modifying occlusion)
  3. Construct restoration
    - Tooth (FDI)
    - Material
    - Thickness
    - Characteristics (stimulate wear facets or white spot lesions)
    - Shade (for comp etc)
    - Translucency (for veneers)
31
Q

What are onlays? (2)

A
  • Like inlays but with cuspal coverage

- Height of cusps needs to be reduced during prep

32
Q

Different types of onlays (4)

A
  1. Gold
  2. Composite
  3. Porcelain
  4. Ceromeric
33
Q

Indications for onlays

A
  1. Sufficient occlusal tooth substance loss
  2. Buccal and or palatal/lingual cusps remaining
  3. Remaining tooth substance weakened
    - Caries
    - Pre-existing large restoration
    - MODs with wide isthmuses
34
Q

When are cast metal inlays/onlays preferable to amalgam?

A
  1. When higher strength is needed

2. Significant tooth recontouring required

35
Q

Why is it easier to do tooth recontouring in inlays/onlays rather than amalgam?

A
  • Much harder to do it directly in a patients mouth

- Working in a small space , saliva in the way etc

36
Q

Uses for onlays (5)

A
  1. Tooth wear cases - increase OVD
  2. Fractured cusps
  3. Restoration of root tx’d teeth
    - More likely to survive if cuspal coverage
  4. Replace failed direct restorations
  5. Minor bridge retainers (not recommended)
37
Q

Onlay prep:

Porcelain vs Gold

Non working cusp
Working cusp

A

1.5mm reduction non working cusp
2mm reduction working cusp

0.5mm reduction non working cusp
1mm reduction working cusp

38
Q

Onlay prep:

Proximal box gold

Proximal box ceramic

A

1mm gold

1.5-2mm ceramic

39
Q

Onlay prep:

Margins Porcelain

Margins Gold

A

1mm shoulder or chamfer

0.5mm chamfer

40
Q

Which type of inlay requires less occlusal reduction?

A

Gold

41
Q

Functional cusps?

A

Upper lingual

Lower buccal

42
Q

Non functional cusps?

A

Upper buccal

Lower lingual

43
Q

When to check occlusion of ceramic onlays (2)

A
  • Weak when not cemented

- Cement then check occlusion otherwise restoration will fracture and back to square 1

44
Q

What material is used to cement ceramic onlays?

A

ABC

45
Q

What material is used to cement for gold inlays

A

GI material

RMGI

46
Q

Inlays/onlays things to do on the 1st appointment (6)

A
  1. Make reduction template
  2. Impression for temporary
  3. Tooth preparation
  4. Make temporary
  5. Impressions, bite regi + record shade
  6. Cement temporary
47
Q

Inlays/onlays things to do on the 2nd appointment (5)

A
  1. Remove temporary
  2. Isolate. clean and dry prepared tooth
  3. Try in, assess fit, adaptation, occlusion etc
  4. Cement if no problems
  5. Minor occlusal adjustments if needed
48
Q

What are some alternatives to inlays/onlays? (3)

A
  1. Large direct restorations
    - Amalgam
    - Composite
    - GI
2. Crowns:
3/4 crown 
Full crowns
- Gold shell crown (GSC)
- Metal ceramic (MCC)
- Porcelain (PJC)
  1. Extraction
49
Q

What is a veneer?

A

Thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin

50
Q

Different types of veneer (3)

A
  1. Ceramic - labial veneers
  2. Composite - labial veneers
  3. Gold - palatal
    veneers/toothwear
51
Q

Indications for veneers (7)

A
  1. Aesthetics
  2. Change teeth shape/contour
  3. Correct peg-shaped laterals
  4. Reduce or close proximal spaces and diastemas
  5. Align labial surfaces of instanding teeth
  6. Enamel defects
  7. Discolouration
52
Q

What can discolouration of teeth be caused by?

A 
INTRINSIC
> Non vital teeth
> Ageing 
> Trauma
> Medications (tetracycline)
> Fluorosis
> Hypoplasia/hypomineralisation
> Amelogenesis imperfecta
> Erosion +abrasion

EXTRINSIC
> Staining not due to bleaching

53
Q

Contraindications for Veneers

A
  1. Poor OH
  2. High caries rate
    - Interprox caries and/or unsound restorations
  3. Gingival recession
  4. Root exposure
  5. High lip lines
  6. Labially positioned, severely rotated + overlapping teeth
  7. Head occlusal contacts
54
Q

Why should veneers be avoided if a patient has extensive tooth tissue loss +severely labially positioned teeth etc?

A
  1. Veneers bond best to enamel
  2. If we need to do extensive prep or the pt has lost a lot of tooth tissue and we are into dentine, we should consider crowns
  3. Crowns have mechanical retention whereas veneers rely on chemical bonding of tooth to enamel
55
Q

Why should veneers be avoided if a patient has heavy occlusal contacts? (2)

A
  • Little facings of porcelain will be subjected to quite substantial heavy loads
  • Making them more likely to fracture
56
Q

Veneer preparation

A

NONE

PREP FOR PLV
Use: Putty index + Depth cuts

CERVICAL REDUCTION
0.3mm
Slight chamfer margin within enamel

MIDFACIAL REDUCTION
0.5mm
Within enamel

INCISAL REDUCTION
1-1.5mm then bevel

57
Q

What kind of bur is used for a veneer prep?

A

Depth cut bur

58
Q

List the different types of veneer preps (4)

A
  1. Feathered incisal edge
  2. Incisal bevel
  3. Intra-enamel (window)
  4. Overlapped incisal edge
59
Q

Overlapped incisal edge veneer prep indication

A

Patients with discoloured incisal edges

60
Q

Whats the most common way to provide temp veneers?

A

Spot bonded composite

  • No etch
  • Divide tooth into 9 sections
  • Put a small spot of primer +adhesive into the centre then
    directly apply composite (veneer) over it
61
Q

Indication for opaque veneers

A

Cases with severe discolouration

62
Q

Indication for translucent veneers

A

Pt has nice natural shade so their tooth shines through and gives a natural appearance

63
Q

What do we use to cement veneers?

A

ABC

N3X

64
Q

1st appointment for Veneers (9)

A

Tooth prep required? YES

> LA 
> Make putty index to help reduce tooth
> Impression for temporary
> Tooth prep 
> Make temporary 
> Impressions, bite regi + record shade
> Cement temporary if necessary

Tooth prep required? NO

> Impressions, bite regi + record shade
Cement temporary if necessary

65
Q

2nd appointment for veneers (4)

A
  1. Remove temporary if provided
  2. Isolate clean and dry prepped tooth
  3. Try in, assess fit, adaptation + occlusion
  4. Cement
66
Q

List some alternatives to veneers (5)

A
  1. No tx
  2. Bleaching/tooth whitening
  3. Microabrasion
  4. Direct composite restorations
  5. Crowns

Operative Dentistry (6 decks)

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