Inlays, Onlays + Veneers Flashcards
What is an indirect restoration?
Made outside the mouth by a technician in a lab
Examples of indirect restorations
- Crowns
- Posts and cores
- Bridgework
- Inlays and onlays
- Veneers
List some examples of pre-operative assessment for an indirect restoration
- Radiographs
- Sensibility testing
- Mounted study models
- Diagnostic wax up
What can radiographs show?
- Caries
- Periodontal condition
- Peri-radicular/peri-apical lesions
- Previous RCT
Examples of sensibility testing
- Ethyl chlroide
2. EPT
Types of articulators
Semi or fully adjustable articulator
What can diagnostic wax up’s show? (4)
- Aesthetics
- Occlusion
- Communication with patient and lab
- Achievability
What are the conventional clinical stages of making an indirect restoration? (4)
- Preparation of the tooth
- Temporisation
- Of tooth thats been prepped - Impressions + occlusal records
- To send off to lab to make the rest - Cementation
Advantages of CAD-CAM
- Quick - single appointment
2. No temporary needed
Disadvantage of CAD-CAM
Accuracy questionable
What are the different types of inlays? (4)
- Gold
- Composite
- Porcelain
- Ceramic
Uses of inlays (3)
- Occlusal + interprox cavities
- Replacing failed direct restorations
- Minor bridge retainers (not advised)
What teeth are inlays recommended for?
- Premolars or molars
- Occlusal - MO/DO
- MOD - If kept narrow
- Low caries rate
Why would an inlay may not be the best option for an MOD?
- 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
Advantages of inlays vs direct restos (2)
- Superior materials + margins
2. Won’t deteriorate over time
Disadvantages of inlays vs direct restos (2)
- Time
- longer prep - Cost
What 2 burs are used for an inlay prep?
- Chamfer bur
- Rounded edge creates ski slope margin around the tooth - Shoulder bur
- Square
Inlay prep:
Ceramic vs Gold
- Isthmus width
- Depth
- Proximal box
- Shoulder or chamfer margin
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
Does ceramic require bevels?
No you want it square
Gold has a 20 degree bevel under 1/3rd of isthmus wall
Why should undercuts be avoided?
- Lab will fill them with cement
- Not ideal as want least cement as possible and tighter fit
Whilst prepping the wall of the cavity, what degree of taper do we want?
4-6 degrees so the rest can slide down and fit into the tooth
Too much taper disadvantage
You can decrease retention
What type of material is a shoulder normally used with?
Ceramic materials
What type of material is a chamfer normally used with?
Gold
Why do we avoid bevels in ceramic inlays? (2)
- Makes them brittle
- Butt joint cavosurface margins means you get a nice thickness of material in all areas of the restoration
Why do we use bevels in gold inlays? (2)
- Gold is strong
- Nice bevel means we get a nicer fit around the restoration margins
Why must you be clear of the occlusal contact point?
Or you will get plaque accumulation or lead to secondary caries
Whats the next steps after taking a temporary restoration for inlays/onlays + veneers? (3)
- Make temporary restoration
- Take the impressions + occlusal records
- Send to lab for restoration fabrication
- 2 weeks - Fit temporary restoration
Why should we be careful with Kalzinol?
- 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
Communication with the lab for inlays / onlays + veneers (3)
- Lab prescription
- Pour impressions
- Type of stone you want them poured in - Mount casts
- Articulator (semi adjustable or fully)
- Occlusal record (wax bite, jet bite)
- Facebow (if modifying occlusion) - Construct restoration
- Tooth (FDI)
- Material
- Thickness
- Characteristics (stimulate wear facets or white spot lesions)
- Shade (for comp etc)
- Translucency (for veneers)
What are onlays? (2)
- Like inlays but with cuspal coverage
- Height of cusps needs to be reduced during prep
Different types of onlays (4)
- Gold
- Composite
- Porcelain
- Ceromeric
Indications for onlays
- Sufficient occlusal tooth substance loss
- Buccal and or palatal/lingual cusps remaining
- Remaining tooth substance weakened
- Caries
- Pre-existing large restoration
- MODs with wide isthmuses
When are cast metal inlays/onlays preferable to amalgam?
- When higher strength is needed
2. Significant tooth recontouring required
Why is it easier to do tooth recontouring in inlays/onlays rather than amalgam?
- Much harder to do it directly in a patients mouth
- Working in a small space , saliva in the way etc
Uses for onlays (5)
- Tooth wear cases - increase OVD
- Fractured cusps
- Restoration of root tx’d teeth
- More likely to survive if cuspal coverage - Replace failed direct restorations
- Minor bridge retainers (not recommended)
Onlay prep:
Porcelain vs Gold
Non working cusp
Working cusp
1.5mm reduction non working cusp
2mm reduction working cusp
0.5mm reduction non working cusp
1mm reduction working cusp
Onlay prep:
Proximal box gold
Proximal box ceramic
1mm gold
1.5-2mm ceramic
Onlay prep:
Margins Porcelain
Margins Gold
1mm shoulder or chamfer
0.5mm chamfer
Which type of inlay requires less occlusal reduction?
Gold
Functional cusps?
Upper lingual
Lower buccal
Non functional cusps?
Upper buccal
Lower lingual
When to check occlusion of ceramic onlays (2)
- Weak when not cemented
- Cement then check occlusion otherwise restoration will fracture and back to square 1
What material is used to cement ceramic onlays?
ABC
What material is used to cement for gold inlays
GI material
RMGI
Inlays/onlays things to do on the 1st appointment (6)
- Make reduction template
- Impression for temporary
- Tooth preparation
- Make temporary
- Impressions, bite regi + record shade
- Cement temporary
Inlays/onlays things to do on the 2nd appointment (5)
- Remove temporary
- Isolate. clean and dry prepared tooth
- Try in, assess fit, adaptation, occlusion etc
- Cement if no problems
- Minor occlusal adjustments if needed
What are some alternatives to inlays/onlays? (3)
- Large direct restorations
- Amalgam
- Composite
- GI
2. Crowns: 3/4 crown Full crowns - Gold shell crown (GSC) - Metal ceramic (MCC) - Porcelain (PJC)
- Extraction
What is a veneer?
Thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin
Different types of veneer (3)
- Ceramic - labial veneers
- Composite - labial veneers
- Gold - palatal
veneers/toothwear
Indications for veneers (7)
- Aesthetics
- Change teeth shape/contour
- Correct peg-shaped laterals
- Reduce or close proximal spaces and diastemas
- Align labial surfaces of instanding teeth
- Enamel defects
- Discolouration
What can discolouration of teeth be caused by?
INTRINSIC > Non vital teeth > Ageing > Trauma > Medications (tetracycline) > Fluorosis > Hypoplasia/hypomineralisation > Amelogenesis imperfecta > Erosion +abrasion
EXTRINSIC
> Staining not due to bleaching
Contraindications for Veneers
- Poor OH
- High caries rate
- Interprox caries and/or unsound restorations - Gingival recession
- Root exposure
- High lip lines
- Labially positioned, severely rotated + overlapping teeth
- Head occlusal contacts
Why should veneers be avoided if a patient has extensive tooth tissue loss +severely labially positioned teeth etc?
- Veneers bond best to enamel
- 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
- Crowns have mechanical retention whereas veneers rely on chemical bonding of tooth to enamel
Why should veneers be avoided if a patient has heavy occlusal contacts? (2)
- Little facings of porcelain will be subjected to quite substantial heavy loads
- Making them more likely to fracture
Veneer preparation
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
What kind of bur is used for a veneer prep?
Depth cut bur
List the different types of veneer preps (4)
- Feathered incisal edge
- Incisal bevel
- Intra-enamel (window)
- Overlapped incisal edge
Overlapped incisal edge veneer prep indication
Patients with discoloured incisal edges
Whats the most common way to provide temp veneers?
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
Indication for opaque veneers
Cases with severe discolouration
Indication for translucent veneers
Pt has nice natural shade so their tooth shines through and gives a natural appearance
What do we use to cement veneers?
ABC
N3X
1st appointment for Veneers (9)
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
2nd appointment for veneers (4)
- Remove temporary if provided
- Isolate clean and dry prepped tooth
- Try in, assess fit, adaptation + occlusion
- Cement
List some alternatives to veneers (5)
- No tx
- Bleaching/tooth whitening
- Microabrasion
- Direct composite restorations
- Crowns
