Inlay, Onlay, Veneers Flashcards
(143 cards)
1
Q
Restorations fabricated outside of the mouth:
A
indirect restorations
2
Q
Describe the process of impressions for indirect restorations:
A
impression take of the prepared tooth, then sent to the lab or milled in-office
3
Q
Inlays, onlays, crowns, bridges and veneers are all examples of:
A
Indirect restorations
4
Q
What covers more surface area: inlay or onlay
A
onlay
5
Q
What materials are used for indirect restorations?
A
- gold
- lithium discillicate (EMAX)
6
Q
When should you place an indirect restoration?
A
- when margin exceeds 2/3 the distance between the central groove and cusp tip
- when margins end 1/2 distance between central groove and cusp tip
7
Q
When placing an indirect restoration for a tooth that the margin exceeds 2/3 of the distance between the central groove and cusp tip, you must:
A
cap weak cusps
8
Q
When placing an indirect restoration for a tooth that the margins end 1/2 the distance between the central groove and cusp tip, consider:
A
capping weak cusps
9
Q
Indirect restoration that is placed within the cusp tips of a tooth:
A
inlay
10
Q
this type of indirect restoration offers no protection of the cusp from occlusal forces:
A
inlay
11
Q
Inlays are used for teeth with: (2)
A
- minimal caries and strong buccal & lingual cusps
- acceptable (normal) occlusal
12
Q
Indirect restoration that covers one or more cusp tips, extending through and beyond the cusp tip to the facial/lingual & proximal slopes of the covered cusps:
A
onlay
13
Q
Onlays incorporate the principles and advantages of both:
A
intracoronal & extra-coronal restorations
14
Q
Describe the occlusion with an onlay:
A
occlusion in all functional positions is supported by restorative material rather than tooth structure
15
Q
Indications for onlays include:
A
- large carious lesions
- existing defective restorations
- cracked teeth
- endo treated teeth
16
Q
Onlays can be used on endodontically treated teeth only when: (2)
A
- they have sufficient tooth structure to retain the onlay and allow for removal of undercuts
- when enough facial and lingual surfaces are relatively intact
17
Q
If an onlay is not an option for an endo treated tooth, what should be used instead?
A
crown
18
Q
When do we use an onlay instead of an inlay?
A
- when the BL width of a cavity preparation is 1/2 distance between central groove and cusp tip
- when the BL width of the cavity prep is 2/3 distance between central groove and cusp tip
- where cusps are undermined after caries removal
- when the occlusion of the tooth nut be altered
19
Q
Should you do an inlay or an onlay in the following scenario?
The BL width of the cavity prep is 1/2 the distance between central groove and cusp tip
A
CONSIDER an onlay
20
Q
Should you do an inlay or an onlay in the following scenario?
The BL width of the cavity prep is 2/3 the distance between central groove and cusp tip
A
SHOULD onlay the cusp
21
Q
Indirect restoration that fully covers the occlusal surface of a tooth & uses the external walls for retention:
A
crownW
22
Q
What does a crown use for a retention?
A
external walls of the tooth
23
Q
Why do we do inlays and onlays? (4)
A
- preference over amalgam
- conserve tooth structure (compared to crown)
- esthetics
- removable prosthodontic abutment
24
Q
Why would we use an inlay or onlay for a removable prosthodontics abutment?
A
Can better control rest seats and guide planes
25
Disadvantages of indirect restorations: (3)
1. expense
2. requires 2 appointments
3. impression is needed
26
Advantages of indirect restorations: (3)
1. strength of materials
2. conservation of tooth structure
3. better control of restoration contours
27
What are two principles to follow with indirect restorations?
1. no undercuts; passive fit
2. no sharp line angles
28
Advantages of gold indirect restorations:
1. strength
2. wear resistance
3. will maintain smooth surface (no tarnish or corrosion)
4. better control of contact & contour
5. potential for greater longevity
6. conserves cementum and periodontal attachment vs. restoring with a crown
29
T/F: with a gold indirect restoration we have netter control of contact and contour especially for large proximal caries where an amalgam would not restore contact & contours
true
30
Contraindications for a gold indirect restoration:
1. facial or lingual caries or previous restorations (crown is better to restore multiple surfaces)
2. need to compare the margin length with that of a crown in some instances
3. patients with high caries rate
31
Why is it a contraindication to use a gold indirect restoration on facial or lingual caries or previous restorations?
Crown is better option to restore multiple surfaces
32
For patient with a high caries rate is a gold indirect restoration a good option?
no
33
MO gold inlay:
Divergence
-short walls:
-long walls:
Bevel
1.
2.
3.
NO _________
short walls: 2 degrees
long walls: 5-7 degrees
Bevel
1. occlusal= 1.0mm
2. axiopulpal line angle
3. gingival wall= 1.0mm
NO SHARP LINE ANGLES
34
MO gold inlay:
Occlusal internal form =
2.0mm deep
35
Do you dovetail a gold inlay preparation? Explain
Yes- prevents distal displacement
36
Do you use a reverse S curve in an inlay preparation? Explain
No- prep is more straight and angles; gold has strength at edge (unlike amalgam)
37
What is the adequate proximal clearance of a gold inlay preparation?
0.5 mm with smooth proximal walls
38
What is the function of a bevel?
Protects enamel from fracturing
39
Ceramic inlay:
occlusal depth=
isthmus width=
pulpal walls=
Facial, lingual & gingival margins should clear contacts by at least:
occlusal depth= 1.5-2.0mm
isthmus width= 2.0mm
pulpal walls= smooth & flat
Facial, lingual & gingival margins should clear contacts by at least: 0.5mm
40
For a ceramic inlay, facial & lingual walls MUST:
DIVERGE
41
For a ceramic inlay, need _____ insertion and greater than a ______ degree taper
passive; 2-5 degree
42
For a ceramic inlay the restoration ______ to the preparation walls
Bonds
43
The base of the main cavity for a ceramic inlay should be:
flat
44
In a ceramic inlay, occlusal margins may not coincide with:
occlusal contacts
45
In a ceramic inlay, margins should be prepared to a _____; alternatively they should present a hollow ______ in an attempt to create an "invisible margin"
90 degree cavosurface line angle; ground chamfer
46
If a prep gets too wide, you must:
onlay either buccal and/or lingual cusps
47
an inlay acts as a _____ whereas an onlay _____
wedge; protect
48
For an onlay, we need _____; this is NOT the same as _____
occlusal clearance; reduction
49
the amount of space between the teeth:
clearance
50
the amount of tooth structure removed:
reduction
51
Gold onlays:
depth cuts
- lingual (functional cusp):
- facial:
lingual: 1.5 mm
facial: 1.0 mm
52
What cusps are beveled with a gold onlay?
both non-functional & functional cusps
53
In gold onlays, the retention from short axial walls=
2 degree divergence
54
The main principle for gold onlays is to cover:
both facial and lingual cusps of maxillary and mandibular teeth
55
What is the minimum amount of gold to cover cusps of SUPPORTING occlusion in a gold onlay?
What is the minimum amount of gold to cover cusps of NON-SUPPORTING occlusion in a gold onlay
1.5 mm of gold
1.0 mm of gold
56
Describe the bevel on cusps supporting occlusion in a gold onlay:
Describe the bevel on cusps not supporting occlusion in a gold onlay:
1-2 mm reverse bevel
0.5 mm reverse bevel
57
What is exception got cuspal coverage with gold onlays?
(typically both facial and lingual cusps are covered)
Exception for esthetics on maxillary teeth
58
What is the exception fort esthetics on maxillary teeth with gold onlays?
Do not cover the facial cusps of maxillary molar or premolar if supported by strong tooth structure
(modified "esthetic" coverage of facial cusp if weak)
59
Indications for porcelain onlays include: (2)
1. esthetics
2. large defects or previous restorations
60
Describe some large defects or previous restorations that would indicate the use of a porcelain onlay: (4)
1. wide labiolingual missing tooth structure
2. teeth that require cuspal coverage
3. contours of large restorations (easier to make these in a lab vs. typical restoration)
4. for durability when replacing occlusion and contacts
61
Contraindications for porcelain onlays include: (4)
1. locations where we can't obtain sufficient bulk
2. areas under excessive stress
3. inability to maintain dry field
4. deep subG preps
62
What are some advantages of porcelains onlays? (3)
1. improved physical properties
2. wear resistance
3. reduced polymerization shrinkage
63
_______ wears the opposing teeth the most but has the most resistance to wear as well
porcelain
64
Can polymerization shrinkage occur with porcelain onlays?
yes- but all shrinkage occurs in the lab, the only material that can shrink is the resin composite cement which is used during cementation
65
Disadvantages to porcelain onlays: (6)
1. increased cost and time
2. technique sensitivity
3. ceramics (porcelain) are brittle
4. ceramics wear down opposing dentition & restorations
5. low potential for repair
6. difficulty try in and delivery
66
The clinical procedure for a porcelain onlay includes:
1. removal old restorations
2. excavate all caries
3. block out undercuts with glass ionomer/liner or resin composite
67
What type of line angle should be present in a porcelain onlay? What bur accomplishes this?
rounded internal line angles; round end bur (such as 245)
68
Why should all line & point angles (internal & external) be rounded in a porcelain onlay?
to avoid stress concentrators
69
Porcelain onlays:
functional cusp reduction:
non-functional cusp reduction:
Bulk of porcelain @ _____, NO ____
____ internal line angles
No _____ margins
Functional cusp: 2.0mm
Non-functional cusp: 1.5mm
Bulk of porcelain at margins- no bevel
smooth internal line angles
No ferrule margins
70
In a porcelain onlay, ceramic retention is based on _____ not _____
surface area; not opposing walls
71
For a porcelain onlay, we need adequate thickness for:
strength of restorative materials
72
The margins in a porcelain onlay should be _____ and have a:
well-defined; 90 degree butt-joint cavosurface angle
73
What is the purpose of the 90 degree butt-joint cavosurface angle in a porcelain onlay?
ensures marginal strength
74
What should NOT be present with a porcelain onlay?
NO external bevels
75
Thin ceramic margins are prone to:
fracture
76
Describe the proximal margin requirements for a porcelain onlay?
need adequate clearance (0.5 mm) from adjacent teeth for die separation
77
Should the exit angle break contact in a porcelain onlay?
yes
78
Provisional considerations:
use _____ cement because:
Eugenol-free; eugenol interferes with bonding
79
Provisional considerations:
If you must use a cement containing eugenol, it is important to:
pumice tooth well to remove eugenol
80
Provisional considerations:
_____ & ______ are delayed until AFTER CEMENTATION because of fragility of porcelain restorations
occlusal evaluation and adjustments
81
The _______ in a provisional are larger than gold inlay and onlay margins
marginal gaps
82
What step in a provisional is often completed by the lab, but if not you need to make sure you do it yourself?
silanation
83
Describe what must occur with a provisional before cementation with a resin cement:
porcelain is acid etched with hydrofluoric acid and then silanated
84
What instruments may be used for finishing and polishing ceramics:
1. medium to fine grit diamond instrument
2. 30-fluted carbide burs
3. rubber, abrasive impregnated porcelain polishing points
4. diamond polishing paste
85
A thin covering used to hide the under layer:
veneers
86
Types of veneers include:
1. indirect
2. direct
87
Indirect veneers are most commonly made of:
Feldspathic porcelain or lithium discilicate
88
Direct veneers are most commonly made of:
composite
89
Indications for veneers include: (6)
1. intrinsic discoloration
2. extrinsic discoloration
3. wear patterns
4. poor restorations
5. diastema closure
6. rotated and misaligned teeth
90
Examples of intrinsic staining include:
1. tetracycline staining
2. fluorosis
91
Examples of external discoloration include:
1. coffee
2. smoking
3. wine
92
Contraindications for veneers include: (9)
1. severely malpositioned teeth
2. denuded dentin
3. unavailable enamel
4. poor oral hygeine
5. beware of highly fluoridated teeth
6. no primary teeth
7. adolescents
8. pregnancy
9. oral habits (bruxism)
93
Porcelain veneer indications include:
1. good oral hygeine
2. good periodontal health
3. poor esthetics (something that will be improved)
4. proper patient psychology
5. caries free
6. met dental needs
7. INFORMED CONSENT/REASONABLE EXPECTATIONS
94
The main advantage of porcelain veneers is:
Excellent esthetics
95
Disadvantages of porcelain veneers include: (4)
1. time
2. cost compared to composite veneers
3. some tooth preparation (must have adequate room)
4. requires laboratory involvement & fee
96
Price of composite veneers:
($100-150/unit)
97
Alternate treatment to porcelain veneers includes:
1. bleaching for discoloration
2. micro- & macro-abrasion
3. direct composite veneers (microfilm composite resin polishes best)
4. PFM/Porcelain jacket crown
5. orthodontics
98
What type of direct composite veneer polishes best?
microfilm composite resin
99
Advantages of composite (direct) veneers:
1. masks discoloration of a tooth
2. less cost to patient
3. usually one appointment
4. can correct simple tooth rotation & diastema easily
100
Disadvantages of composite (direct) veneers:
1. susceptible to wear
2. margin fracture and stain
3. discoloration
101
What are more technique sensitive- Direct (composite) or indirect veneers:
direct (composite) veneers
102
Direct (composite) are often less _______ compared to lab fabricated veneers
less esthetic
103
Why do we do an intra-enamel preparation with a composite veneer?
1. provides space to achieve maximum esthetics
2. removes outer fluoride rich layer of enamel (resistant to etching)
3. roughens surface for improved bonding
4. establishes definite finish line
104
What is the most often recommended preparation for composite veneers?
window preparation where the incise edge remains intact
105
Type of composite veneer preparation where as much tooth structure as possible is conserve and the incisal edge remains intact:
Window preparation (recommended)
106
Type of composite veneer preparation where the preparation includes the incisal edge, and is indicated when toot needs to be lengthened or there is an incisal defect that needs to be corrected:
incisal lapping preparation
107
Some clinicians do too minimal tooth preparation with veneers that leads to:
overcontoured (bulky) veneers
108
Involves use of acidic and abrasive agents applied to enamel surface:
microabrasion
109
Describe what is used for microabrasion:
37% phosphoric acid and pumice or 6% hydrochloric acid and silica
110
Removal of enamel defect with bur:
macroabrasion
111
Describe what is used for macroabrasion:
12 fluted carbide or diamond finishing bur, followed by 30 fluted carbide finishing bur & then polished with a rubber point
112
What is a very important early step in the porcelain veneer procedure?
diagnostic was up
(to see what ca be done for both you and your patient)
113
Used in the porcelain veneer procedure; made form wax up and tells you how much reduction is needed to get ideal from wax up:
prep guide
114
_____ prep is needed for porcelain veneers
minimal
115
For porcelain veneers, try to keep prep in _____ for ____
enamel; optimal bond strength
116
Reduction for porcelain veneers depends on:
material & changes desried
117
Put in order of greatest to least flexure strength for the following materials used for porcelain veneers:
-lithium disciliate
-feldspathic porcelain
-leucite glass ceramic
1. litium discillicate (500 MPa)
2. Leucite glass ceramic (160 MPa)
3. Feldspathic porcelain (100 MPa)
118
- 0.3 mm chamfer at margin or slightly subG
- thickness is 0.5-0.7mm on labial surface
-1.5 mm incisal reduction (1-2 mm reduction is acceptable & 90 degree butt joint is best)
minimal prep veneers
119
What materials can be used for minimal prep veneers?
1. EMAX (pressed monolithic ceramic)
2. Empress (pressed ceramic)
3. Feldspathic porcelain (etched porcelain)
120
Used in situations of:
-moderate alignment corrections
-up to 3 step change in chroma or value
-diastema correction of less than 1mm
moderate prep veneers
121
- 0.3 mm chamfer at margin or slightly subG
- 0.8-1.0 mm on labial surface
- 1.5 mm at incisal reduction (1-2mm reduction is acceptable & 90 degree butt joint is best)
122
Materials used for moderate prep veneers include:
1. EMAX (pressed monolithic ceramic)
2. Empress (pressed ceramic)
3. Feldspathic porcelain (etched porcelain)
123
When would you exceed the gingival crest or 0.3-0.5 subgingival prep for veneers?
when severely discolored enamel is present you may have to go subG
124
For veneers, when the tooth is lingual version:
little to no gingival reduction is necessary
125
For tooth preparation of veneers, contour the ______ amount necessary according to the material you are using to restore the teeth
minimum
126
For the incisal margins of veneers, a minimum of _____ reduction is needed for material bulk, or _____ reduction of incisal if lengthening incisal edge
1.0-2.0 mm; NO reduction
127
What type of shoulder should be seen on the incisal margin of veneer preps?
Butt shoulder
128
We do we not incorporate a lingual margin for veneer preps:
1. seating issues
2. lingual margin failure from inadequate porcelain thickenss
3. porcelain needs bulk when loaded
4. incisal butt margin preferred
129
What should you use as a matrix to fabricate provisionals for porcelain veneers?
Provisional is made with temporary material such as:
wax up; Densply integrity
130
Veneer insertion:
Remove provisional and clean prep with:
non fluoridated pumice
131
Veneer insertion:
Clean interproximal lightly with:
finishing strip
132
Veneer insertion:
Isolate with:
rubber dam & sometimes retraction cord
133
Veneer insertion:
Etch with:
37% phosphoric acid
(if in enamel for 30 sec)
(if in dentin (15 sec)
134
Veneer insertion:
After etching with 37% phosphoric acid, you should place:
bonding agent
135
Veneer insertion:
Place ______ in veneer and place veneer on tooth
light-cured composite cement
136
Veneer insertion:
Why would you ONLY use a light cured composite cement?
1. working time
2. no color shift
(dual cure cements often have color change because of tertiary amines)
137
Veneer insertion:
_____ in order to clean cement from margin
tack cure
138
When should you polish and check occlusion with a veneer? Why?
After veneers have been bonded; fracture more likely otherwise
139
What should you use to polish a veneer after bonding?
diamond bur & water spray
140
What may excess heat cause when polishing veneers because:
excess heat may cause degredation of cement bond
141
In order- what are the top seven mistakes with veneers?
1. failure to address gingival asymmetry
2. failure to do a wax-up for the case
3. failure to work with an experienced esthetic ceramist
4. using ferric sulfate (astringedent) hemostatic agent to stop bleeding around gingiva (stains margins)
5. improper bonding technique
6. failure to communication effectively with patient
7. starting a case that should have NEVER been started in the first place
142
What should you avoid using with veneers to stop bleeding around gingiva? What should you used instead?
Avoid using Ferric sulfate hemostatic agent (Astringedent)- this stains margin
Use aluminum chloride (Hemodent) instead
143
