Inlays, Onlays and Veneers Flashcards
(41 cards)
What are the parts of the pre-operative assessment?
Special Investigations
◦ Radiographs
◦ Caries
◦ Periodontal condition
◦ Peri-radicular/Peri-apicallesions
◦ Previous RCT
◦ Quality
◦ Sensibility testing
◦ Ethyl chloride
◦ Electric pulp test (EPT)
◦ Mounted study models
◦ Semi- or fully adjustable articulator
◦ Diagnostic wax-up
◦ Aesthetics
◦ Occlusion
◦ Communication with patient and lab ◦ Achievability
What are the conventional clinical stages of indirect restorations?
- Preparation
- Temporisation
- Impressions and occlusal records
- Cementation
How can indirect restorations be done chairside and what is a disadvantage?
CAD-CAM
◦ Restorations milled from block of ceramic
◦ Quick with no temporary needed
However may not be very accurate
What are inlays and what are the different materials?
intra-coronal restorations made in lab
materials
- 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 type of prep is used for a gold inlay and what type of prep is used for a ceramic inlay?
gold - rounded
ceramic - square
Indications for inlays?
◦ Premolars or molars
◦ Occlusal restorations
◦ Mesio-occlusal or disto-occlusal restoration
◦ MOD
◦ If kept narrow
◦ If not – consider onlay
◦ Low caries rate
Advantages Vs Disadvantages of Inlays
compared to direct restorations
Advantages (vs direct restorations)
◦ Superior materials and margins
◦ Won’t deteriorate over time
Disadvantages
◦ Time
◦ Cost
◦ Fractures (ceramic)
What is the inlay prep for ceramic?
isthmus, depth, chamfer, CSAM
- 1.5-2mm isthmus width
- 1.5mm depth
- 1mm (min) shoulder or chamfer margin
- Butt-joint cavosurface margins (No bevels)
What is the inlay prep for gold?
isthmus, depth, chamfer, CSAM
- 1mm isthmus width
- 1.5mm depth
- 0.5mm chamfer margin
- 15-20 o bevel upper 1/3 of isthmus wall
What are general prep features inlays may have?
- Occlusal key/Dovetail
- Grooves (internal retention features)
(proximal buccal and lingual/palatal axial walls gingival floor). - No undercuts
- Flat pulpal floor
- Margins clear of occlusal contact points
- ## Rounded line angles
What materials are usually used for the temporary restoration?
alternatives (less common too)
pre-op putty
protemp
less common;
kalzinol (ZOE)
clip (composite based)
GI
How are impressions taken?
time scale for lab
Take impressions and occlusal records ◦ Send to lab for restoration fabrication
◦ 2 weeks (typically)
What should the lab prescription include?
Lab prescription
Pour impressions
Mount casts
◦ Articulator
◦ Waxbite
◦ Occlusal record – e.g. JetBite, wax bite
◦ Facebow
Construct restoration
◦ Tooth (FDI notation)
◦ Material
◦ Thickness
◦ Shade
◦ Characteristics
What should you not do when the ceramic inlays/onlays are not cemented?
do not check occlusion
they may fracture
What are the adhesive systems used for cementing ceramic inlays/inlays?
3
◦ NX3 (Nexus) - main
◦ ABC
◦ RelyX Unicem self adhesive resin cement- Self etching, self priming resin based adhesive system
What are the adhesive systems used for cementing gold inlays/onlays?
3
◦ AquaCem - main
◦ Panavia
◦ RMGI (RelyX)
What are onlays and what are the different materials?
Extra-coronal restorations made in lab Like inlays but with cuspal coverage
Height of cusps need to be reduced during preparation
◦ Gold
◦ Composite
◦ Porcelain
What are indications of 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 preferred to amalgam?
◦ Higher strength needed
◦ Significant tooth recontouring required
What are the 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)
What is the onlay prep for porcelain?
working/ non cusp reduction, margin , csam
- Non working cusp – 1.5mm reduction
- Working cusp – 2mm reduction
- 1mm shoulder or chamfer
What is the onlay prep for gold?
working/ non cusp reduction, margin , csam
- Non working cusp – 0.5mm reduction
- Working cusp – 1mm reduction
- 0.5mm chamfer
What are all the steps of the 1st appointment for inlays/onlays?
7
- LA (if no RCT)
- Make reduction template
- Impression for temporary
- Tooth preparation
- Make temporary
- Impressions, bite reg, record shade
- Cement temporary
