Inlays, Onlays and Veneers (Georgie) Flashcards
(88 cards)
1
Q
What is an ‘indirect’ restoration?
A
- Restorations fabricated outside the mouth by a technician in a lab
2
Q
What are examples of indirect restorations? (5)
A
- Crowns
- Post and cores
- Bridgework
- Inlays and onlays
- Veneers
3
Q
What would you include within a pre-operative assessment? (12)
A
Full history and exam:
- CO
- HPC
- PMH
- PDH
- FH
- SH
- EO
- IO
- Oral hygiene
- Caries, fractures (restorable?)
- Periodontal condition
4
Q
What special investigations might you include in a pre-operative assessment? (4)
A
- Radiographs
- Sensibility testing
- Mounted study models
- Diagnostic wax up
5
Q
What are you looking for in radiographs in a pre-operative assessment? (5)
A
- Caries
- Periodontal condition
- Peri-radicular/peri-apical lesions
- Previous RCT
- Quality
6
Q
What does the diagnostic wax up allow you to do? (4)
A
- Aesthetics
- Occlusion
- Communication with patient and lab
- Achievability
7
Q
What are the 4 conventional clinical stages for indirect restorations?
A
- Preparation
- Temporisation
- Impressions and occlusal records
- Cementation
8
Q
What are the benefits of the CAD-CAM restorations milled from a block of ceramic? (2)
A
- Quick
- No temporary needed
9
Q
What is the possible negative of the CAD-CAM restorations milled from a block of ceramic?
A
There are questions over the accuracy of it
10
Q
What is an inlay?
A
Intra coronal restoration made in lab - like a filling made outside the mouth
11
Q
What are the different types of inlays? (4)
A
- Gold
- Composite
- Porcelain
- Ceromeric (mix of composite and porcelain)
12
Q
What are the uses of inlays? (4)
A
- Occlusal cavities
- Occlusal/interproximal cavities
- Replace failed direct restorations
- Minor bridge retainers (not advised)
13
Q
What are indications for inlays? (5)
A
- Premolars and molars
- Occlusal
- Mesio-occlusal or disto-occlusal restoration
- MOD (if kept narrow as if not thin would find that cusps are quite thin and so might fracture off)
- Low caries rate (good chance of maintaining the restoration)
14
Q
What are advantages of inlays vs direct restorations? (2)
A
- Superior materials and margins
- Won’t deteriorate over time
15
Q
What are disadvantages of inlays vs direct restorations? (2)
A
- Time
- Cost
16
Q
What tools can we use for inlay preparations? (5)
A
- Handpiece
- Burs
- Enamel hatchet
- Binangle chisel
- Gingival margin trimmers
(bottom 3 might use but not needed)
17
Q
What burs are available to use for inlay preparations? (7)
A
- No. 170L
- No. 169L
- Coarse-grit flame diamond
- Flame (H4BL-010)
- Ready made bur kits
- Shamper bur
- Shoulder bur
18
Q
What are the 2 burs we would use the most for inlay preparations?
A
- Shamper shape bur
- Shoulder bur
19
Q
When preparing a tooth for an inlay where do we not wan the margin to be near?
A
- Don’t want it to be near the natural contact point
20
Q
Do we want undercuts when preparing a tooth for an inlay?
A
- No
21
Q
Do we want tapered walls when preparing a tooth for an inlay?
A
- Want a slight taper (4-6 degrees)
22
Q
What do we want the pulpal floor to be like?
A
Flat with an even depth (approx. 1.5m)
23
Q
What do we want the line angles to be like for an inlay preparation?
A
Rounded
24
Q
With what material would you use a shoulder bur?
A
When you are using ceramic materials
25
With what material would you use a shamper bur?
When you are using gold
26
If you don't think you have enough retention in a cavity prep for an inlay what can you do?
- Can cut grooves and scores into the tooth
27
Why do we want rounded internal line angles for an inlay cavity prep?
- To prevent fracture of the restoration
28
What are the dimensions we want for a cavity prep for a ceramic inlay? (4)
- 1.5-2mm isthmus width
- 1.5mm depth
- 1.5-2mm proximal box
- 1mm (min) shoulder or chamfer margin
29
What are the dimensions we want for a cavity prep for a gold inlay? (4)
- 1mm isthmus width
- 1.5mm depth
- 1mm proximal box (min)
- 0.5mm chamfer margin
30
What should we do first when preparing for an inlay?
- Make the temporary restoration
| - do this first so if you run out of time in the session at least this is done
31
What is the temporisation and impression stage of preparing inlays? (3)
- Make temporary restoration
- Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
- Fit temporary restoration (with protemp)
32
What are alternative temporary restorations to protemp? (4)
Direct temporary materials:
- Kalzinol
- Clip
- GI (will have to cut GI back out and so might alter the cavity prep which is not what we want)
33
When we want an inlay to be produced, what should we write on our lab card? (3)
Pour impressions
- Say what type of stone you want them poured in
Mount casts
- Articulator (which one)
- Occlusal record e.g. jetbite, wax bite
- Facebrow (if altering the occlusion in any way
Construct restoration
- Tooth (FDI notation)
- Material
- Thickness
- Characteristics
- Shade
34
What is the key difference between inlays and onlays?
- Onlays have cuspal coverage
| - So need to do some cuspal modification for onlays
35
What is an onlay?
Extra-coronal restorations made in lab
| - Like inlays but with cuspal coverage (height of cusps need to be reduced during restoration)
36
What are the different types of onlays? (4)
- Gold
- Composite
- Porcelain
- Ceromeric
37
What are indications for onlays? (6)
Sufficient occlusal tooth substance loss
- Buccal and/or palatal/lingual cusps remaining
Remaining tooth substance weakened
- Caries
- Pre-existing large restorations
- MOD's with wide isthmuses
38
When are cast inlays/onlays preferable to amalgam? (2)
When:
- Higher strength needed
- Significant tooth recontouring required
39
What is the main advantage of onlays?
- Less destructive alternative to crowns
40
What are the uses of onlays? (5)
- Tooth wear cases (increase OVD)
- Fractured cusps
- Restoration of root retained teeth (more likely to survive if the restoration has cuspal coverage)
- Replace failed direct restorations
- Minor bridge retainers (not recommended)
41
What are the tools used for inlays? (5)
- Handpiece
- Burs
- Enamel hatchets
- Binangle chisel
- Gingival margin trimmers
42
What occlusal reduction would you want to do on a working cusp if replacing it with a porcelain onlay?
2mm reduction
43
What occlusal reduction would you want to do on a non-working cusp if replacing it with a porcelain onlay?
1.5mm reduction
44
What occlusal reduction would you want to do on a working cusp if replacing it with a gold onlay?
1mm reduction
45
What occlusal reduction would you want to do on a non-working cusp if replacing it with a gold onlay?
0.5mm reduction
46
If a proximal box is required for an onlay prep how big would it have to be for a gold onlay?
1mm
47
If a proximal box is required for an onlay prep how big would it have to be for a ceramic onlay?
2mm
48
What should the margin be like for a porcelain onlay preparation?
1mm shoulder or chamfer
49
What should the margin be like for a gold onlay preparation?
0.5mm chamfer
50
When preparing for an onlay what should we make sure the margins are clear of?
- Should be clear of occlusal contact points
51
When preparing for an onlay, if we are using ceramic should we have a bevel?
- No
| - Want to have butt-joint cavosurface margins
52
When preparing for an onlay we want to ensure the margins are supra-gingival. Why is this?
- So the patient can keep the margins nice and clean
53
If preparing a tooth for a gold onlay do we want a bevelled margin?
Yes, want 15-20 degrees bevel in the upper 1/3 of isthmus wall
And want 4-6 degrees tapered wall on other margins
54
For an onlay preparation do we want undercuts?
- No
55
For an onlay preparation what do we want the internal line angles to be like?
- Want them to be rounded
56
What is the procedure for temporisation and impression of an onlay? (3)
- Make temporary restoration
- Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
- Fit temporary restoration
57
When we want an onlay to be produces, what should we include in the lab card? (3)
Pour impressions
- Say what type of stone you want them poured in
Mount casts
- Articulator (which one)
- Occlusal record e.g. jetbite, wax bite
- Facebrow (if altering the occlusion in any way
Construct restoration
- Tooth (FDI notation)
- Material
- Thickness
- Characteristics
- Shade
58
What do we need to be careful of prior to cementing a ceramic onlay?
- They are weak when not cemented
| - Be very careful if checking the occlusion as they might fracture
59
What are the different adhesive systems used for ceramic onlays? (3)
- NX3 (Nexus)
- ABC
- RelyX Unicem self adhesive resin cement - self etching, self priming resin based adhesive system
60
What are the different adhesive systems used for gold onlays? (3)
- AquaCem (GI)
- Panavia (composite with 10-MDP)
- RMGI (RelyX)
61
What would be included within the first appointment for inlay/onlay prep? (7)
- LA (if no RCT)
- Make reduction template
- Impression for temporary
- Tooth preparation
- Make temporary
- Impressions, bite registration and record shade
- Cement temporary
62
What would be included within the second appointment for inlay/onlay prep? (6)
- Remove temporary
- Isolate, clean and dry prepared tooth
- Try-in, assess fit, adaptation, occlusion etc
- If happy to cement: cement -> minor occlusal adjustments (if required)
- If not happy to cement: address problems
63
What are alternatives to inlays/onlays?
Large direct restorations:
- Amalgam
- Composite
- GI
Crowns:
- 3/4 crown - gold
- Full crown (gold shell crown, metal-ceramic, porcelain)
Extraction
64
What are 2 names for veneers?
- Porcelain laminate veneer
| - Laminate veneer
65
What is a laminate veneer?
- A laminate veneer is a thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin
66
What are the 3 different types of veneer?
- Ceramic
- Composite
- Gold
67
What kind of veneer are ceramic and composite usually used for?
- Usually used for labial veneers
68
What kind of veneer is gold usually used for?
Palatal veneers - can be used in tooth wear cases
69
What are indications for veneers? (5)
- Improved aesthetics
- Change teeth shape and/or contour
- Correct peg-shaped laterals
- Reduce or close proximal spaces and diastemas
- Align labial surfaces of in standing teeth
70
Why might veneers be indicated for teeth with discoloration? (long answer)
- Enamel defects
```
Discolouration:
Intrinsic:
- Non-vital teeth
- Ageing
- Trauma
- Medications (tetracycline)
- Fluorosis
- Hypoplasia or hypo mineralisation
- Amelogenesis imperfects
- Erosion and abrasion
```
Extrinsic:
- Staining not amenable to bleaching
71
What are contraindications for veneers? (10)
- Poor OH
- High caries rate (interproximal caries and/or unsound restorations)
- Gingival recession
- Root exposure
- High lip lines
- If extensive prep needed (>50%of surface area no longer in enamel)
- Labially positioned, severely rotated and overlapping teeth
- Extensive TSL/insufficient bonding area
- Heavy occlusal contacts
- Severe discoloration
72
What preparation is required for porcelain laminate veneers? (2)
Use:
- Putty index
- Depth cuts
73
What cervical reduction needs to be done for veneer preparation? (3)
- 0.3mm
- Slight chamfer margin
- Within enamel
- Supragingival or slightly subgingival
74
What midfacial reduction needs to be done for veneer preparation? (2)
- 0.5mm
| - Within enamel
75
What incisal reduction needs to be done for veneer preparation?
1-1.5mm
76
What is a depth cut bur used for?
- Used for veneer preparation
- Makes 0.5mm grooves into the tooth
- Gives you a guide to be as conservative as you can
77
What are the 4 types of veneer preparation?
- Feathered incisal edge
- Incisal bevel
- Intra-enamel (window)
- Overlapped incisal edge
78
What is the veneer preparation type dictated by?
- Dictated by the patients occlusion
- Don't want patient to be biting on the edge of the margin as it will just fracture
- Also need to bear in mind aesthetics - some patients might have a stained incisal edge so need to overlap this
79
What is the name of the technique for minimal preparation for veneers?
- Gurel technique
80
Explain the Gurel technique?
- Impression has been taken and wax up done
- Then a putty index was taken
- The space between the teeth and the putty index tells you how much porcelain you are going to put and how much tooth prep you need
- Then take the index and fill the spaces up - put it in the patients mouth and once it sets it gives a mock up of the veneers in the patients mouth
- Then prepare ideal tooth prep through the mock up - will preserve tooth tissue in areas you don't need to cut
81
What is the process for temporising and impressions for veneers? (4)
- May not need temporary
- Make temporary restoration (if need it)
- Take impressions and occlusal records (send to lab for restoration fabrication - 2 weeks)
- Fit temporary restoration
- Alternative - spot bond composite
- No etch
- Small spot of primer and adhesive
- Directly apply composite (veneer)
82
When preparing for veneers, what should we include in the lab prescription (3)
Pour impressions
- Say what type of stone you want them poured in
Mount casts
- Articulator (which one)
- Occlusal record e.g. jetbite, wax bite
- Facebrow (if altering the occlusion in any way
Construct restoration
- Tooth (FDI notation)
- Material
- Thickness
- Characteristics
- Shade
- Translucency
83
What might we use to cement veneers? (3)
- NX3 (Nexus)
- ABC
- RelyX Unicem
Want to be using a composite based resin cement
84
What is included in the process of cementing veneers? (2)
- Matrix strip or PTFE in interproximal surfaces to stop you from cementing all of the teeth together
Remove excess:
- When cement not set
- Micro-brushes
85
What would the first appointment be like for veneers if no tooth prep is required? (3)
- No tooth prep required
- Impressions, bite registration and record shade
- Cement temporary (if necessary)
86
What would the first appointment be like for veneers if tooth prep is required? (8)
- Tooth prep required
- LA (if necessary)
- Make putty index
- Impression for temporary
- Tooth preparation
- Make temporary
- Impressions, bite registration and record shade
- Cement temporary (if necessary)
87
What would the second appointment be like for veneers ? (5)
- Remove temporary (if provided)
- Isolate, clean and dry prepared tooth
- Try in, assess fit, adaptation and occlusion
- If happy to cement then cement
- If not happy to cement then address the problems
88
What are the possible alternatives to veneers? (5)
- No treatment
- Bleaching/tooth whitening
- Micro-abrasion
- Direct composite restorations
- Crowns
