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BDS3 CLINICAL Optech > Inlays, Onlays & Veneers > Flashcards

Inlays, Onlays & Veneers Flashcards

(60 cards)

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1
Q

What are indirect restorations

A

Indirect restorations are restorations that are fabricated outside of the mouth by a technician in a laboratory

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2
Q

What are examples of indirect restorations

A 
○ Crowns
		○ Post and cores
		○ Bridgework
		○ Inlays and onlays 
		○ Veneers
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3
Q

What does the full history consist of

A 
○ Complaining of 
		○ History of complaint 
		○ Past medical history
		○ Past dental history
Social history
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4
Q

What do we look for in the intra oral exam

A

§ Oral hygiene
§ Caries/Fractures
□ Are these teeth restorable?
Periodontal condition

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5
Q

What special investigations can be carried out to get further info

A

radiographs
sensibility testing
mounted study models
diagnostic wax up

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6
Q

What is the radiograph useful for

A 
§ Caries
			§ Perio condition
			§ Peri-radicular/periapical lesion 
			§ Previous RCT 
What is the quality?
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7
Q

What do we mount the study models on

A

Semi- or fully adjustable articulator

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8
Q

What is the use of the diagnostic wax up

A

§ Aesthetics
§ Occlusion
§ Communication with patient and lab
§ Achievability

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9
Q

What are the conventional stages of preparation

A
  1. Preparation
    1. Temporisation
    2. Impressions and occlusal records
      Cementation
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10
Q

What are chair side indirect restorations

A

Restorations milled from block of ceramic via CADCAM

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11
Q

Why are chair side restorations good

A

§ Quickly done - can be a single appointment
§ No temporary required
§ There are questions over the accuracy compared to the conventional technique

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12
Q

What is an inlay

A

intra coronal restoration made in the lab and it is like a filling made outside of the mouth

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13
Q

What are different types of inlays

A

○ Gold
○ Composite
○ Porcelain
Ceromeric (combination of composite and porcelain)

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14
Q

What are the uses of inlays

A

○ Occlusal cavities
○ Occlusal/interproximal cavities
○ Replace failed direct restorations
○ Minor bridge retainers (old technique that is not advised anymore)

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15
Q

What are indications of inlays

A 
○ For premolars or molars
		○ For occlusal restorations
		○ For mesio-occlusal or disto-occlusal restorations 
		○ MOD if kept narrow
Low caries rate
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16
Q

Why does MOD need to be narrow for inlays

A

§ If it is wide it means the cusps are now thin and if you put an inlay it will create a wedge effect causing the cusps to fracture off
§ For a wide MOD consider an inlay

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17
Q

What is the advantage of an inlay vs direct restoration

A

○ Superior materials and margins

○ Wont deteriorate over time and so will hopefully last longer because of that

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18
Q

What are the disadvantages of an inlay

A

○ Time

○ Cost (better materials)

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19
Q

What tools are required for inlay/onlay

A 
○ Handpiece
		○ Burs
		○ Enamel hatchets
		○ Binangle chisel
GM trimmers
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20
Q

What is the inlay prep for ceramic

A

1.5-2mm isthmus width
1.5mm depth
1.5-2mm proximal box
1mm (min) shoulder or chamfer margin

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21
Q

What does the prep consist of for an inlay

A 
4-6 degree tapered walls
no undercuts
margins clear of occlusal contact points
shoulder or chamfer supra gingival margins 
no bevel for ceramic but bevel for gold
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22
Q

What is the bevel for gold inlay

A

15-20 degrees bevel upper 1/3 of isthmus wall

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23
Q

Describe the process of temporization and impression

A

○ Make temporary restoration
○ Take impressions and occlusal records and send to the lab for restoration fabrication which will take around 2 weeks
○ Fit the temporary restoration
○ Alternative is using direct temporary materials

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24
Q

What are direct temp materials

A

Kalzinol
Clip
GI

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25
What is the risk with GI
although a risk with GI is that it bonds well to the tooth so have to cut it back out which can modify prep
26
What do you communicate with the lab
``` ○ Lab prescription § Pour impressions ○ Mount casts § Articulator □ Occlusal record - e.g jetbite, wax bite □ Facebow ○ Construct restoration § Tooth (FDI notation) § Material § Thickness § Characteristics § Shade ```
27
What are onlays
xtra-coronal restorations are made in the lab | They are like inlays but with cuspal coverage meaning the height of the cusps needs to be reduced during preparation
28
What are the types of onlays
gold comp porcelain ceromeric
29
What are the adhesive systems for gold
□ Aqua CEM (GI) □ Panavia (comp with 10-MDP) □ RMGI (relyX)
30
What is the disadvantages of porcelain
§ Weak when not cemented | § Do not check the occlusion or if you do have to be super gentle because it may result in fracture
31
What is the adhesive system for porcelain
https://us02web.zoom.us/j/86142355242?pwd=QzBLMnA0dURlK011RGYrZFEwZU5ydz09
32
What are indications for onlays
○ Sufficient occlusal tooth substance loss with buccal and/or palatal/lingual cusps remaining ○ Remaining tooth substance is weakened
33
Why may remaining tooth substance be weakened
§ Caries § Pre-existing large restoration § MODs with wide isthmuses
34
When are cast metal inlays/onlays preferable to amalgam
§ Higher strength is needed | § Significant teeth recontouring is required
35
What are 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 ```
36
For porcelain onlay what are the occlusal reductions
1.5mm for non working cusp | 2mm for working cusp
37
For gold onlay what are the occlusal reductions
non working cusp = 0.5mm reduction | working cusp = 1mm reduction
38
What is the proximal box if required for onlay prep
1mm for gold, 1.5-2mm ceramic
39
What are the margins for an onlay
1mm shoulder or chamfer for porcelain | 0.5mm chamfer for gold
40
What happens at first appointment for inlay onlay
1. LA 2. make reduction template 3. impression for temp 4. make temporary 5. impressions, bite registration and record shade 6. cement temp
41
What happens at the second appointment for inlay onlay
1. remove temp 2. isolate, clean and dry prepared tooth 3. try in, assess fit, adaption, occlusion etc 4. cement 5. minor occlusal adjustment if needed
42
What are alternatives to inlays and onlays
``` • Large direct restorations ○ Amalgam ○ Composite ○ GI • Crowns ○ 3/4 crown § Gold ○ Full crown § Gold shell crown GSC § Metal cerramic (MCC) § Porcelain (PJC) • Extraction ```
43
What are veneers
* Also known as porcelain laminate veneers (PLV) or laminate veneer * A laminate veneer is a thin layer of cast ceramic that is bonded to the surface of a tooth with resin
44
What are types of veneers
○ Ceramic ○ Composite ○ Gold
45
What are indications for veneers
○ Improve aesthetics (if considerable changes then use diagnostic wax ups or composite mockups ○ Change teeth shape/contour ○ Correct peg shaped laterals ○ Reduce or close proximal spaces and diastemas ○ Align labial surfaces of in standing teeth ○ Enamel defects ○ Discolouration
46
What are causes of discoloration
``` □ Non-vital teeth □ Ageing □ Trauma □ Medications (tetracycline) □ Fluorosis □ Hypoplasia or hypomineralisation □ Amelogenesis imperfecta □ Erosion and abrasion ```
47
What are contraindications for veneers
○ Poor OH ○ High caries rate ○ Gingival recession ○ Root exposure ○ High lip lines ○ If extensive prep is needed (>50% of surface enamel) then consider alternatives - PJC, DBC, MCCs § We want to bond to enamel so if it is into dentine then may want to look at crowns as they have a degree of chemical retention ○ Labially positioned, severely rotated and overlapping teeth § Would require a lot of prep so could end up in dentine ○ Extensive TSL/insufficient bonding area ○ Heavy occlusal contacts ○ Severe discoluration
48
What is the cervical reduction for a veneer
0.3mm slight chamfer margin within enamel supra gingival or slightly sub gingival
49
What is the mid facial reduction for a veneer
0.5mm | within enamel
50
What is the incisor reduction
1-1.5mm
51
What are the types of veneer prep
feathered incisor edge incisor bevel intra-enamel window overlapped incisor edge
52
What is your choice of veneer prep dictated by
• What choice you make as to which type of prep is dictated by the patients occlusion. We don’t want the patient to be biting where the veneer meets the tooth as till come off so we need to
53
What is the gurel technique
○ The putty index is made and shows the space between the tooth and the index. The space tells you where its going to go and some teeth are so in standing that they don’t require much preparation but some do Fill any spaces in the index with protemp and then make the ideal veneer prep with the mockup so the tooth tissue required to be removed will be removed and you will preserve tooth tissue in areas that don’t need to be cut
54
What is temporization and impression for veneers
``` ○ May not need temp ○ Make a temporary restoration ○ Take impressions and occlusal records and send to lab for fabrication (takes 2 weeks) ○ Fit temp ○ Composite temp is an alternative § No etch § Small spot of primer and adhesive § Directly apply composite ```
55
What is the lab card for veneers
``` ○ Lab prescription § Pour impressions ○ Mount casts § Articulator □ Occlusal record - e.g jetbite, wax bite □ Facebow ○ Construct restoration § Tooth (FDI notation) § Material § Thickness § Characteristics § Shade § Translucency ```
56
What is the cementation for veneers
○ Adhesive systems § NX3 § ABC relyX unicem
57
What is the matrix strip for cementation
○ Matrix strip or PFTE interproximal surfaces to prevent cement flowing over adjacent teeth and bonding over it Remove excess when the cement isnt set with a microbrush
58
What is the first visit for veneers
tooth prep make temp impressions bite registration and record shade cement temp
59
What is the second visit for veneers
remove temp isolate, clean and dry prepared tooth try in, asses fit, adaptation and occlusion cement and address problems
60
What are alternatives to veneers
``` ○ No tx ○ Bleaching/whitening ○ Micro abrasion ○ Direct composite restorations Crowns ```

BDS3 CLINICAL Optech (4 decks)

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