Inlays, Onlays + Veneers Flashcards Preview

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Flashcards in Inlays, Onlays + Veneers Deck (66)
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1

What is an indirect restoration?

Made outside the mouth by a technician in a lab

2

Examples of indirect restorations

1. Crowns
2. Posts and cores
3. Bridgework
4. Inlays and onlays
5. Veneers

3

List some examples of pre-operative assessment for an indirect restoration

1. Radiographs
2. Sensibility testing
3. Mounted study models
4. Diagnostic wax up

4

What can radiographs show?

1. Caries
2. Periodontal condition
3. Peri-radicular/peri-apical lesions
4. Previous RCT

5

Examples of sensibility testing

1. Ethyl chlroide
2. EPT

6

Types of articulators

Semi or fully adjustable articulator

7

What can diagnostic wax up's show? (4)

1. Aesthetics
2. Occlusion
3. Communication with patient and lab
4. Achievability

8

What are the conventional clinical stages of making an indirect restoration? (4)

1. Preparation of the tooth

2. Temporisation
- Of tooth thats been prepped

3. Impressions + occlusal records
- To send off to lab to make the rest

4. Cementation

9

Advantages of CAD-CAM

1. Quick - single appointment
2. No temporary needed

10

Disadvantage of CAD-CAM

Accuracy questionable

11

What are the different types of inlays? (4)

1. Gold
2. Composite
3. Porcelain
4. Ceramic

12

Uses of inlays (3)

1. Occlusal + interprox cavities
2. Replacing failed direct restorations
3. Minor bridge retainers (not advised)

13

What teeth are inlays recommended for?

1. Premolars or molars
2. Occlusal - MO/DO
3. MOD - If kept narrow
4. Low caries rate

14

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

15

Advantages of inlays vs direct restos (2)

1. Superior materials + margins
2. Won't deteriorate over time

16

Disadvantages of inlays vs direct restos (2)

1. Time
- longer prep

2. Cost

17

What 2 burs are used for an inlay prep?

1. Chamfer bur
- Rounded edge creates ski slope margin around the tooth

2. Shoulder bur
- Square

18

Inlay prep:

Ceramic vs Gold

1. Isthmus width
2. Depth
3. Proximal box
4. 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

19

Does ceramic require bevels?

No you want it square
Gold has a 20 degree bevel under 1/3rd of isthmus wall

20

Why should undercuts be avoided?

- Lab will fill them with cement
- Not ideal as want least cement as possible and tighter fit

21

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

22

Too much taper disadvantage

You can decrease retention

23

What type of material is a shoulder normally used with?

Ceramic materials

24

What type of material is a chamfer normally used with?

Gold

25

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

26

Why do we use bevels in gold inlays? (2)

- Gold is strong
- Nice bevel means we get a nicer fit around the restoration margins

27

Why must you be clear of the occlusal contact point?

Or you will get plaque accumulation or lead to secondary caries

28

Whats the next steps after taking a temporary restoration for inlays/onlays + veneers? (3)

1. Make temporary restoration

2. Take the impressions + occlusal records
- Send to lab for restoration fabrication
- 2 weeks

3. Fit temporary restoration

29

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

30

Communication with the lab for inlays / onlays + veneers (3)

1. Lab prescription
- Pour impressions
- Type of stone you want them poured in

2. Mount casts
- Articulator (semi adjustable or fully)
- Occlusal record (wax bite, jet bite)
- Facebow (if modifying occlusion)

3. Construct restoration
- Tooth (FDI)
- Material
- Thickness
- Characteristics (stimulate wear facets or white spot lesions)
- Shade (for comp etc)
- Translucency (for veneers)

31

What are onlays? (2)

- Like inlays but with cuspal coverage
- Height of cusps needs to be reduced during prep

32

Different types of onlays (4)

1. Gold
2. Composite
3. Porcelain
4. Ceromeric

33

Indications for onlays

1. Sufficient occlusal tooth substance loss

2. Buccal and or palatal/lingual cusps remaining

3. Remaining tooth substance weakened
- Caries
- Pre-existing large restoration
- MODs with wide isthmuses

34

When are cast metal inlays/onlays preferable to amalgam?

1. When higher strength is needed
2. Significant tooth recontouring required

35

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

36

Uses for onlays (5)

1. Tooth wear cases - increase OVD

2. Fractured cusps

3. Restoration of root tx'd teeth
- More likely to survive if cuspal coverage

4. Replace failed direct restorations

5. Minor bridge retainers (not recommended)

37

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

38

Onlay prep:

Proximal box gold

Proximal box ceramic

1mm gold


1.5-2mm ceramic

39

Onlay prep:

Margins Porcelain

Margins Gold

1mm shoulder or chamfer

0.5mm chamfer

40

Which type of inlay requires less occlusal reduction?

Gold

41

Functional cusps?

Upper lingual
Lower buccal

42

Non functional cusps?

Upper buccal
Lower lingual

43

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

44

What material is used to cement ceramic onlays?

ABC

45

What material is used to cement for gold inlays

GI material
RMGI

46

Inlays/onlays things to do on the 1st appointment (6)

1. Make reduction template

2. Impression for temporary

3. Tooth preparation

4. Make temporary

5. Impressions, bite regi + record shade

6. Cement temporary

47

Inlays/onlays things to do on the 2nd appointment (5)

1. Remove temporary

2. Isolate. clean and dry prepared tooth

3. Try in, assess fit, adaptation, occlusion etc

4. Cement if no problems

5. Minor occlusal adjustments if needed

48

What are some alternatives to inlays/onlays? (3)

1. Large direct restorations
- Amalgam
- Composite
- GI

2. Crowns:
3/4 crown
Full crowns
- Gold shell crown (GSC)
- Metal ceramic (MCC)
- Porcelain (PJC)

3. Extraction

49

What is a veneer?

Thin layer of cast ceramic that is bonded to the labial or palatal surface of a tooth with resin

50

Different types of veneer (3)

1. Ceramic - labial veneers

2. Composite - labial veneers

3. Gold - palatal
veneers/toothwear

51

Indications for veneers (7)

1. Aesthetics

2. Change teeth shape/contour

3. Correct peg-shaped laterals

4. Reduce or close proximal spaces and diastemas

5. Align labial surfaces of instanding teeth

6. Enamel defects

7. Discolouration

52

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

53

Contraindications for Veneers

1. Poor OH

2. High caries rate
- Interprox caries and/or unsound restorations

3. Gingival recession

4. Root exposure

5. High lip lines

6. Labially positioned, severely rotated + overlapping teeth

7. Head occlusal contacts

54

Why should veneers be avoided if a patient has extensive tooth tissue loss +severely labially positioned teeth etc?

1. Veneers bond best to enamel

2. 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

3. Crowns have mechanical retention whereas veneers rely on chemical bonding of tooth to enamel

55

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

56

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

57

What kind of bur is used for a veneer prep?

Depth cut bur

58

List the different types of veneer preps (4)

1. Feathered incisal edge

2. Incisal bevel

3. Intra-enamel (window)

4. Overlapped incisal edge

59

Overlapped incisal edge veneer prep indication

Patients with discoloured incisal edges

60

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

61

Indication for opaque veneers

Cases with severe discolouration

62

Indication for translucent veneers

Pt has nice natural shade so their tooth shines through and gives a natural appearance

63

What do we use to cement veneers?

ABC
N3X

64

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

65

2nd appointment for veneers (4)

1. Remove temporary if provided

2. Isolate clean and dry prepped tooth

3. Try in, assess fit, adaptation + occlusion

4. Cement

66

List some alternatives to veneers (5)

1. No tx

2. Bleaching/tooth whitening

3. Microabrasion

4. Direct composite restorations

5. Crowns