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Esthetic inlays &

onlays

By: Yousif abdulla & Yazen


modhar

contents

Introduction

Indication

Contra-indication

Advantages

Disadvantages

types

Tooth preparation

cementation

Introduction

An indirect restoration is any restoration that is


fabricated extraorally and then cemented into/onto
the tooth.

Intracoronal restorations that fit within the


contours of a tooth (e.g. inlays, Onlays, cast intraradicular posts)

Extra-coronal restorations that cover the outer


surface of a tooth to recreate the anatomic
contours (e.g. full or partial coverage crowns,
veneers)

inlay
Inlay is intra coronal dental rest. That
made out of the oral cavity to restore
some of the occlusal s. of the tooth
but does not restore any of the cusps.

Onlay(overlay)

Onlay involves the proximal surfaces


(class II) of a posterior tooth, and caps
one or more of the cusps.

Indications

Large Restorations or Large carious


lesions or defective restorations - when
restoration replaces more than 2/3 of the
intercuspal distance.
It

only surrounds the cusp and holds it to


prevent tooth split.

Cracked -teeth- incomplete vertical


fracture of teeth (i.e. fracture not
propagated into pulp chamber).
an

onlay will hold the 2th together unless


the crack goes down to the pulp
chamber.

indication

Endodontically

Treated Teeth

after RCT teeth


dehydrate and become more prone to fracture; cuspal coverage is a
must after endo treatmen

Diastema

Closure and Occlusal Plane


Correction can significantly adjust plane of occlusion for a single
tooth or entire arch without placing full coverage.

Removable

Prosthodontic Abutment

Contraindications

High Caries Rate

When adequate isolation and


control of saliva cannot be
achieved in adhesive process.

When the tooth is subjected to


higher occ. Forces in pt who
clench or brux.

Small Restorations

advantages

High compressive & tensile


strength-little possibility of fracture or
marginal breakdown over time; can
support occlusal forces.

Conservative Preparation- much more


tooth structure conserved vs.
preparation for full coverage. (crown)

Biocompatibility

advantage
Cementation-

can be cemented with fluoride


releasing glass ionomer cement.
Polymerization shrinkage is restricted to the thin
luting resin composite.
Control

of Contours and Contacts laboratory


fabrication allows control of contact contour and
anatomy; more control with large restorations
and when margins are subgingival.

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Disadvantages

Multiple appointments and higher Chairside


Time

Costly

Technique sensitive and require skilled


technician and special equipments.

Splitting Forces:

Small inlays may produce a wedging effect on


facial and/or lingual tooth structure, and thereby
increase the potential for splitting the tooth

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When to Onlay Cusp

Whenever bucco-lingual width of the cavity preparation


is:
2/3 of the way between central groove and the cusp
tips - must onlay the cusps

when cusps are undermined after caries removal.

when both marginal ridges have been compromised,


consider cuspal coverage.

when patient has a history of fracture.

types
Composite

resin inlays & onlays.


Porcelain inlays & onlays.

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Composite Resin Inlay & Onlays


[Compared with direct composite resin restoration]
Contours and contacts can be
developed outside of the mouth.
if contact is inadequate, it can be easily
corrected prior to cementation.
Polymerization shrinkage should be
less because they are
polymerized before cementation.
Less microleakage
Greater strength and hardness
Less post-operative sensitivity

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Composite Resin Inlay & Onlays


[Compared with ceramic]
Less abrasive to opposing tooth
structure.
Repairable
Cheaper

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Tooth preparation

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Similar to amalgam preparation with some modifications.

all point ,line angles sould be rounded to avoid stress


concentration area in tooth and restoration.

Bevels ,retention forms, resistence forms are generally not


required in small restorations.

Cavity walls are flared and the gingival floor can be prepared
with a butt joint.

Most composite &ceramic sys. Require that the mim. Depth


is 1.5 mm to reduce possibility of fracture of restoration

For onlay restorations functional and non functional cusps


are covered by at least 1.5-2.0 mm of material.

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Direct Resin Inlay and Onlays

Outline of Clinical Procedures

1. Select shade

2. Isolate with rubber dam

3. Pre-wedge for proximal lesions

4. Cavity preparation

All margins in enamel when possible

Break proximal contact

Tapered preparation

(path of insertion)

Divergent wall 8-12 degree

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Direct Resin Inlay and Onlays

Rounded internal line angles

Eliminate undercuts (glass ionomer cement


for block-out)

Ends of enamel rods exposed for etching try


to avoid bevels

5. Matrix and wedge

6. Apply separating medium following


manufacturers instructions

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Direct Resin Inlay and Onlays

7. Place composite resin in an incremental


fashion, curing thoroughly 60 sec.

8. Remove restoration from tooth (scaler)

9. Clean restoration and provide additional


curing

10.Check fit, contour and contact and


adjust/add resin as necessary

11.Clean internal surface of restoration


(sandblast, etching gel)

12.Apply special bond

13.Protect adjacent teeth (celluloid strips,


matrix)

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Direct Resin Inlay and Onlays

14.Clean and etch enamel (condition dentin


if using dentin bonding system) and apply
appropriate bonding resin

15.Cement inlay following manufacturers


instructions

Always use dual-cure cement

Apply cement to tooth and restoration

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Composite Resin Luting Agents

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Several factors must be considered when the luting agent is


selected, applied and cured.

Hybrid composite resin with a soft, small particle glass


(Barium, Strontium) more resistant to wear

Filler 70% by volume to minimize amount of available


resin to break down at the margin.

Hybrid resin has good marginal seal and stain resistance


because has the highest potential degree of filler and good
tensile and compressive strength.

Must be dual-cure composite resin? activated by white


light and undergoes chemical polymerization.

Composite Resin Luting Agents

Application
Light curing

Time 60 seconds per surface

Shade of resin darker require more


curing time

Angle of contact curing light at right


angle to the resin interface

Distance light source 1mm from the


surface

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Indirect Composite Inlay and Onlay Systems


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(Laboratory Procedure)
Outline of Clinical Procedures

1. Isolate Select shade

2. with rubber dam

3. Pre-wedge for proximal lesions

4. Cavity preparation same as for direct inlay systems

Indirect Composite Inlay and Onlay Systems


(Laboratory Procedure)

Impression

Elastomeric impression material

Polysulfides

Polyethers

Condensation silicones

Vinyl polysiloxanes (addition silicones)

Should have

High tensile strength

Good surface detail

Low deformation

Able to disinfect it without distortion

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Indirect Composite Inlay and Onlay


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5. Take impression

Use addition silicone

For onlays or large inlays take impression for opposing


model and bite registration
Provisional Restoration

The provisional restoration should:

1. Stabilize the existing occlusal relationship

2. Protect the prepared teeth from any anxious stimuli

Indirect Composite Inlay and Onlay


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A. Direct/Indirect Method

Self-curing acrylic resin with:

Vacuform shell

Preoperative alginate impression

B. Direct Method

Direct composite resin withor without vacuform matrix

C. Indirect Method

Indirect composite resin/acrylic resin provisional


restoration

Fabricated in a laboratory on a working cast.

Must be cemented with a non-eugenolbased

Indirect Composite Inlay and Onlay 30

6. Temporize

Use appropriate material

Always cement temporary with a non-eugenol luting agent.


AT SECOND APPOINTMENT

7. Isolate with rubber dam

8. Remove all temporary material

9. Follow steps 10

through 16 listed under direct inlays systems

references
Sturdevant's

art & science


of operative dentistry2006- Theodore M. Roberson,
Harald O. Heymann, Edward J.
Swift, Jr.
Principles of operative
dentistry (2005)- A.J.E.

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Thank you