Dental Restorations: Inlay and Onlay
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Questions and Answers

Why is it not necessary to remove undermined enamel when preparing a tooth for a composite resin restoration?

  • Because it does not weaken the tooth structure
  • Because it does not affect the bond of the composite resin
  • Because it can be blocked out with glass ionomer prior to final preparation and impression (correct)
  • Because esthetics is not a consideration
  • What is the purpose of providing convenience access for the restoration?

  • To remove compromised tooth structure
  • To facilitate easy restoration and maintenance (correct)
  • To improve esthetics
  • To evaluate affected dentin
  • What is the recommended reduction for a functional cusp?

  • 2.0 - 2.5 mm (correct)
  • 1.5 - 2.0 mm
  • 1.0 - 1.5 mm
  • 2.5 - 3.0 mm
  • Why is it important to evaluate affected dentin?

    <p>To determine the extent of caries</p> Signup and view all the answers

    How should the margins be finished in both capping and shoeing?

    <p>Flat and smooth</p> Signup and view all the answers

    What is the ideal width of the isthmus?

    <p>1.5 - 2.0 mm</p> Signup and view all the answers

    What determines the depth of the pulpal floor?

    <p>The planned restored anatomy</p> Signup and view all the answers

    What is the purpose of divergent axial walls in preparations?

    <p>All of the above</p> Signup and view all the answers

    Why may the fossa areas need to be deeper?

    <p>To accommodate a deeper depth of the restoration</p> Signup and view all the answers

    Why do walls not need to be parallel in these preparations?

    <p>Due to retention by adhesion</p> Signup and view all the answers

    What determines the proximal extensions of the preparation?

    <p>The extent of caries or previous restoration</p> Signup and view all the answers

    What is the benefit of increased taper in preparations?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of temporization after final impression?

    <p>To prevent shifting of teeth and sensitivity</p> Signup and view all the answers

    What is the ideal gingival floor depth?

    <p>1.0-1.5 mm</p> Signup and view all the answers

    What is used to create a temporary fabrication?

    <p>All of the above</p> Signup and view all the answers

    What is used for directly temporizing a preparation?

    <p>A light-cured temporary resin material</p> Signup and view all the answers

    What should be done if the restoration does not seat easily?

    <p>Check for residual provisional material</p> Signup and view all the answers

    How should marginal integrity be checked?

    <p>With a sharp explorer</p> Signup and view all the answers

    What affects the color of the ceramic restoration?

    <p>Shade selection, opacity versus translucency of the ceramic restoration, and opacity versus translucency of the resin luting cement</p> Signup and view all the answers

    Why should occlusal contacts be checked after the restoration has been seated?

    <p>To prevent restoration fracture</p> Signup and view all the answers

    What is the purpose of the silane coupling agent?

    <p>To make the etched ceramic reactive to chemically bond to the composite resin</p> Signup and view all the answers

    What type of resin is used to link the tooth and restoration interfaces?

    <p>Dual cured hybrid resin</p> Signup and view all the answers

    What should be done to the restoration after it is received from the lab?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of the try-in process?

    <p>To test the fit of the restoration</p> Signup and view all the answers

    What is the purpose of using a wet slurry of flour pumice, soft bristle brush, or micro air abrasion in cavity preparation?

    <p>To clean the cavity preparation</p> Signup and view all the answers

    How long should 37% phosphoric acid be applied to the enamel?

    <p>15 seconds</p> Signup and view all the answers

    What is the purpose of applying a thin layer of unfilled resin or enamel bonding agent?

    <p>To allow the reactive silane to bond with the surface</p> Signup and view all the answers

    Why is a dual cure capacity composite resin luting agent used for onlay/inlay restorations?

    <p>Because of the thickness and opacity of the restoration</p> Signup and view all the answers

    What is the minimum thickness of ceramic required in the central fossa?

    <p>1.5 mm</p> Signup and view all the answers

    What is the purpose of 'tacking' the restoration onto the tooth?

    <p>To hold the restoration in place while excess cement is removed</p> Signup and view all the answers

    Why is it necessary to avoid pooling during the application of the luting agent?

    <p>To prevent the restoration from seating</p> Signup and view all the answers

    What is the purpose of applying a thin layer of resin bonding agent to the etched surface of the restoration?

    <p>To allow the composite resin luting agent to bond with the surface</p> Signup and view all the answers

    What type of restoration is indicated for an extensive preparation that requires strength greater than a composite or amalgam restoration but does not require cuspal coverage?

    <p>Inlay</p> Signup and view all the answers

    What is the primary difference between an inlay and an onlay?

    <p>The extent of cuspal coverage</p> Signup and view all the answers

    What is the purpose of beveling the gingival cavosurface?

    <p>To remove weakened enamel</p> Signup and view all the answers

    What is the ideal degree of beveling for the gingival cavosurface?

    <p>30 degrees</p> Signup and view all the answers

    What is the purpose of the occlusal dovetail?

    <p>To provide additional retention</p> Signup and view all the answers

    What is the reduction of nonfunctional cusps for an onlay?

    <p>0.75-1.0 mm</p> Signup and view all the answers

    What is the recommended height of the shoulder following the lingual or facial axial walls of the cusp?

    <p>2.0-3.0 mm</p> Signup and view all the answers

    What is the purpose of 'tacking' the restoration onto the tooth?

    <p>To hold restoration in place during cementation</p> Signup and view all the answers

    What type of resin is used for linking the tooth and restoration interfaces?

    <p>Unfilled resin or enamel bonding agent</p> Signup and view all the answers

    Why is a dual cure capacity composite resin luting agent used for onlay/inlay restorations?

    <p>Due to the thickness and opacity of the onlay/inlay</p> Signup and view all the answers

    How long should 37% phosphoric acid be applied to the enamel?

    <p>15 seconds</p> Signup and view all the answers

    What is the purpose of applying a thin layer of unfilled resin or enamel bonding agent?

    <p>To avoid pooling during the application of the luting agent</p> Signup and view all the answers

    What is the minimum thickness of ceramic required in the central fossa?

    <p>1.5 mm</p> Signup and view all the answers

    Why is it necessary to avoid pooling during the application of the luting agent?

    <p>To ensure proper seating of the restoration</p> Signup and view all the answers

    What is the purpose of applying a thin layer of resin bonding agent to the etched surface of the restoration?

    <p>To create a bond between the restoration and the tooth</p> Signup and view all the answers

    What is the minimum recommended width of the isthmus to avoid fracture?

    <p>2.0 mm</p> Signup and view all the answers

    What type of walls are recommended for onlay and inlay preparations?

    <p>Divergent</p> Signup and view all the answers

    Why are thin areas of ceramic prone to fracture?

    <p>Due to insufficient thickness</p> Signup and view all the answers

    What is the purpose of rounding all line angles in onlay and inlay preparations?

    <p>To reduce stress concentrations</p> Signup and view all the answers

    Why is it important to avoid concavities and divots in the floors and walls of onlay and inlay preparations?

    <p>To reduce stress concentrations</p> Signup and view all the answers

    What is the retention mechanism for onlay and inlay restorations?

    <p>Adhesion of resin cement to dentin and enamel</p> Signup and view all the answers

    Why are cavosurface margins placed to avoid contact with opposing teeth?

    <p>To prevent interferences</p> Signup and view all the answers

    What is the characteristic of the prep for onlay and inlay restorations?

    <p>Nonmechanically retentive</p> Signup and view all the answers

    Why should occlusal contacts be analyzed after the restoration has been seated?

    <p>To prevent restoration fracture</p> Signup and view all the answers

    What is the purpose of trying in a restoration with a light transmitting medium?

    <p>To check the opacity versus translucency of the ceramic restoration</p> Signup and view all the answers

    What should be done if the restoration does not seat easily?

    <p>Check for residual provisional material</p> Signup and view all the answers

    What affects the color of the ceramic restoration?

    <p>Shade selection and opacity versus translucency of the resin luting cement</p> Signup and view all the answers

    What is the purpose of applying a silane coupling agent to the restoration?

    <p>To make the etched ceramic reactive to chemically bond to the unfilled resin layer</p> Signup and view all the answers

    What links the tooth and restoration interfaces?

    <p>A dual cured hybrid resin luting cement</p> Signup and view all the answers

    What should be done to the restoration after it is received from the lab?

    <p>Clean the restoration of any debris and coat it with a silane coupling agent</p> Signup and view all the answers

    Why is it important to check for residual provisional material?

    <p>To prevent the restoration from not seating easily</p> Signup and view all the answers

    What is the recommended reduction for a functional cusp in onlay restorations?

    <p>2.0 – 2.5 mm</p> Signup and view all the answers

    What is the purpose of temporization after final impression?

    <p>To avoid shifting of the teeth and sensitivity</p> Signup and view all the answers

    What is used to create a temporary fabrication in indirect temporary cementation?

    <p>Poured model</p> Signup and view all the answers

    How should the margins be finished in both capping and shoeing?

    <p>Follow the contour of the cusp tip and ridges</p> Signup and view all the answers

    What is the benefit of using a hollow-ground chamfer in onlay restorations?

    <p>Better blending of the restoration with tooth structure</p> Signup and view all the answers

    What is the purpose of using a non-eugenol temporary cement in indirect temporary cementation?

    <p>To allow for easy removal</p> Signup and view all the answers

    What is the recommended method for directly temporizing a preparation?

    <p>Using light-cured temporary resin material</p> Signup and view all the answers

    Why is it important to have divergent axial walls in onlay preparations?

    <p>To allow for easier placement and removal</p> Signup and view all the answers

    What is the primary indication for an onlay restoration?

    <p>Preparations requiring strength greater than composite or amalgam</p> Signup and view all the answers

    What is the purpose of beveling the gingival cavosurface?

    <p>To remove weakened enamel</p> Signup and view all the answers

    What is the ideal degree of beveling for the gingival cavosurface?

    <p>30 degrees</p> Signup and view all the answers

    What is the purpose of the occlusal dovetail?

    <p>To facilitate proximal box preparation</p> Signup and view all the answers

    What is the reduction of nonfunctional cusps for an onlay?

    <p>0.75-1.0 mm</p> Signup and view all the answers

    What is the recommended height of the shoulder following the lingual or facial axial walls of the cusp?

    <p>2.0-3.0 mm</p> Signup and view all the answers

    What type of restoration is indicated for compromised teeth in high-stress areas?

    <p>Gold/metallic onlays</p> Signup and view all the answers

    What is the primary difference between an inlay and an onlay?

    <p>Onlays require cuspal coverage while inlays do not</p> Signup and view all the answers

    What is the primary indication for using ceramic onlays?

    <p>Large restorative defects in low stress areas with esthetic concerns</p> Signup and view all the answers

    What is the purpose of beveling the gingival cavosurface in onlay preparations?

    <p>To remove weakened enamel</p> Signup and view all the answers

    What is the recommended occlusal reduction for non-functional cusps in onlay preparations?

    <p>0.75-1.0 mm</p> Signup and view all the answers

    What is the purpose of the occlusal dovetail in onlay preparations?

    <p>To create a retention form</p> Signup and view all the answers

    What is the recommended height of the shoulder following the lingual or facial axial walls of the cusp?

    <p>2.0-3.0 mm</p> Signup and view all the answers

    What type of walls are recommended for onlay and inlay preparations?

    <p>Divergent walls</p> Signup and view all the answers

    What is the purpose of secondary flaring of the proximal facial and lingual cavosurfaces?

    <p>To join the gingival bevel uninterrupted</p> Signup and view all the answers

    What is the primary difference between an inlay and an onlay?

    <p>Onlays require cuspal coverage, inlays do not</p> Signup and view all the answers

    What is the primary consideration for determining the extent of proximal extensions in a tooth preparation?

    <p>Extent of caries or previous restoration</p> Signup and view all the answers

    What is the recommended height of the shoulder following the lingual or facial axial walls of the cusp in a tooth preparation?

    <p>1.5 mm</p> Signup and view all the answers

    Why may the fossa areas need to be deeper in a tooth preparation?

    <p>To accommodate a deeper depth of the restoration</p> Signup and view all the answers

    What is the purpose of blocking out undermined enamel with glass ionomer prior to final preparation and impression?

    <p>To prevent further tooth structure loss</p> Signup and view all the answers

    What is the recommended width of the isthmus in a tooth preparation?

    <p>1.5-2.0 mm</p> Signup and view all the answers

    Why is it important to evaluate affected dentin during tooth preparation?

    <p>To determine the extent of caries</p> Signup and view all the answers

    What is the primary purpose of having a divergent axial wall in an onlay preparation?

    <p>To allow for easier placement and removal of the restoration</p> Signup and view all the answers

    What type of finish line is recommended for proximal boxes?

    <p>A well-defined, smooth butt joint</p> Signup and view all the answers

    What is the purpose of providing a rounded internal line and point angles in a tooth preparation?

    <p>To facilitate impression making and casting</p> Signup and view all the answers

    What is the purpose of temporization after final impression?

    <p>To prevent shifting of the teeth and sensitivity</p> Signup and view all the answers

    What is the purpose of using a flat-ended diamond in a tooth preparation?

    <p>To define internal line angles</p> Signup and view all the answers

    What is the recommended method for direct temporization?

    <p>Using a light-cured temporary resin material</p> Signup and view all the answers

    What is the recommended reduction for a non-functional cusp?

    <p>1.5-2.0 mm</p> Signup and view all the answers

    What is the purpose of having a butt joint in functional cusps?

    <p>To cap the cusp with a shoulder</p> Signup and view all the answers

    What is the benefit of having a hollow-ground chamfer?

    <p>It allows for better blending of the restoration with tooth structure</p> Signup and view all the answers

    What is the purpose of finishing the margins in capping and shoeing?

    <p>To follow the contour of the cusp tip and ridges</p> Signup and view all the answers

    What should you do if the restoration does not seat easily?

    <p>Check for residual provisional material</p> Signup and view all the answers

    Why should occlusal contacts be checked after the restoration has been seated?

    <p>To prevent restoration fracture</p> Signup and view all the answers

    What determines the color of the ceramic restoration?

    <p>Shade selection and opacity versus translucency of the ceramic restoration</p> Signup and view all the answers

    What is the purpose of the silane coupling agent?

    <p>To make the etched ceramic reactive to chemically bond to the composite resin</p> Signup and view all the answers

    What is used to link the tooth and restoration interfaces?

    <p>Dual cured hybrid resin luting cement</p> Signup and view all the answers

    What should be done to the restoration after it is received from the lab?

    <p>All of the above</p> Signup and view all the answers

    Why is it important to check for marginal integrity?

    <p>To ensure the margin is smooth and not catching</p> Signup and view all the answers

    What is the purpose of the try-in process?

    <p>To try-in the restoration with a light transmitting medium</p> Signup and view all the answers

    What is the primary purpose of placing cavosurface margins in a specific location?

    <p>To avoid contact with opposing teeth</p> Signup and view all the answers

    Why are thin areas of ceramic prone to fracture?

    <p>Due to the increased stress concentration in thin areas</p> Signup and view all the answers

    What is the minimum recommended width of the isthmus to avoid fracture?

    <p>2.0 mm</p> Signup and view all the answers

    Why are divergent axial walls recommended for onlay and inlay preparations?

    <p>To reduce the risk of fracture</p> Signup and view all the answers

    What is the purpose of applying a thin layer of unfilled resin or enamel bonding agent?

    <p>To enhance the bond strength between the tooth and restoration</p> Signup and view all the answers

    Why is a dual cure capacity composite resin luting agent used for onlay/inlay restorations?

    <p>To enhance the bond strength between the tooth and restoration</p> Signup and view all the answers

    What is the purpose of 'tacking' the restoration onto the tooth?

    <p>To hold the restoration in place during cementation</p> Signup and view all the answers

    Why is it necessary to avoid pooling during the application of the luting agent?

    <p>To prevent voids in the restoration</p> Signup and view all the answers

    Study Notes

    Inlay vs. Onlay

    • Inlay: an intracoronal indirect restoration that does not involve cuspal coverage
    • Onlay: a partial extracoronal indirect restoration that involves one or more cuspal coverage

    Indications for Inlay and Onlay

    • Inlay: indicated for extensive preparations that require strength greater than a composite or amalgam restoration but do not require cuspal coverage
    • Onlay: indicated for compromised teeth in high stress areas, and for large restorative defects in low stress areas where esthetics are involved

    Advantages of Inlay and Onlay

    • Improved esthetics
    • Cover and reinforce cusps without removal of healthy tooth structure
    • Supragingival margins for easier maintenance

    Preparation for Inlay and Onlay

    • Removal of caries or defect
    • Initial preparation similar to direct restoration
    • Cavosurface margins are beveled, including the proximal box
    • All walls are divergent
    • Occlusal dovetail is placed if mesial or distal proximal box is not prepared
    • Secondary flaring of the proximal facial and lingual cavosurfaces joins the gingival bevel uninterrupted

    Occlusal Reduction for Onlay

    • Functional cusps: reduced 1.5 mm
    • Nonfunctional cusps: reduced 0.75-1.0 mm with minimal extension onto the axial wall
    • Shoulder following the lingual or facial axial walls of the cusp has a depth of 0.8 mm and occlusogingival height of 2.0-3.0 mm

    Conservative Preparation

    • Remove only compromised tooth structure
    • Convenience access is provided for the restoration
    • Affected dentin should be evaluated
    • Dentin discolored by caries or amalgam may need to be removed or covered by an opaquer

    Internal Line Angles and Isthmus Width

    • Rounded internal line and point angles
    • Flat ended diamonds work well to define internal line angles
    • Isthmus width: 1.5-2.0 mm

    Pulpal Floor and Proximal Extensions

    • Pulpal floor can vary according to the planned restored anatomy
    • Should be 1.5-2.0 mm for adequate bulk for fabrication
    • Proximal extensions are determined by the extent of caries or previous restoration

    Gingival Floor Depth and Cuspal Protection

    • Gingival floor depth: 1.0-1.5 mm
    • Should be maintained in enamel whenever possible
    • Cuspal protection or replacement: extensions of the coverage are a clinical judgment, considering factors such as amount of enamel, occlusal forces, size of functional contact, esthetics, and mesial-distal width of affected area

    Cuspal Reduction for Bulk of Restorations

    • Functional cusp: 2.0-2.5 mm
    • Nonfunctional cusp: 1.5-2.0 mm

    Finish Line and Axial Wall

    • Finish line should NOT be beveled
    • Two schools of thought for the finish line:
      1. A well-defined, smooth butt joint (shoulder)
      2. A hollow-ground chamfer (deep chamfer, or modified butt joint)
    • Axial wall should be divergent, more than what is required of a gold restoration

    Temporization and Cementation

    • After final impression, the preparation(s) need to be temporized to avoid shifting of the teeth and sensitivity
    • Indirectly using a preoperative matrix, poured model, temporary fabrication with cementation using a non-eugenol temporary cement
    • Directly with composite with NO etching or bonding

    Try-In and Cementation

    • Try-in of the restoration with a light transmitting medium like glycerine, water, or try-in paste
    • Check for proximal contact, marginal integrity, and color
    • Bonding of the ceramic restoration involves a series of individual links, including tooth interface, restoration interface, and hybrid resin luting cement

    Bonding and Cementation

    • Clean the restoration of any debris
    • Coat the restoration with a silane coupling agent
    • Apply a thin layer of unfilled resin or enamel bonding agent
    • Light cure
    • Apply composite resin luting agent to the preparation and restoration
    • Seat the restoration into the preparation, cement should extrude from the margins
    • Clean off excess cement and floss

    Onlay/Inlay Preparation and Cementation

    • The coupling agent is volatile and allowed to vaporize, leaving a reactive silane on the surface (Crispin, 1994)
    • A thin layer of unfilled resin or enamel bonding agent is applied to the etched surface of the restoration
    • The cavity preparation is cleaned using a wet slurry of flour of pumice, soft bristle brush, or micro air abrasion

    Luting Agent Application

    • A thin layer of luting agent is applied to the etched surface of the restoration
    • The luting agent should be of dual cure capacity due to the thickness and opacity of the onlay/inlay
    • The restoration is seated into the preparation, and the cement should extrude from the margins

    Cementation and Occlusal Reduction

    • Clean off excess cement and floss to check for any interproximal overhangs
    • Occlusal reduction should be uniform and of sufficient thickness for ceramic to provide optimal strength
    • Thickness of ceramic should be at least 1.5 mm in the central fossa and over nonfunctional cusps
    • Marginal integrity: A sharp explorer should travel from the restoration to tooth structure, and vice versa, smoothly and without catching

    Bonding of Ceramic Restoration

    • Tooth interface: etched enamel micro mechanically bonds with the bonding agent
    • Restoration interface: The etched porcelain is made reactive by a silane, causing it to mechanically and chemically bond to an unfilled resin layer
    • Both interfaces are linked together by a dual cured hybrid resin luting cement

    Ceramic Restoration Preparation

    • Cavosurface margins should be placed to avoid contact with opposing teeth
    • Margins should be smooth and well-defined with no beveling
    • Thin areas of the ceramic are prone to fracture
    • Onlay/Inlays rely on adhesion of the resin cement to the dentin and enamel for retention

    Preparation Requirements

    • Prep is nonmechanically retentive
    • Floors and walls should avoid concavities and divots
    • All line angles are rounded
    • Isthmus is at least 2.0 mm to avoid onlay/inlay fracture

    Final Thoughts

    • Occlusal contacts should be checked AFTER the restoration has been seated
    • Centric and excursive contacts should be checked and adjusted as needed
    • Bonding of the ceramic restoration involves a series of individual links

    Inlays and Onlays

    • Inlays: intracoronal indirect restorations, not involving cuspal coverage
    • Onlays: partial extracoronal indirect restorations, involving one or more cuspal coverage

    Indications and Contraindications

    • Inlays: indicated for extensive preparations requiring strength greater than a composite or amalgam restoration, but not requiring cuspal coverage
    • Onlays: indicated for compromised teeth in high-stress areas, large restorative defects in low-stress areas, and when esthetics are involved

    Advantages

    • Conservative, as only compromised tooth structure is removed
    • Improved esthetics
    • Cover and reinforce cusps without removing healthy tooth structure
    • Supragingival margins, easier for patients to maintain

    Preparation

    • Initial preparation similar to direct restoration
    • Cavosurface margins are beveled, including the proximal box
    • All walls are divergent
    • Occlusal dovetail is placed if mesial or distal proximal box is not prepared
    • Secondary flaring of the proximal facial and lingual cavosurfaces joins the gingival bevel uninterrupted

    Onlay Preparation

    • Similar to inlay preparation, but with one or more cuspal coverage
    • Occlusal reduction of nonfunctional cusps is 0.75-1.0 mm with minimal extension onto the axial wall
    • Functional cusps are reduced 1.5 mm
    • Shoulder following the lingual or facial axial walls of the cusp has a depth of 0.8 mm and occlusogingival height of 2.0-3.0 mm

    Cuspal Reduction

    • Functional cusps: 2.0-2.5 mm, capped with a butt joint shoulder
    • Nonfunctional cusps: 1.5-2.0 mm, shoed just beyond the tip and ridge of the cusp
    • In both capping and shoeing, the margins should follow the contour of the cusp tip and ridges

    Finish Line

    • Two schools of thought: well-defined, smooth butt joint (shoulder) or hollow-ground chamfer (deep chamfer, or modified butt joint)
    • Axial wall should be divergent, more than what is required of a gold restoration
    • Increased taper, without unnecessary removal of tooth structure, allows for easier placement and removal when trying the restoration in

    Temporization and Cementation

    • After final impression, the preparation(s) need to be temporized to avoid shifting of the teeth and sensitivity
    • Indirectly using a preoperative matrix, poured model, temporary fabrication with cementation using a non-eugenol temporary cement
    • Directly with composite with NO etching or bonding
    • Light-cured temporary resin material

    Try-in and Cementation

    • Check for residual provisional material, interproximal overhangs, and marginal integrity
    • Color is dependent on shade selection, opacity versus translucency of the ceramic restoration, and the resin luting cement
    • Occlusal contacts should be checked AFTER the restoration has been seated
    • Bonding of the ceramic restoration involves a series of individual links: tooth interface, restoration interface, and a dual-cured hybrid resin luting cement

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    Description

    This quiz covers the differences between inlay and onlay dental restorations, including their characteristics and indications. Learn about the types of restorations and their applications.

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