OPR lecture

Dr. Hanadi
Esthetic Posterior Inlays & Onlays
Definition:
 Inlay: Posterior restoration (gold or esthetic material) made on slightly large & flared
cavity to be cemented afterwards.
 Onlay: Posterior restoration that made to protect the tooth by covering the occlusal
surface.

Problems of direct filled composite:

1. Very technique sensitive.
2. Incomplete polymerization.
3. Post operative sensitivity.
4. Marginal staining & leakage.
5. Inter-cuspal deformation & cracks.
6. Lack of inter-proximal contact  the main problem.
7. Occlusal wear??

 Composite resin (inlay & onlay):

- Direct technique.
- Semi-direct (direct-indirect technique).
- Indirect technique.
 Ceramic (inlay & onlay):
- 2 appointment visits (indirect technique).
- Single appointment visit (CAD/CAM).
 General consideration:

 When we can do inlay & onlay?

Inlay preparation is indicated when >50% of strong continuous tooth structure is intact.
Onlay preparation is indicated when large MOD preparation with non-connected thin
wall remains. N.B: Full coverage is commonly needed.

 Case selection:
1. Cavity geometry, isthmus width (Moderate-large level of damage usually
replacing metallic restoration) access to cavity for careful preparation taken
important bonding under rubber dam.
2. Outer enamel margin needed to provide reliable seal (supra-gingival).
3. Margins of restoration never coincide with occlusal contact.
4. Extensive unsupported areas of restoration must be avoided.
5. Not indicated in poor oral hygiene & para-functional habit (high occlusal veneer).
6. Not indicated in short teeth (coronal height) because
*Insufficient depth for restoration.
*Sub-gingival margin interfere with bonding due to
a) Fluid contamination
b) No enamel margin for good bonding.
 Wide MOD inlay  wedging effect..

 Advantages of onlay:
1. Stress distribution.
2. Preserve more tooth structure than full coverage.
3. Prevent cusp fracture.

 Selection of appropriate esthetic restoration material:

Depends on:
1. Analysis of treatment priorities (indications).
2. Patient attitude (maintain good oral hygiene).
3. Skill of the operator.
4. Cost wise.

I) Preparation design:
Composite Vs Ceramic inlays & onlays..
Factors:
1- Remove existing restoration or caries.
2- Assess occlusion & identify occlusal contact.
3- Assess the strength of remaining tooth structure.
4- Adjust the proportion & extension of preparation to optimize the form & strength
of the restored tooth.
5- Management of undercut.

Inlay Onlay

 Divergent walls (not retentive occlusally)  Important for impression.

Retention & resistance can be gained by adhesion to enamel (mainly) & dentin.

 Rounded internal line angles, points, surface , proximal boxes (resistance form).

 Smooth flat walls & floor (no grooves).

 Type of cavo-surface margin (90 butt joint), should be in sound enamel (1mm width).
No beveling @ occlusal margin.
Advantages minimize chipping.
Disadvantages  Visible demarcation between teeth & restoration.
Inlay has greater tooth loss  more proximal flaring & extension @ non-functional cusp.

 Occlusal reduction:
Fractured or undermined cusp.
2mm  functioning cusp.
1.5mm  non-functioning cusp.
Cuspal capping: wrapping of functional cusp to create step or shoulder (heavy
chamfer).
Area of extension for NFC is slightly beyond cusp tip axially.

 1.5 - 2 mm thickness  strength.

 Taper & extension (from 3-5  6-8)

a) Inter-proximal lines extend into BL
b) Ceramic is brittle.
c) Color matching of tooth.

 Axial reduction (uniform):

- (ONLAY) 0.8-1mm (sometimes 1.5mm) extend 2-3mm cervically from original
cusp height.
- Heavy chamfer or rounder shallower of axial margin.

 Area o esthetic (ex. Maxillary PM) Long chamfer

 Rational of inlay & onlay preparation: (Very important):

1. Removal of diseased unsupported tooth structure & replacing missing large area.
2. Preserve the tooth structure from full crown preparation.
3. Provide adequate retentive surfaces (enamel for bonding).
4. Provide adequate bulk of material for fabrication, cementation & resist functional
stresses (fracture of ceramic).
5. Provide path of insertion (seating).
 Burs:
1. Round end diamond.
2. Tapered diamond.
3. End cutting diamond.

 Factors that determine covering the cusp:

1. Amount of remaining tooth structure & enamel.
2. Functional occlusal forces.
3. Size of occlusal functional contact.
4. Esthetics.
5. Mesial & distal length of marginal ridge of the questionable area.
6. Type of restoration & prognosis.
7. Dentist’s experience.

 Advantages of occlusal coverage:

1. Tooth/restoration margin located on labial & lingua surface away from occlusal
contacts is less fragile & subjected to fracture.
2. Superior esthetic.

II) Treatment of dentin:

All dentinal surfaces covered with 0.5mm GI liner , 1.5mm GI base.
Deep pulpal floor , axial wall, undercut should be blocked with GIC ketafill (base) ,
vitrebon (liner), keta bond (base).
Near pulpal exposure  Covered with CaOH & GI.

Advanatges of GI:
1. It bonds to dentin, resin composite.
2. More conservative preparation more than excessive flaring.
3. Coefficient of thermal expansion similar to tooth.
4. Release fluoride.
5. Dimensional stability.
6. Compression strength.

III) Final cementation with resin cement:

Types:
*Light cured.
*Self chemical cured.
*Dual cured.
 - Can be bonded to enamel & dentin restoration margin.
- Micro leakage.
- Strength the restoration retention.
- Should be done under RD

Mistake in contacts can cause:

1. Micro leakage.
2. Post operative sensitivity.
3. Marginal discrepancy.
4. Loss of bonding.

N.B: ZPH + GI cements are not recommended

IV) Shade selection:

- Thickness of the porcelain.
- Underlying tooth color.
- Resins cement shade (minimal effect).
- Usually done before rubber dam application to minimize shade alteration caused
by desiccation.