Guayaquil University.

Pilot Faculty of Dentistry .

Chair: Operative

Teacher: Dr. Willian Córdova C.

Topic: Onlay and Inlay Inlays.
GROUP 7
Members:
 Jhoana Loachamin.
 Ace Camacho.
 Bella Reyes
 Veronica Mendieta.
 Jose Valdiviezo.
 Kevin Zuniga.

Parallel: 7/3

School year.
2016-2017
 Dental Inlays
Inlay/Onlay

Dental inlays and onlays are restorations used to repair back teeth that have mild to
moderate decay. They can also be used to restore teeth that are cracked or fractured if
the damage is not significant enough to require a dental crown. Typically, inlays and
onlays are made of porcelain, composite resin, and sometimes even gold. Because they
can be made from tooth-colored materials, inlays and onlays are frequently used to
replace metal fillings in patients who desire a more natural-looking smile. Read on to
learn how inlays and onlays can improve the health and appearance of your smile.

Benefits of inlay and onlay dental inlays

By treating tooth decay, inlays and onlays help eliminate tooth sensitivity and
ultimately tooth loss. Inlay and onlay inlays also offer the following benefits:

 Because they can be made from a tooth-colored material, such as porcelain and
composite resin, inlays and onlays are virtually invisible.
 Unlike metal fillings, inlays and onlays will not expand or contract in response
to temperature changes caused by hot and cold foods. This dimensional change
can cause the tooth to weaken or fracture.
  The use of inlays and onlays requires less tooth reduction than the use of metal
fillings. This allows dentists to preserve more of the patient's natural tooth
structure in the treatment process.
 Due to the way inlays and onlays are made, they help reinforce the tooth by up
to 75 percent.
 The durable material used to make inlays and onlays helps them last up to 30
years, much longer than conventional fillings.
 Inlays and onlays can replace silver fillings to create a healthier, more natural-
looking smile.
 By preserving decayed teeth, inlays and onlays avoid the need for more
extensive treatment later.

INDICATIONS
Inlays/onlays are most suitable for vitalized premolars and molars with average
structural loss in the vestibulo-lingual direction. If the structural loss is greater and the
cusp is less than 1.5mm wide, coating is recommended.
A prior occlusal analysis is also advisable for the decision between an inlay or onlay,
since it is not recommended that the occlusal contact coincide with the margins of the
preparation. If this occurs, the thickness of the preparation must guarantee structural
integrity to avoid fractures in the medium term.

 Need for aesthetic and adhesive restoration

 Individuals allergic to metals.
 Endodontically treated teeth where access to the cavity has compromised the
strength and prognosis of the tooth. An indirect restoration is a conservative
alternative to a full crown.
 Teeth where it is difficult to achieve a retentive shape.
 Teeth with fractured cusps.
 When complete treatment of occlusal surfaces is required.
 Teeth with steep cusp slopes.
CONTRAINDICATIONS
 Patients who present parafunctional habits and can damage the restoration.
 Patients who have metal restorations on the teeth opposing the restoration.
 Patients showing excessive wear. 63.6% of fractured inlay restorations occur in
patients with signs of bruxism.
 Extensive coronary destructions that do not provide forms of retention and
mechanical resistance and little enamel surface for union.
 If the margin of the preparation is located in an infragingival extension that
prevents moisture control and enamel conditioning, a gingivoplasty should be
considered or this type of restoration should be contraindicated.
 Parts that need conservative class I or II restorations.

Inlay
The inlay is one of the types of intracoronary dental inlays that is used when the teeth
are very damaged and the restoration to be made is too large for a composite
reconstruction.

Used:
 Dental inlays are used to treat teeth that have cavities or damage between the
upper protruding surfaces. They can also be used to replace old or damaged
metal fillings .
 Inlay placement is usually done in two sessions. During your first visit to the
dentist, an impression of your tooth will be taken and a temporary inlay will be
placed on the tooth.

Indicated:
 This type of restorations are indicated in posterior teeth, in class I, II, simple or
compound MOD cavities (according to Black's classification) of medium - large
size, in teeth that have undergone endodontic treatment and for anatomical
and functional it is necessary to perform a total or partial cusp coverage. This
type of restoration is also indicated when the antagonist of an endodontically
treated tooth has a total or partial ceramic restoration. (1, 2, 17, 27)

ADVANTAGES
 Esthetic
 Quality controlled by the technician.
 More stable than composite resin restoration.
 The aesthetics can be modified using ceramic dyes
 Possibility to choose between many materials and techniques
 Satisfactory in larger restorations.
 It is possible to perform a more adequate anatomy.

DISADVANTAGES
 Indirect restoration has a higher cost than direct restoration.
 Requires laboratory procedures
  More abrasive for opposing teeth than composite resin.
 They require a more meticulous finish than composite.
 They require special equipment.
 Need for two sessions.

INLAY TYPE TOOTH PREPARATION

CHARACTERISTICS OF THE PREPARATION
 The occlusal surface must be prepared to form a cavosuperficial margin on
healthy enamel. The thickness of healthy enamel can vary but should be at
least 1mm. The pulp floor should have a depth of 1.5-2mm to provide adequate
thickness for the inlay. (Figure 7).


 The final step in finishing the occlusal portion of the preparation is to use a
point-cut diamond to smooth the pulp floor. This step simplifies fabrication by
minimizing the need to block rough dies and reduces the risk of having to
adjust uneven inlays during the placement visit. In all ceramic inlays it is
advisable to have smooth, well-finished preparations.
 The proximal portion of a ceramic inlay often requires removal of a previous
restoration that determines the size and extent. The proximal wall of the inlay
preparations should diverge occlusally, requiring additional tooth reduction.
There are three options. The first is to reduce equivalent amounts of the buccal
and lingual proximal walls (Figure. 8) which is appropriate in preparations of
minimum size. In situations where tooth loss is greater, this approach may
involve excessive removal of tooth structure (Figure. 9). In these situations, the
proximal extension should be more extensive at the expense of the non-
functional cusp, thus minimizing tooth loss near the functional cusp. (Figure.10)
 
 The gingival cavosuperficial margin should be kept in the enamel whenever
possible. When healthy gingival enamel is undermined by caries or a previous
restoration, the previous ones should be removed and treated in a similar way
to the deep occlusal areas. At the edge of the cavity, the minimum thickness
must be 2mm in the case of being under an occlusal contact point, it increases
to 2.5mm and the marginal edge must have a chamfered finish to gain
thickness.
 The depth of the axial wall should be 1–1.5mm (Figure 11). The depth and
width of the axial wall should provide sufficient ceramic thickness in the
proximal region to allow for and eliminate unwanted tooth structure or
previous restorations.


 The design of a tooth preparation for ceramics must consider three important
points: 1) avoid internal areas of stress concentration by rounding the internal
angles.
 2) provide an adequate thickness to the ceramic since the resistance of the
ceramic is proportional to its thickness, which is why an occlusal height of 2mm
is considered ideal for both inlays and onlays.
  3) create a passive axial insertion of the restoration, which is determined by the
inclination of the walls of the preparation.
 The main factors in the design of the tooth preparation that influence the
longevity of the inlay restoration are: the depth of the cavity, the width of the
occlusal isthmus, taper of the preparation and the morphology of the internal
angles.
 Thompson et al. (2010) did a bibliographic review about the design of tooth
preparation for ceramic inlays where they concluded that to achieve a balance
between the preservation of the tooth structure and the resistance of the
restorative material, the preparation should have the following dimensions:
cavity depth between 1.5 and 2mm, isthmus 1/3 width of the intercuspal
distance, total occlusal convergence of 20° and rounded internal angles.

CLINICAL SEQUENCE
 occlusal isthmus
The depth in the vestibulo-lingual direction should be approximately 1.5-2mm and the
width of the occlusal isthmus a third of the intercuspal distance (Figure 12) in order to
provide greater volume and resistance of the restorative material and the remnant.
The internal configuration of the occlusal box requires rounded internal angles and 90°
cavosuperficial angles. A No. 2131 KG Sorensen diamond tip or similar can be used to
achieve rounded dihedral angles and slightly expulsive surrounding walls towards the
occlusal (Figure 13). Porcelain or composite resin inlay preparations need a more
pronounced expulsivity (about 10°) to facilitate the adjustment and cementation
stages of the final restoration.
Low flexural strength is a limiting property of brittle materials such as ceramics,
because the most likely failure mechanism is tension or impact damage rather than
compression, a fairly high property of ceramics.
However, it should be taken into account that clinically the preparations tend to be
wider and deeper, especially in the case of previous restorations or the presence of
caries.
Borges et al. (2007) evaluated the influence of different designs of cavity preparations
on the accuracy of marginal sealing of laboratory-processed resin restorations. Two
experimental factors were evaluated: the width of the occlusal isthmus and cusp
coverage. The depth of the occlusal box was 2.5mm and the proximal box was 1.5mm
for both groups.
They were divided as follows:

 Narrow isthmus (2.5mm)

 Inlay, onlay of 1 cusp, 2 cusps and all cusps.
 Wide isthmus (5mm)
 Inlay, onlay of 1 cusp, 2 cusps and all cusps.
The results showed that an inlay restoration with a wide isthmus presented better
marginal accuracy than an inlay restoration with a narrow occlusal isthmus.
Ahlers et al. (2009) evaluated the characteristics for the preparation of ceramic inlays
and partial crowns with the CAD/CAM system. The study states that fractures are the
main cause of failure for ceramic restorations for both old and new systems. This can
be avoided by modifying the preparation technique in which the stress zones are
reduced and therefore the fracture resistance is increased. The characteristics of a
ceramic preparation are: rounded internal angles, surrounding walls with a degree of
expulsivity of 6-10°, the depth in the fissure should not be less than 1.5mm, the width
of the occlusal isthmus not less than 2.6mm to avoid his fracture. If there is no
remaining wall of at least 1.5 to 2mm, a cusp reduction should be performed. Acute
angles should be avoided and the surface angle at the proximal box should be 90°,
which gives rigidity to the ceramic. In the proximal area there should be a separation
from the adjacent tooth to facilitate impression and cementation of the restoration.
Margins in enamel and without bevel.
  Proximal box
The preparation of the proximal boxes should be carried out with diamond points No.
2133 or 4138 or a 171-L multilaminated carbide stone, slightly extending the
surrounding buccal and lingual walls (Figure 14).
The gingival wall is extended until a separation of 0.5 to 0.8 mm is achieved from the
cervical region of the adjacent tooth in order to establish a horizontal biological
distance (Figure 15). The gingival wall in the proximal axial direction corresponds to
twice the diameter (0.76mm) of the active tip of stone No. 171-L and, consequently,
the apical end of the axial wall is also determined with that depth, approximately
1.5mm. In the same way, the expulsivity of the buccal and lingual walls should be more
accentuated (10-30 15°). In the proximal cases, the cavosuperficial angle should be
between 60 and 80° in relation to the proximal surface, without any type of bevel or
slice.

The finishing of the occlusal and proximal box must be carried out with multilaminated
stones No. 7642, 7644 or with a 2136F diamond tip following the orientation of the
walls and angles (Figure 16) and with great care so as not to alter the preparation.

The buccal and lingual walls are not beveled. The straight finish of the external surface
should provide a 70 to 90° edge for the restorative material. If there is access, the
finish can be done with sanding discs. The angle finish
Cavosuperficial of the cervical wall can be done with gingival margin trimmers in order
to remove fragile prisms (Figure 17).

The gingival margin trimmer should be used to round the axio-pulpal angles, thus
minimizing the concentration of forces in that area and avoiding fracture of the
restoration (Figure 18).

Garber and Goldstein recommend a concave bevel as a finishing line. This can be
reproduced by the ceramic material with relative precision in the laboratory. The risks
of fracture of the restoration edges on the occlusal surface may be greater than when
a right-angle geometric model of the cavity is used. For this reason, it is appropriate to
use a cavity model with a chamfered or concave bevel, especially in the finishing lines
of the buccal and lingual surfaces of cusp protections and the occlusal margins.

Cerómer Inlay Inlay:

Once the simulation was carried out, it gave the following data as seen in Figure 12.
For mechanical design criteria, the Von Misses stress was used, which is the most used,
and here it gives us the yield stress of the entire premolar, which is 6 MPa ( Mega
Pascal).
The simulation of the Safety Factor with which the maximum range was set at 1.23 and
the minimum at 0.
Fig. 16 a and b. Simulation with comparative graphs of the Safety Factor with the
Porcelain material in an inlay inlay.

Ceramic Inlay Inlay:

Once the simulation has been carried out with the ceramic material, comparisons can
be made with the previous simulation, as can be seen in the figure below, both the
Von Mises Stress and the Safety Factor are much higher since the mechanical
properties of the porcelain They are much better for working with compression as in
this case. The values in the Von Mises Stress are almost 10 times more than those
obtained with the ceromer material, and the Safety Factor graph tells us from the
distribution of colors that as a critical case, the structure of the premolar will first fail.
original before ceramic, showing that it is more resistant than the original properties of
a premolar in the case of Inlay inlay

Onlay Inlay

The onlay inlay is a type of extracoronary dental inlay , that is, it covers one or two
cusps of the tooth to be restored.
The advantages of dental inlays are that they require less tooth preparation than
crowns or dental prostheses, which is why they are more conservative rehabilitative
treatments for the tooth. There are 3 types of inlays depending on the extent of the
damaged tooth to be restored: inlays, onlays and overlays (endocrowns).

While dental inlays are designed to treat cavities between the cusps, or upper
projections, of the tooth, onlays are used to treat cavities that extend to one or more
cusps. Onlay dental inlays are placed in almost the same way as inlay inlays. First, an
impression of the decayed tooth is taken and a temporary onlay is placed on the tooth.
The impression is sent to a laboratory where a dental technician creates the onlay
according to the dimensions of the tooth. When the patient returns to the dentist's
office, the temporary onlay is removed and the permanent restoration is placed on the
tooth and firmly bonded using high-strength dental resins.

Like inlay dental inlays, onlay inlays can be made from a tooth-colored material,
making them almost imperceptible to the naked eye. Additionally, onlays help
preserve more tooth structure because their use requires minimal removal of the
tooth surface. However, perhaps the most important benefit is that, by preserving
damaged teeth, onlays help patients prevent the eventual need for more extensive
treatment with dental crowns, dental bridges, or dental implants.

HOW IT IS PERFORMED?

At the first appointment, the dentist will remove any old fillings and clean the area.
The dentist will take an impression of the tooth, which is sent to the dental laboratory
where the inlay or onlay is constructed. At this appointment, a temporary accessory
will be applied.

At the second appointment, once the inlay or overlay has been made, the temporary
connection will be removed and the permanent inlay or overlay is fitted.

Materials

Typically inlays and onlays are made of highly resistant materials such as gold or
porcelain, although sometimes resins are also used.

Anesthesia

Local anesthesia.

Duration of the procedure

The Inlays / Onlays last between 2 and 4 hours.

During the first appointment, the dentist will remove the existing filling if necessary
and prepare the tooth for the inlay and onlay. The dentist will then take a mold of your
mouth which they will send to the laboratory so they can create the inlay and onlay.

The next appointment will be days later, once they are ready to be cemented in place.
 Composite onlay inlay preparation

Onlay type restorations are indicated for premolars and molars with structural loss
greater than 1/3 of the vestibulo-lingual dimension.

 Expulsive walls (10º divergence).

 Flat pulp chamber floor (base material).
 Rounded internal angles.
 Cavity surface angles 90º.
 Functional cusp carving 2 mm and rounded angles.
 Carved functional cusp margin 1-1.5 mm on shoulder/chamfer.
 Minimum remaining cusp wall thickness is 1.5-2 mm.
 Premolar isthmus → 2 mm (distance between cusp and cusp).
 Molar isthmus → 3 mm
 Bibliography.

 http://www.odontologia-online.com/publicaciones/estetica-dental/122-
inlayonlay-ceramicos-como-herramienta-terapeutica-en-odontologia.html
 https://dialnet.unirioja.es/descarga/articulo/5597296.pdf
 http://www.docshop.com/es/education/dental/general-dentistry/inlays-onlays
 https://www.propdental.es/estetica-dental/incrustaciones/incrustacion-onlay/
 https://www.medigo.com/es/procedure-pages/odontologia/inlays-onlays
 http://www.docshop.com/es/education/dental/general-dentistry/inlays-onlays
 https://www.propdental.es/estetica-dental/incrustaciones/preparacion-de-las-
incrustaciones/
 https://www.propdental.es/blog/odontologia/los-tallados-para-coronas-
partciales-inlay-onlay-y-overlay/
 http://www.cop.org.pe/bib/investigacionbibliografica/
SALLYSTEFANIPONCEAPLONARIO.pdf
 http://www.odontologia.unal.edu.co/docs/habilitacion/
prot_incrustaciones_inlay_onlay.pdf