Because of the increasing demand on the gold & amalgam alternatives, inlay & onlay

develop.

Composite
Direct
Semi direct (direct/indirect)
Indirect

Ceramic
2 appointment visit (indirect).
Single appointment visit.

General consideration:

Definition:
 Inlay: posterior filling (gold or esthetic material) made on slightly large & flared
cavity to be cemented after word.
 Onlay: posterior restoration that made to protect the tooth by covering the
occlusal surface.

Problems of direct composite:

1. Very technique sensitive.
2. Post operative sensitivity.
3. Marginal staining & leakage.
4. Lack of interproximal contact.
5. Intercuspal deformation & cracks.
6. Occlusal wear.(nowadays the new composites have resistance to wear as
enamel).
7. Incomplete curing.

When we do inlay?
When 50% of strong continuous tooth structure remain intact.
When we do onlay?
When wide MOD cavity (with non continuous thin walls of tooth structure remain).

Case selection (indications):

1. Cavity geometry, isthmus width (medium to large level of damage). Usually
replacing metallic restoration or fractured tooth. Access to cavity for careful
preparation, tacking imp, bonding under RD.
2. Outer enamel margin is needed to provide reliable “bonding” seal (supra
gingival).
3. Margin should never be coincide with occlusal contact.
4. Extensive unsupported areas of restoration should be avoided.
5. Not indicated in poor oral hygiene & Para functional habits (high occlusa
wear).
6. Not indicated in short teeth (clinical crown) because:
a) Insufficient depth for restoration.
b) sub gingival margin interfere with bonding because:

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-fluid contamination.
-no enamel bonding.

N.B. wide & deep MOD inlay  wedge effect (especially in lower premolars
because of lingual inclination causing lingual cusp fracture)  so only is better.

Advantages of occlusal coverage (onlay):

1- Prevent cusp fracture.
2- Preserve tooth structure than full crown.
3- Stress distribution.

Selection of appropriate esthetic restorative material depend on:

1- Analysis of treatment priorities (indications).
2- Patient’s attitude (maintaining good oral hygiene).
3- Skill of operator.
4- Cost wise.

N.B. inlay  composite.

Onlay  porcelain.
Good OH  composite.
Bad OH  porcelain.

Preparation design (the same for composite / ceramic)

a) Factors:
1- Remove existing restoration or caries.
2- Assess occlusion & identify occlusal contacts in centric & eccentric.
3- Assess the strength of the remaining tooth structure.
4- Adjust the proportion & extension of preparation to optimize the form
& Strength of the restored tooth.
5- Management of undercut.
- We need a flared cavity design.
- You may block the undercut by glass ionomer.

b) Criteria:
1- Divergent walls “not retentive” occlusaly (retention & resistance form
can be gained by adhesion to enamel “mainly” & dentin).
2- Rounded internal line angles, points, surfaces, & proximal boxes
(resistance form)  prevent stress concentration.
3- Smooth flat walls & floor (no grooves).
4- Type of cavosurface margin (90 butt joint) should be in sound enamel
“1mm width”  good seal.
No beveling at occlusal or gingival margin.
 Minimum chipping.
 Visible demarcation between tooth & restoration.
Greater tooth loss  more proximal extension at non functional cusp.
5- occlusal reduction: (onlay)
Fractured or undermined cusp.
3mm  functional cusp.
1.5mm  non functional cusp.

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 Warping of functional cusp to create step or shoulder “rounded”
area of extension for non functional cusp is slightly beyond cusp tip
axially “flat” or with slight inclination.
6- 1.5 – 2 mm  thickness  strength.
7- Taper & extension (from 3-5 in gold to 6-8 in porcelain & composite)
Why?
a) Ceramic is brittle (gold is ductile material).
b) Interproximal lines extend into B & L embrasures for finishing
after bonding.
c) Color matching of tooth.
8- axial reduction:
“Uniform” 0.8 – 1 mm (sometimes 1.5mm)
Extend 2 – 3 mm cervically from the original cusp hight.
Heavy chamfer or rounded shoulder for axial margin.
9- Area of esthetics  long chamfer.
Whether functional or non functional cusp
This especially performed buccly on maxillary premolar.

Rationale of the preparation: (V.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 bonding”.
4. Provide adequate bulk of the material for fabrication, cementation, &
resist functional stress (fracture of ceramic).
5. Provide path of insertion.

Burs:
Round end diamond  chamfer finish line.
Tapered diamond  open contact.
End cutting diamond  smooth pulpal floor & remove irregularities.

Factors that determine covering of the cusp: (V.Important)

1. Amount of remaining tooth structure & enamel.
2. Functional occlusal forces: occlusal contact either in sound tooth
structure or included in the restoration.
3. Size of the occlusal functional contact: area of heavy contact (large
size)  onlay.
4. Esthetics.
5. Mesial & distal length of marginal ridge of the questionable area.
6. Type of restoration & prognosis.
7. Dentist experience.

N.B. ceramic  2mm reduction or more but not 3mm.

Composite  1.5mm reduction or more but not 2mm.

advantages of occlusal coverage (onlay):

1. Tooth/restoration margins located on labial & lingual surface  less
fragile & less subjected to fracture.
2. Superior esthetics.

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Treatment of dentin:
 All dentinal surfaces covered with 0.5mm GI liner, or 1.5mm GI base.
 Deep pulpal floor, axial wall, undercut should be blocked with GI.
 Deep, almost pulp exposure, cover it by Ca(OH)2 & GI.

Advantages of GI:
1. It bond to dentin, resin composite.
2. More conservative preparation rather than excessive flaring.
3. Coeffient of thermal expansion.
4. Fluoride release.
5. Dimensional stability.
6. high compressive strength

Disadvantages of GI:
1. Cracks because of moisture sensitivity.

Final cementation:
Use “Dual cure resin cement”   :
1. Can be bonded to enamel, dentin, & restoration.
2. Decrease microlekage.
3. Strengthen the restoration  increase retention.
4. Moisture control (under RD).
N.B. zinc phosphate & GI not used.

Shade selection(factors):
1. Thickness of porcelain.
2. Underlying tooth structure color.
3. Resin cement shade “minimal effect”.
4. Usually done before RD application to minimize shade alternations
caused by desiccation.

MoooooooooooooooooooooooooooooooooooooooSa

Onlay (prep. + resto.)

Inlay (prep.)

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