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Cast Metal Inlays/Onlays

Preparation design and considerations

Inlay vs Onlay
Inlay
Involves occlusal and/or proximal May replace or hood some cusps Primarily intracoronal elements Can have extracoronal

Onlay
Involves occlusal and proximal Covers all cusps Both intra and extracoronal elements
Dent 538 Dent 538

Advantages
Superior Strength Control of contour and contacts Biocompatibility Low wear No discoloration
Dent 538

Disadvantages
Demanding 2 appointments Gold color unacceptable to many Provisionals

Dent 538

Indications
Large restoration size Diastemata closure RPD abutment

Contraindications
High caries rate
Young patients

Esthetic concerns Small restoration size

Dent 538

Dent 538

Cast Metal Inlay


Remove amalgam Taper all walls
Primary retention features of inlays are: The walls of isthmus and box short walls-minimal taper long (tall) walls - more taper Features that resist displacement or removal of the restoration from tipping or lifting forces. Dent 538

Cast Metal Inlay


Remove amalgam Taper all walls (3-6)
Primary resistance form of inlays are: Dovetail and box forms Rounded internal line angles Adequate cusp thickness and dentin support Features that enable tooth and restoration to withstand without fracture, masticatory forces delivered to long axis

Dent 538

Cast Metal Inlay


Existing undercut

Cast Metal Inlay


Remove amalgam Taper all walls Bevel proximal

Undercut removed

Evaluating undercuts

Dent 538

Dent 538

Function of the Bevel


Increases strength of enamel Improves margin seal Burnishability of margins
30

Cast Metal Inlay


Remove amalgam Taper all walls Bevel proximal Occlusal bevel

Dent 538

Dent 538

Occlusal Bevel
30
30

Additional Retention Features


Used when opposing walls (primary retention) are short
Dovetails Grooves Slots

No bevel

Steep cusp inclines

Dent 538

Dent 538

Two Surface Inlays


Dovetail
Adds to wall area Resists lateral movements

Two Surface Inlays


Grooves
Adds to wall area Resists lateral movements

Dent 538

Dent 538

Two Surface Inlays


Slots or wells
Help drive inlay toward axial during seating 2 resistance form

Two Surface Inlays


Gingival seat
Help drive inlay toward axial during seating 2 resistance form

Dent 538

Dent 538

Replacing and Protecting Cusps


Hooding or Capping Onlay feature Continuous with bevels

Replacing and Protecting Cusps


Replacing fractured cusps Box extension Flat gingival floor Retain axial wall

Dent 538

Dent 538

Cast Metal Onlay


Remove amalgam Taper all walls Decision to hood cusps

Decision to Onlay

Remaining cusp thickness


Dent 538 Dent 538

Decision to Onlay
Rule of thumb: greater than 1/2 the intercuspal distance

Mandibular Cast Metal Onlay


Functional cusp reduction
1.5mm Multi-planar

Remaining cusp thickness


Dent 538 Dent 538

Mandibular Cast Metal Onlay


Non-functional cusp reduction
1.0 mm Multi-planar

Mandibular Cast Metal Onlay


Functional cusp shoulder
Uniform 1.0 mm

Dent 538

Dent 538

Mandibular Cast Metal Onlay


Functional cusp 2 plane Functional cusp bevel
Uniform 1.0 mm

Mandibular Cast Metal Onlay


Non-functional cusp bevel
Uniform 1.0 mm

Dent 538

Dent 538

Mandibular Cast Metal Onlay


Proximal flares Gingival bevels
Bevels continuous

Cast Inlay and Onlay Longevity


Not lots of clinical data Data varies from median age of 1234 yrs Cast Inlays not cost effective with amalgam Onlays can compete with crowns in longevity and cost effectiveness
Dent 538

Dent 538

Maxillary Onlay
Managing facial margin for esthetics

Maxillary Onlay
Functional cusp reduction
Multiplanar 1.5 mm reduction From opposing

Dent 538

Dent 538

Maxillary Onlay
Reduce nonfunctional cusp
1.0 mm Consider visibility Consider function

Maxillary Onlay
Functional cusp shoulder
1.2 mm wide (pre-bevel) At level of pulp floor Parallel to buccal wall

Dent 538

Dent 538

Maxillary Onlay
FC 2 plane
Similar to crown Makes room for metal without overcontour Loose some wall height

Maxillary Onlay
Functional cusp bevel
1.0 mm remaining shoulder Continuous with all bevels and flares Smooth - finishing burs

Dent 538

Dent 538

Maxillary Onlay
Proximal flares and bevels
Develop together > 0.5 mm wide Surround corners of box Smooth- finishing burs or hand instruments

Maxillary Onlay
Facial margin
Esthetic considerations Strength considerations

Margin show Dent 538 Dent 538

Maxillary Onlay
Best functional lock Shows more margin

Maxillary Onlay
functional lock poor Shows less margin

Dent 538

Dent 538

Maxillary Onlay
Lateral forces not shielded Tooth susceptible to fracture
Least margin show

Maxillary Onlay
Minimizing margin appearance by contouring

Dent 538

Dent 538

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