Simply Saves Tooth Structure. the Occlusal Onlay. the Traditional Approach: Advantages: PFM Crowns Are the Traditional Restoration Long-Established Method

Simply saves tooth structure. The occlusal onlay. The traditional approach: Advantages: PFM crowns are the traditional restoration Long-established method. Durable method for extensive defects in the hard restorations all dentists are familiar with. substance of premolars and molars. Disadvantages: The preparation causes a substantial loss of hard substance. This increases the probability of biological complications, such as pulpitis and crown margins almost reaching up to the gingival.

68,8 % loss of substance

Traditional crown preparation 68,8 % loss of substance during a traditional of a first molar. crown preparation*.

*) from: Edelhoff D, Sorensen JA.: Tooth structure removal associated with various preparation designs for posterior teeth. Int J Periodontics Restorative Dent. 2002 Jun;22(3):241-9. Occlusal onlays | 3

Occlusal onlays. The innovative alternative to crowns.

The minimally invasive approach: Advantages: Occlusal onlays (“Table Tops”). Clearly reduced loss of hard dental Occlusal onlays have been introduced as a substance – and fewer biological risks. new, minimally invasive alternative for the restoration of occlusal defects in the hard Disadvantage: substance of premolars and molars. The preparation of occlusal onlays used to be difficult without special instruments from a technical point of view.

32,5 % loss of substance

Minimally preparation for an The loss of substance involved with the occlusal onlay on a first molar. preparation for occlusal onlays* is less than half of that caused by the preparation of crowns. 4 | Occlusal onlays

Special instruments. Simple preparation.

These days, indirect all-ceramic restora- In response to this, the DGPro (German tions are gaining in popularity all the time. Association for Prosthetic Dental Medicine They do, however, require special shapes [...] and Biomaterials) issued a statement in to allow for the properties of the materials 2004 in which they recommended that, to and to ensure firm fixation. To this end, reduce the risk of pulpitis, dentists should preparation guidelines* were compiled check other options first before crowning a Private Lecturer Dr. M. Oliver Ahlers and special preparation instruments** tooth. In case of defects limited to the Specialist in function diagnostic and therapy were developed to suit the requirements occlusal area, suitable alternatives might Head of the CMD Center, Hamburg-Eppendorf of all-ceramic inlays, partial crowns and include occlusal onlays (also called occlu-

crowns. Beyond the traditional options, sal veneers or table tops). These types of the properties of the high-strength dental restorations are, however, difficult to pre- ceramics – such as for example monolithic pare with traditional instruments. This lithium silicate – open the door to new, prompted us to put together a whole new less invasive types of preparation. sequence of preparation steps and develop appropriate new abrasive instruments that These new preparations greatly reduce the greatly facilitate the procedure. Prof. Dr. Daniel Edelhoff trauma involved with the grinding of the Specialist in dental prosthetics Director of the site and the fitting of the restoration and Indications Poliklinik für Zahnärztliche Prothetik therefore, the risk of pulpitis. This is par- Preparation of occlusal onlays LMU Munich ticularly important from a clinical aspect • for the therapy of carious teeth because post-operative pulpitis is the main • for the treatment of individual or risk associated with crowns and partial several premolars and molars crowns. damaged by bruxism and/or biocorrosion • to restore the occlusion

* Ahlers, M.O., Mörig, G., Blunck, U., Hajtó, J., ** “Expert Set 4562 ST for ceramic inlays/partial *** Refers to Ivoclar Vivadent IPS e.max CAD Pröbster, L., Frankenberger, R.: “Guidelines for crowns” and “Expert Set 4573ST for ceramic (LS2) in case of adhesive fixation (as at 11/2018). the Preparation of CAD/CAM Ceramic Inlays and crowns” Please observe the instructions provided by the Partial Crowns” Int J Computer Dent 12,4 (2009) manufacturer of the material. 309–325 Occlusal onlays | 5

1 3

Depth mark

2 4 5

Pre-preparation Occlusal contouring and finishing Oro-vestibular sides According to the information currently pro- Ceramic preparations* require perfectly To give the ceramic restoration stability, vided by manufacturers, occlusal onlays round contours. The centre of the occlusal the lateral surfaces on the oral and vestibu- made of lithium silicate require a minimum surface needs to have a concave shape, lar sides have to be intact and of sufficient thickness of 1 mm***. Teeth damaged by whereas the area of the former cusps size. To make sure that these surfaces can biocorrosion often have an irregular shape. should have a convex shape to optimally be prepared to the required depth in a reli- It is therefore recommended to unite the support the occlusal onlay. Since none of able manner, we have taken an abrasive steps of depth marking and pre-contouring the previously existing abrasive instru- diamond instrument with an ideal length/ in a pre-preparation process. To this end, ments were able to create such a special diameter ratio and provided it with a guide we have provided an abrasive diamond shape, we developed brand new occlusal pin at the front end of the instrument. instrument of a suitable shape with a black abrasive cutters to this end, the so-called Thanks to its special diameter, the instru- laser mark at 1 mm from the instrument OccluShapers (370). These are the first ment can already be used during the first tip. Whenever you wish to remove occlusal instruments to be able to combine both step as a finisher with controlled penetra- substance, apply the instrument 855D to shapes. To ensure that the abrasive instru- tion depth. The instrument hardly vibrates the occlusal surface in a vertical position ments [3] match the occlusal surfaces of which makes it pleasant to use [5]. With and prepare guide grooves with a depth of each tooth, the OccluShapers are available the guide pin instrument 8849P, you can 1 mm [1]. Then even out the occlusal sur- in 2 sizes, one for molars and another one prepare the lateral sides from a vestibular face, making sure to maintain the correct for premolars. To complete the range, we and oral direction – as deeply as the guide cusp-fossa relationship (see image) and have added finishers of matching shape pin lets you and as far away from the adja- level any sharp burr at the edges of the 8370 [4]. For occlusal contouring, prepare cent tooth as the contour of the instrument occlusal surface [2]. Like this, you can the occlusal surface with an OccluShaper allows. control the amount of substance removed of suitable size in a mesio-distal direction, already at the pre-preparation stage – along the central fissure. Repeat with a fin- completely without a depth marker – isher of the same size and congruent shape. unless, of course, the loss of dental hard substance is so extensive that there is no OccluShaper need to create further occlusal space. for premolars for molars

370.314.030 370.314.035 Contouring Contouring

855D.314.016 8370.314.030 8370.314.035 8849P.314.016 with laser mark Finishing Finishing 6 | Occlusal onlays

7 8 9

Separation and finishing As an even better alternative – compared Note: The SFM6 and SFD6 are not suita- Minimally invasive preparations do not to the finisher 8858 –, we recommend our ble for the interproximal preparation prior stop at the interproximal region. That’s sonic tips SFM6 and SFD6 [8] for inter- to inserting ceramic inlays! Please use our why the set includes particularly slim sepa- proximal smoothing and finishing which we sonic tips SFM7 and SFD7 instead – they rating instruments that allow interproximal specially developed in line with our occlu- were specially designed for this purpose! preparation in the dental enamel. Prepare sal onlay set. Coated with diamond grit on the interproximal region with the separat- one side only, the geometry of these sonic Transitions ing instrument 858 in an axial direction, tips was specially made for the interproxi- To finish the treatment, connect the vestib- protecting the adjacent tooth with a ten- mal preparation prior to applying occlusal ular and oral preparations with the inter- sion-free matrix strip and without extend- onlays. Our tests revealed that these tips proximal preparations in all four transi- ing the preparation [6]. Next, smooth the are particularly suitable for the interproxi- tional regions by means of the finisher interproximal surface with a finisher of mal finishing of crown preparations. You 8856 – and you’re done! [9] matching shape 8858 in preparation for will be amazed to see how fast interproxi- impression taking and production of the mal surfaces can be smoothed with these restoration [7]. tips – without any risk of damaging the neighbouring teeth!

SFM6 mesial

SFD6 distal

Handy hint: If you have the required equipment 858.314.010 available at your practice, we suggest that you smooth the interproximal surface with the sonic tips of matching shape and diamond coating on 8858.314.010 one side – without the need for a matrix. 8856.314.014 Occlusal onlays | 7

Set 4665 ST Set 4665 Occlusal onlay set Occlusal onlay set “Table tops” in a stain- “Table tops” less steel bur block in a plastic bur block (suitable for sterilization)

OccluShaper for premolars for molars

855D.314.016 370.314.030 370.314.035 8849P.314.016 858.314.010 Pre-preparation Contouring Contouring Oro-vestibular preparation Separation with laser mark

8370.314.030 8370.314.035 8856.314.014 8858.314.010 Finishing Finishing Transitions Finishing

TIP: For veneers in the anterior region, we recommend the Perfect Veneer Preparations Set 4686/ST.

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