DOCSLIB.ORG

Clinical Performance of All-Ceramic Inlay and Onlay Restorations in Posterior Teeth

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Performance of All-Ceramic Inlay and Onlay Restorations in Posterior Teeth Clinical Performance of All-Ceramic Inlay and Onlay Restorations in Posterior Teeth Ulrike Stephanie Beier, MSc, DMDa/Ines Kapferer, MSc, DMDa/Doris Burtscher, MD, DMDa/ Johannes M. Giesinger, PhDb/Herbert Dumfahrt, MD, DMD, PhDc Purpose: The aim of this clinical retrospective study was to evaluate the clinical performance and longevity of glass-ceramic onlays and inlays in stress-bearing posterior teeth. Materials and Methods: Five hundred forty-seven posterior teeth in the maxillae and mandibles of 120 patients (46 males, 74 females) were restored with 213 onlays, 38 single-surface inlays, 141 two-surface inlays, and 155 three- surface inlays between 1987 and 2009 at Innsbruck Medical University, Innsbruck, Austria, by two experienced dentists. The restoration sample included 9 (1.6%) nonvital teeth and 40 (33%) patients diagnosed with bruxism. The study population was examined clinically during regularly scheduled maintenance appointments. The risk of failure was determined using Kaplan-Meier survival analyses. Results: The mean observation periods for onlays and all inlays were 80 ± 34 months and 111 ± 63 months, respectively. Twenty-seven failures were recorded. The estimated survival rates for onlays and all inlays after 5, 10, and 12 years were 98.9% and 98.9%, 92.4% and 96.8%, and 92.4% and 89.6%, respectively. Nonvital teeth showed a significantly higher risk of failure (P < .001). There was no greater risk of failure associated with existing parafunction (bruxism) (P = .408). Restorations on premolars survived longer in the first 15 years than restorations on molars, but no statistical significance was found (P = .913). Conclusion: Glass-ceramic onlays and inlays were demonstrated to be successful in posterior teeth; however, at this time, their efficacy is inferior to that of cast gold restorations. Int J Prosthodont 2012;25:395–402. ver the past decade, patients’ demands for highly The most common problem associated with failure Oesthetic restorations, problems with the use of of ceramic inlays and onlays is fracture of the ceramic composite resins for large restorations in posterior material.2,5,8–11 It is recommended that ceramic res- teeth, and discussions regarding possible side effects torations be carefully selected in patients where ex- of dental amalgam have led to increased interest in tensive occlusal loads are expected, such as in the the use of all-ceramic inlays and onlays to restore rehabilitation of posterior teeth in patients who ex- posterior teeth.1–7 Clinical studies on the success of hibit signs of parafunctional habits.7,12,13 The Academy stress-bearing all-ceramic inlays and onlays in per- of Prosthodontics defines bruxism as the parafunc- manent posterior teeth have already identified that tional grinding of teeth and an oral habit consisting the longevity of dental restorations is dependent on of involuntary rhythmic or spasmodic nonfunctional many different factors, including material-, patient-, gnashing, grinding, or clenching of teeth, in other and dentist-related factors.5 However, improved all- than chewing movements of the mandible, which may ceramic materials, new bonding procedures, and use lead to occlusal trauma.14 Its prevalence is reported of composite resin cements have increased their use.7 to be 20% among the adult population.15 However, only limited information is available on the longevity of ceramic inlays and onlays in patients with bruxism 16,17 aAssistant Professor, Clinical Department of Restorative and Pros- habits. thetic Dentistry, Innsbruck Medical University, Innsbruck, Austria. In this context, the present retrospective study bResearcher, Department of Psychiatry and Psychotherapy, Inns- evaluated the clinical performance and longevity of bruck Medical University, Innsbruck, Austria. silicate glass-ceramic onlays and inlays in stress- c Professor, Clinical Department of Restorative and Prosthetic Den- bearing posterior teeth to find confounding factors tistry, Innsbruck Medical University, Innsbruck, Austria. other than the porcelain system used that might Correspondence to: Dr Ulrike Stephanie Beier, Clinical Depart- influence clinical performance. Therefore, over an ment of Restorative and Prosthetic Dentistry, Innsbruck Medical observation period of 10 to 261 months, this study University, MZA, Anichstrasse 35, A-6020 Innsbruck, Austria. Fax: +43-512-504-27157. Email: [email protected] retrospectively evaluated the clinical performance Volume 25, Number 4, 2012 395 © 2012 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Clinical Performance of All-Ceramic Restorations in Posterior Teeth 250 Onlay Single-surface inlay 213 200 Two-surface inlay Three-surface inlay 155 150 141 127 114 100 99 99 No. of restorations 50 42 38 24 28 14 0 Premolars Molars Total Fig 1 Distribution of restoration type according to tooth position. Taper between 8 Taper between 8 and 10 degrees and 10 degrees Occlusal reduction of at least 1.5 mm Shoulder from deepest pit preparation in fossae of 1.0 mm a b Fig 2 Ceramic preparation design. (a) Approximal view; (b) lingual view. of all-ceramic restorations in premolar and molar re- was inferred from the presence of clear wear facets gions placed in vital teeth and teeth with endodontic caused by clenching, gnashing, and grinding activi- treatment as well as in patients with and without di- ties of the teeth not interpreted to be a result of masti- agnosed bruxism. catory function. No sleep laboratory recordings were performed. The clinical procedure and evaluation Materials and Methods were similar to those described previously.18 The sample of posterior teeth included 547 glass- The evaluated inlays and onlays were a subgroup from ceramic restorations comprising 213 (38.9%) onlays, a long-term evaluation of 1,335 glass-ceramic resto- 38 (6.9%) single-surface inlays, 141 (25.8%) two- rations. A detailed description of the study design is surface inlays, and 155 (28.3%) three-surface inlays available elsewhere.18 In brief, 120 patients were ex- placed between November 1987 and December 2009 amined during their regularly scheduled maintenance at the Department of Restorative and Prosthetic appointments at the Department of Restorative and Dentistry, Innsbruck Medical University. The distribu- Prosthetic Dentistry, Innsbruck Medical University, tion of restored teeth and types of restorations are Innsbruck, Austria, as described.18 The study popu- presented in Fig 1. lation included 46 males (38.8%) and 74 females All-ceramic preparations were performed using (61.7%). The restoration sample included 9 (1.6%) slightly conical diamond burs (nos. 847KR-016 and nonvital teeth, and 40 patients (33%) were diagnosed -018, 848KR, A8847KR-016 and -018, A8848KR-016; with bruxism. The mean age of patients at insertion Innsbruck Preparation Set, Brasseler) to develop a ta- of the all-ceramic restoration was 46.2 ± 12.5 years per of approximately 8 to 10 degrees (Fig 2). The cavi- (range: 14 to 72 years). Parafunction (bruxism) was ties were box-shaped with sharp-edged cavosurface identified by means of direct questions and visual angles for the occlusal margins and rounded shoulder observation of the behavior. In instances of the ab- preparations (minimum: 1 mm) for the axial surface sence of subjective awareness, past bruxism behavior margins. Additionally, a wide isthmus was prepared. 396 The International Journal of Prosthodontics © 2012 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Beier et al Concerning the internal form, all angles were round- Table 1 Mean Observation Period Based on Type of ed to smooth the preparation. An occlusal reduction Restoration of at least 1.5 mm from the deepest pit in the fossae n Mean ± SD (mo) Range (mo) was performed (Fig 2). Cavities with mesial or dis- Onlay 213 80 ± 34 12 to 160 tal preparations were created interproximally so that Inlay (all) 334 112 ± 64 10 to 261 contact with adjacent teeth was completely broken. Single-surface 38 135 ± 88 10 to 254 The gingival margin was prepared entirely in enamel whenever possible following the gingival line. In teeth Two-surface 141 109 ± 63 10 to 261 with deep subgingival preparations, no adhesive ce- Three-surface 155 108 ± 56 13 to 246 ramic restorations were performed; the teeth were SD = standard deviation. restored with cast gold inlays and onlays. If a cusp was fractured or hopelessly undermined, the cusp was capped for onlay preparation. The func- tional cusps in premolars and molars were reduced periods for the different restoration types are pre- approximately 1.5 mm. Nonfunctional cusps were re- sented in Table 1. duced less than 1 mm. The restorations were fabricat- Twenty-seven failures were recorded for the entire ed with a range of glass-ceramic materials following sample (547 restorations). The main reason for failure the manufacturers’ recommendations in the dental was of ceramic origin (fracture, crack, or chipping) laboratory of the department. No dentin bonding was in 11 (40.74%) restorations, followed by secondary performed in 73 (13.3%) restorations; in the others, caries in 8 (29.63%) (Table 2). Concerning the dif- Optibond FL (Kerr; 83%) and Syntac Classic (Ivoclar ferent restoration types, 5 failures were recorded in Vivadent; 3.7%)
Load more

Recommended publications
  • Retrospective Clinical Study of 656 Cast Gold Inlays/Onlays in Posterior Teeth, in a 5 to 44-Year Period: Analysis of Results
    Retrospective clinical study of 656 cast gold inlays/onlays in posterior teeth, in a 5 to 44-year period: Analysis of results Ernesto Borgia, DDS1, Rosario Barón, DDS2, José Luis Borgia, DDS3 DOI: 10.22592/ode2018n31a6 Abstract Objective. 1) To assess the clinical performance of 656 cast gold inlay/onlays in a 44-year period; 2) To analyze their indications and distribution regarding the evolution of scientific evidence. Materials and Methods. A total of 656 cast gold inlays/onlays had been placed in 100 patients. Out of 2552 registered patients, 210 fulfilled the inclusion criteria. The statistical representative sample was 136 patients; 140 were randomly selected and 138 were the patients studied. Twelve variables were analyzed. Data processing was done using Epidat 3.1 and SPPS software 13.0. Results. At the clinical examination, 536 (81.7%) were still in function and 120 (18.3%) had failed. According to Kaplan-Meier’s method, the estimated mean survival for the whole sample was 77.4% at 39 years and 10 months. Conclusions. Knowledge updating is an ethical responsibility of professionals, which will allow them to introduce conceptual and clinical changes that consider new scientific evidence. Keywords: inlays/onlays, molar, premolar, dental bonding restorations, scientific evidence-based, minimally invasive dentistry. Disclosure The authors declare no conflicts of interest related with this study. Acknowledgements To Lic. Mr. Eduardo Cuitiño, for his responsible and efficient statistical analysis of the data col- lected by the authors. 1 Professor, Postgraduate Degree in Comprehensive Restorative Dentistry, Postgraduate School, School of Dentistry, Universidad de la República, Montevideo, Uruguay.
    [Show full text]
  • Gold in Dentistry: Alloys, Uses and Performance
    Gold in Dentistry: Introduction Gold is the oldest dental restorative material, having been used for dental repairs for more than 4000 years. These early Alloys, Uses and dental applications were based on aesthetics, rather than masticatory ability. The early Phoenicians used gold wire to Performance bind teeth, and subsequently, the Etruscans and then the Romans introduced the art of making fixed bridges from gold strip. During the Middle Ages these techniques were lost, and only rediscovered in a modified form in the middle of the Helmut Knosp, nineteenth century. Consultant, Pforzheim, Germany The use of gold in dentistry remains significant today, with Richard J Holliday, annual consumption typically estimated to be approximately World Gold Council, London, UK 70 tonnes worldwide (1). However, with an increasingly wide Christopher W. Corti, range of alternative materials available for dental repairs, it is World Gold Council, London, UK considered appropriate to review the current gold based technology available today and thereby highlight the The current uses of gold in dental applications are exceptional performance that competing materials must reviewed and the major gold-based dental alloys are demonstrate if they are to displace gold from current uses. described with reference to current International New gold-based dental technologies are also highlighted. Standards. Newer techniques, such as electroforming, are highlighted with suggestions for potential future areas for research and development. The future role of Uses of Gold in Dentistry gold in restorative and conservative dentistry is also discussed in the light of increasing competition from In conservative and restorative dentistry, as well as in alternative materials.
    [Show full text]
  • Removable Partial Denture  Complex Partial Denture (Fixed+ Removable)  Overdenture  Complete Denture Removable Partial Denture
    ”Dental Restaurations.” Prosthetic Dentistry Krisztina Márton Lecturer Department of Dental Preclinical Practice SEMMELWEIS UNIVERSITY The Role of the Teeth Mastication Speech Esthetics Defects Caused by Edentulousness Reduction of the chewing capacity Disturbances in the speech Esthetic problems Pathological movement of the teeth Overloading of the teeth Extension of the tongue Reduction of the Chewing Capacity The loss of premolar or molar teeth reduces the effectivity of mastication The loss of front teeth makes the biting difficult Speech (Fonation) Disturbances Formation of certain consonants can be affected, depending on the location of the edentulos area –‘f’, ‘s’, ‘sh’, ‘z’, ‘t’ Extension of the Tongue Unfavorable Esthetics Edentulousness Upset face harmony Pathological Shift of the Remaining Teeth Tilting Overeruption Torsion Bodily shift Consequences of the Pathological Tooth Shift Loss of the contact point Unfavorable direction of the occlusal load Periodontal disease Overloading of the remaining teeth Tilting Tilting Decreased occlusal vertical dimension due to the loss of the posterior teeth Overeruption of the antagonistic teeth Overloading of the anterior teeth. Wear Upset face harmony Overeruption Roles Of the Prosthetic Appliances Restoration Prevention Roles of the Prosthetic Appliances Restoration – Rehabilitation of the chewing capacity – Treatment of the speech disorder – Esthetic rehabilitation Roles of the Prosthetic Appliances Prevention of further disorders – Overeruption of the antagonistic
    [Show full text]
  • Eloquence Document
    Concordia Plus Schedule of Benefits Plan University of Pittsburgh Faculty and Staff IMPORTANT INFORMATION ABOUT YOUR PLAN Effective 01/01/2018 ­ 12/31/2018 4 This schedule of benefits provides a listing of procedures covered by your plan. For procedures that require a copayment, the amount to be paid is shown in the column titled “Member Pays $.” You pay these copayments to the dental office at the time of service. 4 You must select a United Concordia Primary Dental Office (PDO) to receive covered services. Your PDO will perform the below procedures or refer you to a specialty care dentist for further care. Treatment by an Out-of-Network dentist is not covered, except as described in the Certificate of Coverage. 4 Only procedures listed on this Schedule of Benefits are Covered Services. For services not listed (not covered), You are responsible for the full fee charged by the dentist. Procedure codes and member Copayments may be updated to meet American Dental Association (ADA) Current Dental Terminology (CDT) in accordance with national standards. 4 For a complete description of your plan, please refer to the Certificate of Coverage and the Schedule of Exclusions and Limitations in addition to this Schedule of Benefits. 4 If you have questions about your United Concordia Dental Plan, please call our Customer Service Department toll free at 1-877-215- 3616 or access our website at www.unitedconcordia.com. ADA ADA Member ADA ADA Member Code Description Pays $ Code Description Pays $ CLINICAL ORAL EVALUATIONS ORAL PATHOLOGY LABORATORY D0120
    [Show full text]
  • CDT 2021 Code on Dental Procedures and Nomenclature
    CDT 2021 Code on Dental Procedures and Nomenclature Arkansas Procedure Guidelines Analysis +.ltl. Arkansas +.~ BlueCross BlueShield Health Advantage An Independent Licensee of the Blue Cross and Blue Shield Association An Independent Licensee of the Blue Cross and Blue Shield Association Revised: May 2021 Table of Contents Diagnostic Services ..................................................................................................................................... 3 Preventive Services ................................................................................................................................... 12 Restorative Services ................................................................................................................................. 14 Endodontic Services ................................................................................................................................. 22 Please note the following: ........................................................................................................................ 22 Periodontal Services ................................................................................................................................. 27 Procedure Billing Guidelines ................................................................................................................... 27 Payment for Surgical Services ................................................................................................................ 27 Prosthodontics, Removable
    [Show full text]
  • The Use of Gold and Gold Alloys in Prosthetic Dentistry
    Curr. Issues Pharm. Med. Sci., Vol. 28, No. 3, Pages 192-195 Current Issues in Pharmacy and Medical Sciences Formerly ANNALES UNIVERSITATIS MARIAE CURIE-SKLODOWSKA, SECTIO DDD, PHARMACIA journal homepage: http://www.curipms.umlub.pl/ The use of gold and gold alloys in prosthetic dentistry – a literature review Justyna Oleszek-Listopad1, Katarzyna Sarna-Bos1, Anna Szabelska1, Elzbieta Czelej-Piszcz1, Janusz Borowicz1, Jolanta Szymanska2* 1 Department of Prosthetic Dentistry, Medical University of Lublin, Poland 2 Chair and Department of Paedodontics, Medical University of Lublin, Karmelicka 7, 20-081 Lublin, Poland ARTICLE INFO ABSTRACT Received 08 July 2015 Gold is a noble metal with very good chemical resistance. It also does not become Accepted 15 July 2015 oxidized in water or air. Pure gold has a bright yellow color and shine, and it is a heavy, Keywords: but soft metal with huge plasticity and ductility. For many years, gold and its alloys gold, have been recognized as being great prosthetic material in dental practice. In current gold alloys, dentistry, the progress in materials science and galvanoforming techniques have made galvanoforming technique, crowns, it possible to create precise restorations utilizing this metal. This pertains both to fixed dowels. and removable dentures. Galvanized gold has a range of advantages, among these being biocompatibility, proper marginal tightness, endurance, its esthetic design and the fact that it boasts bacteriostatic features. INTRODUCTION The alloys which are still used in dentistry nowadays, can be made of galvanized gold [11,16,28]. Thus, new tech- are placed within several groups. These are the noble ones, nologies has made gold and its alloys a kind of a universal that have a high content of noble metals (gold, platinum, material.
    [Show full text]
  • Critical Review and Evaluation of Composite/Ceramic Onlaysversus
    tist Den ry Dentistry Nikolopoulou E and Loukidis M, Dentistry 2014, 4:9 ISSN: 2161-1122 DOI: 10.4172/2157-7633.1000261 Review Article Open Access Critical Review and Evaluation of Composite/Ceramic Onlaysversus Crowns Fotoula Nikolopoulou1* and Michael Loukidis2 1Department of Prosthodontics, Dental school, University of Athens, Greece 2Department of Operative Dentistry, Dental school, University of Athens, Greece *Corresponding author: Dr. Fotoula Nikolopoulou, MD, DDS, MPH, PhD, Asst.Proffesor, Department of Prosthodontics, Dental school, University of Athens, Greece, Tel: +302106411926; E-mail: [email protected] ; [email protected] Rec Date: July 07, 2014; Acc Date: Oct 25, 2014; Pub Date: Nov 1, 2014 Copyright: © 2014 Nikolopoulou F et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The purpose of this comprehensive review was to evaluate and identify the performance of composite/ceramic onlays versus crowns. The strength of the evidence is based on published trials, systematic reviews and observational studies. Methods: The dental literature was reviewed for controlled clinical studies and retrospective cross-sectional studies from 1966 to 2013. Longevity of onlay or crown is dependent upon many different factors, including material, patient-and dentist-related. Principal reasons for failure were secondary caries fractures, marginal deficiencies, wear and postoperative sensitivity. Minimally invasive dentistry, in cases in which it is appropriate, is a concept that preserves dentition, supports structures and involves low cost therapy. Keywords: Onlay; Crown; Composite resin; Porcelain laminate proximal contacts and reduce the negative effect of polymerization veneers shrinkage when compared to direct restorations [8].
    [Show full text]
  • Survival and Complication Rates of Resin and Ceramic Inlays, Onlays and Overlays
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2016 Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis Morimoto, S ; Rebello de Sampaio, F B W ; Braga, M M ; Sesma, N ; Özcan, M Abstract: This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y (n = 5,811 restorations) and were 91% at 10 y (n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%).
    [Show full text]
  • Preparation Design and Considerations for Direct Posterior Composite Inlay/Onlay Restoration
    Clinical Preparation design and considerations for direct posterior composite inlay/onlay restoration Jason Fligor 1 Abstract In order to ensure a functional, aesthetic, and long-lasting porcelain result, clinicians need to anticipate the strengths and limits of the restorative material, as well as the specific requisites of the presented case. As flaws in preparation design can have significant and detrimental effects on the final result, clinical comprehension of the dimensions and limitations during this step is of utmost importance. This article discusses a case presentation in which porcelain restorations were placed for two adjacent teeth. Although the clinician anticipated placing inlay or onlay restorations, the degree of decay and the location of hairline fractures would necessitate prophylactic removal of a weakened or undermined cusp. Learning Objectives This article presents the factors that must be addressed when considering the type of tooth reduction required for contemporary inlay/onlay restoration. Upon reading this article, the reader should: • Understand the role of correct preparation design on the success of a posterior composite restoration. • Recognize the preparation sequence associated with successful inlay/onlay restoration. The long-term success of an indirect posterior restoration Preparation and Convenience Form is dependent upon many factors. The clinician must first Individual preparation design for inlays and onlays can assess the tooth being treated, and then select a vary greatly, and is dictated by the existing conditions restorative material that will provide a durable result, within the tooth being restored. If an area of tooth while preserving sound tooth structure wherever possible. Current materials and adhesive techniques have demonstrated predictable, aesthetic results.
    [Show full text]
  • Opinions of Dentists on an Integrated Fixed and Removable
    M. A. I. (Lex) MacNeii, DDS Assistant Professor Assistant Dean, Ctinical Affairs M, I. MacEntee. PhD, LDStI), Dip Prostb, FRCDiO opinions of Dentists on an Professor and Chair Division of Proithodonlics Integrated Fixed and Department of Clinical Dental Sciences Removable Prosthodontic Faculty of Dentistry University of British Columbia Curriculum Vancouver, British Columbia, Canada Dentists in practice from 3 to 5 years who were exposed to an integrated fi>;ed and removable prosthodontic curriculum as students al the tjniversity of British Columlîia responded to a survey on the relevance of their prosthodontic education to current dental practice. The majority of the respondents reported fhat the integrated curriculum prepared them adequately for general dental practice, although many felt fhat they would have benefited from a greater emphasis on specific treatments, mosf notably cast metal inlays and onlays, all-ceramic restorations, and implant-supported prostheses. In! I ProsthodonI 1997,10:14-18. he Commission on Dental Accreditation in 9. Single-unit ceramic and metal ceramic resto- TCanada uses the Curriculum Guidelines devel- rations oped by the American Association of Dental 10. Fixed partial dentures Schools to assess and approve the quality of dental 11. Restoration of nonvital teeth professional education in Canada.^ The guidelines 12. Partial denture abutments for prosthodontics state that students "must under- 13. Resin-bonded restorations stand and demonstrate competence in "a wide 14. Implant-supported fixed prostheses (when range of procedures, from complete dentures to available). various intracoronal and extracoronal restorations." Graduates must demonstrate competence in: Graduates must also have an understanding of: 1. Complete dentures 1. Attachments for removable prostheses 2.
    [Show full text]
  • Problems Solvers the Other Dental Restorations 50
    Problems Solvers 50 Inlays, Onlays and ¾ crowns Oh My! Synonyms: Inlays, Onlays, ¾ Crowns, 7/8 crowns When people have a cavity or a large filling there are times when a full crown is not the best choice for a restoration. When crowns are performed they require that the tooth be reduced 360 degrees around the tooth so that the entire tooth can be covered. The crown procedure can be a bit aggressive at times and if there is some well supported tooth structure it may be better to consider a partial crown. This problem solvers will discuss different types of restorations known as inlays, onlays and ¾ crowns. Definitions: An inlay is a filling that is made in the dental laboratory and then cemented into the tooth after it is fabricated outside the mouth. Inlays are most often made of gold or porcelain and are not able to be made out of Zirconia. An Onlay is similar to an inlay, but what distinguishes it from an inlay is that an inlay sits within the remaining tooth structure but the onlay sits on top of part of the remaining tooth. This onlay will cover part or all of a cusp so that half the tooth may be restoration and the other half will be natural tooth structure. A ¾ or 7/8 crown is an almost full crown. It covers the majority of the tooth but there is still a wall or walls of tooth that are solid and healthy and the dentist will construct this restoration around this sound tooth structure. The ¾ crown covers ¾ of the tooth and 7/8 crowns cover –yes you guessed it, 7/8’s of a tooth.
    [Show full text]
  • Defining and Differentiating Inlays and Onlays Position Statement
    Defining and Differentiating Inlays and Onlays Position Statement Introduction The availability of new technology continues to advance the practice of dentistry and provides dentists with opportunities to practice more efficiently with improved treatment outcomes. However, as more dentists incorporate new technology into their practices, there are also signs of associated changes in treatment and billing patterns. Recent trends show an increase in the number of inlays being charged as onlays. This may be directly related to increased use of CAD­ CAM technology by dentists and fostered by company sales representatives and trainers who may be advising dentists to alter their billing practices as a means of bypassing potential benefit limitations from dental insurers on inlays. Under most dental benefit plans inlays are often assigned an alternative benefit to minor restorations (amalgams or composites) but onlays are covered at the benefit level for major services. Another factor contributing to this trend may be related to the significant acquisition costs associated with CAD­ CAM technology and the need to generate the additional income to improve the dentist's return on investment. Dentists are now also being advised that an inlay restoration that includes 1/2 to 2/3 of the cuspal incline of a tooth qualifies as an onlay. However, this interpretation is problematic and inconsistent with the current definition found in CDT 2007­2008 which clearly defines an onlay as an indirect restoration that overlays a cusp or cusps of a tooth. Inlays that are billed as onlays have direct cost impact on insurers, dentists, purchasers and patients. The cost impact for all insurers may not be significant today due to the low overall utilization of inlays and onlays relative to other types of restorations.
    [Show full text]