Cast Metal Inlays/Onlays

Inlay vs Onlay
Inlay

Preparation design and

considerations

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

Advantages

Dent 538

Disadvantages
Superior Strength
Control of contour
and contacts
Biocompatibility
Low wear
No discoloration

Demanding
2 appointments
Gold color
unacceptable to
many
Provisionals

Dent 538

Indications

Dent 538

Contraindications
Large restoration
size
Diastemata closure
RPD abutment

Dent 538

High caries rate

Young patients

Esthetic concerns
Small restoration
size

Dent 538

Cast Metal Inlay

Cast Metal Inlay

Remove amalgam
Taper all walls
Primary retention features of inlays are:

Remove amalgam
Taper all walls (3-6)
Primary resistance form of inlays are:
Dovetail and box forms

The walls of isthmus and box

short walls-minimal taper

Rounded internal line angles

long (tall) walls - more taper

Adequate cusp thickness and

dentin support

Features that resist displacement or removal of the restoration

from tipping or lifting forces.
Dent 538

Cast Metal Inlay

Features that enable tooth and restoration to withstand

without fracture, masticatory forces delivered to long axis

Dent 538

Cast Metal Inlay

Existing
undercut

Remove amalgam
Taper all walls
Bevel proximal

Undercut
removed

Evaluating undercuts

Dent 538

Function of the Bevel

Dent 538

Cast Metal Inlay

Increases strength of enamel

Improves margin seal
Burnishability of margins

Remove amalgam
Taper all walls
Bevel proximal
Occlusal bevel

30

Dent 538

Dent 538

Occlusal Bevel

Additional Retention Features

30

Used when opposing walls

(primary retention) are short

30

No bevel

Steep cusp inclines

Dovetails
Grooves
Slots

Dent 538

Two Surface Inlays

Dent 538

Two Surface Inlays

Dovetail

Grooves

Adds to wall area

Resists lateral movements

Adds to wall area

Resists lateral movements

Dent 538

Two Surface Inlays

Dent 538

Two Surface Inlays

Slots or wells

Gingival seat

Help drive inlay toward

axial during seating
2 resistance form

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

Cast Metal Onlay

Dent 538

Decision to Onlay

Remove amalgam
Taper all walls
Decision to hood
cusps

Remaining cusp thickness

Dent 538

Decision to Onlay

Dent 538

Mandibular Cast Metal Onlay

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

Functional cusp reduction

1.5mm
Multi-planar

Remaining cusp thickness

Dent 538

Dent 538

Mandibular Cast Metal Onlay

Non-functional cusp
reduction

Mandibular Cast Metal Onlay

Functional cusp shoulder
Uniform 1.0 mm

1.0 mm
Multi-planar

Dent 538

Mandibular Cast Metal Onlay

Functional cusp 2 plane
Functional cusp bevel
Uniform 1.0 mm

Dent 538

Mandibular Cast Metal Onlay

Non-functional cusp
bevel
Uniform 1.0 mm

Dent 538

Dent 538

Mandibular Cast Metal Onlay

Cast Inlay and Onlay Longevity

Proximal flares
Gingival bevels

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

Bevels continuous

Dent 538

Dent 538

Maxillary Onlay

Maxillary Onlay
Managing facial
margin for esthetics

Functional cusp
reduction
Multiplanar
1.5 mm reduction
From opposing

Dent 538

Maxillary Onlay

Dent 538

Maxillary Onlay
Reduce nonfunctional cusp
1.0 mm
Consider visibility
Consider function

Functional cusp shoulder

1.2 mm wide (pre-bevel)
At level of pulp floor
Parallel to buccal wall

Dent 538

Maxillary Onlay

Dent 538

Maxillary Onlay
Functional cusp bevel

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

Dent 538

1.0 mm remaining shoulder

Continuous with all bevels
and flares
Smooth - finishing burs

Dent 538

Maxillary Onlay

Maxillary Onlay

Proximal flares and bevels

Develop together
> 0.5 mm wide
Surround corners of box
Smooth- finishing burs or
hand instruments

Facial margin
Esthetic considerations
Strength considerations

Margin show
Dent 538

Maxillary Onlay

Dent 538

Maxillary Onlay

Best functional lock

Shows more margin

functional lock poor

Shows less margin

Dent 538

Maxillary Onlay

Dent 538

Maxillary Onlay

Lateral forces not shielded

Tooth susceptible to fracture

Minimizing margin appearance

by contouring

Least margin show

Dent 538

Dent 538