INLAY AND ONLAY

PORCELAINS
DRG.JUWITA RADITYA NINGSIH, MSC
 Indication

1. Class I or Class II restorations located in areas of esthetic

importance for the patient
2. Large defects or previous restorations-Indirect tooth colored
restorations
3. Replacement of large existing compromised restorations,
especially those that are wide faciolingually and require cusp
coverage
4. Economic factors-Some patients desire the best dental
treatment available, regardless of cost
 CONTRAINDICATIONS

1. Heavy occlusal forces-Ceramic restorations may fracture when

they lack sufficient bulk or are subject to excessive occlusal
stress
2. Inability to maintain a dry field-Despite some research
suggesting that modern dental adhesives can counteract
certain types of contamination
3. Deep subgingival preparations- These margins are difficult to
record with an impression and are difficult to finish
 ADVANTAGES

Similar to those of direct composite restorations (excluding cost and

time)
1. Improved physical properties: color stability, hardness,
translucency
2. Wear resistance
3. Reduced polymerization shrinkage
4. Ability to strengthen remaining tooth structure
5. More precise control of contours and contacts
6. Biocompatibility and good tissue response
7. Increased auxiliary support
 DISADVANTAGES
1. Increased cost and time. Most indirect techniques require two
patient appointments, plus fabrication of a temporary restoration.
2. Technique sensitivity-Restorations made using indirect techniques
require a high level of operator skill.
3. Brittleness of ceramics-A ceramic restoration can fracture if the
preparation does not provide adequate thickness to resist occlusal
forces and/or if the restoration is not appropriately supported by
the cement medium and the preparation
4. Wear of opposing dentition and restorations-Ceramic materials
can cause excessive wear of opposing enamel and/or restorations
5. Resin-to-resin bonding difficulties-Laboratory-processed
composites are highly cross-linked, so few double bonds remain
available for chemical adhesion of the composite cement
Cont’

6. Short clinical track record-Indirect bonded toothcolored

restorations have become relatively popular only in recent
years and are still not placed by many practitioners
7. Low potential for repair-Indirect restorations, particularly
ceramic inlays/onlays, are difficult to repair in the event of a
partial fracture
8. Difficult intraoral polishing-Indirect composite
restorations can be polished intraorally with the same
instruments/ materials used to polish direct composites.
Ceramics, on the other hand, are more difficult to polish
after they have been cemented because of either
(1) limited access
(2) lack of appropriate instrumentation
LABORATORY-PROCESSED COMPOSITE
INLAYS AND ONLAYS

▪ more resistant to occlusal wear than direct

composites, particularly in occlusal contact areas
▪ less wear-resistant than ceramic restorations
▪ easy adjustment
▪ low wear of the opposing dentition
▪ good esthetics
▪ potential for repair
Processed
composite restorations indication

(1) Maximum wear resistance is desired from a

composite restoration,
(2) Achievement of proper contours and contacts
would otherwise be difficult
(3) A ceramic restoration is not indicated because of
cost or concerns about wear of the opposing
dentition
Laboratory procedure
Dental
porcelains

▪ Dental porcelains are partially crystalline minerals

(feldspar, silica, alumina) dispersed in a glass
matrix.
▪ Porcelain restorations are made from finely
ground ceramic powders that are mixed with
distilled water or a special liquid, shaped into the
desired form, then fired and fused together to
form a translucent, material that looks like tooth
structure
The fabrication steps for fired ceramic
inlays and onlays

1. After tooth preparation, an impression is made and

a "master' working cast is poured of die stone
 The fabrication steps for fired ceramic
inlays and onlays

2. The die is duplicated and

poured with a refractory
Investment capable of
withstanding porcelain
firing temperatures. The
duplication method must
result in the master die and
the refractory die being
accurately interchangeable.
 The fabrication steps for fired ceramic
inlays and onlays

3. Porcelain is added into

the preparation area of the
refractory die and fired in
an oven. Multiple
increments and firings are
necessary to compensate
for sintering shrinkage
 The fabrication steps for fired ceramic
inlays and onlays

4. The ceramic restoration is recovered

from the refractory die, cleaned of all
investment, and seated on the master die
and working cast for final adjustments and
finishing (Fig. 14-12).
The fabrication steps for one type of
leucite-reinforced hot pressed ceramic
restoration

1. After tooth preparation, an impression is made and

a master working cast is poured of die stone. A wax
pattern of the restoration is made using conventional
techniques (Fig. 14-13).
 Cont’
2. After spruing, investing, and wax pattern burn-out, a
shaded ceramic ingot and aluminum oxide plunger are placed
into a special furnace.
Cont’

3. At approximately 1100° C, the ceramic ingot

becomes plastic and is slowly pressed into the mold
by an automated mechanism.
Cont’

4. The restoration is seated on the master die and

working cast for final adjustments and finishing.
Cont’

5. To accurately reproduce the tooth shade, a heavily

pigmented surface stain is typically applied.
The advantages of hot pressed
ceramics

(1) Similarity to traditional "wax-up" processes

(2) Excellent marginal fit
(3) Relatively high strength
(4) The surface hardness and occlusal wear of these
ceramics are very similar to enamel
CAD/CAM restorations
TOOTH PREPARATION

▪ Patient should be anesthetized

▪ The area isolated
▪ Preparations for indirect tooth-colored inlays and
onlays and provide adequate thickness
▪ All margins should have a 90-degree butt-joint
cavosurface angle to ensure marginal strength of
the restoration
▪ All line and point angles should be rounded to
avoid stress
Cont’

▪ Tooth preparation should occlusally divergent

facial and lingual walls
▪ Gingival-occlusal divergence allows for passive
insertion and removal of the restoration (2° to 5°)
▪ The junction of the sides and tip of the cutting
instrument should have a rounded design to avoid
creating sharp stress-inducing internal angles in
the preparation.
▪ The occlusal step should be prepared 1.5 to 2 mm
in depth.
TRY-IN AND CEMENTATION

Why ceramic restoration need try in

(1) the relatively fragile nature of the ceramic or
composite material
(2) the requirement of near-perfect moisture control
(3) the use of composite cements
Step by step

1. Removing the temporary restoration,

2. All the temporary cement cleaned from preparation
walls
3. Inlay or onlay is placed into the preparation using very
light pressure to evaluate its fit
▪ If the restoration does not seat completely, the most likely
cause is an overcontoured proximal surface.
▪ embrasures should be viewed from the facial, lingual, and
occlusal aspects to determine where the proximal contour
needs adjustment

4. Passing thin dental floss through the contact(s) will

reveal the tightness and position
Cont’

5. Articulating papers also can be successfully used to

identify overtight proximal contacts.
6. Abrasive disks are used to adjust the proximal
contour and contact relationship.
7. Marginal fit is verified after the restoration is
completely seated
Cementation

▪ Internal surface of the inlay/onlay must be treated

before cementation
▪ sandblasting (air-abrading) the inside of the
composite restoration with aluminum-oxide
abrasive particles to increase surface roughness
and surface area for bonding
▪ hydrofluoric acid is usually used to etch the
internal surfaces of the restoration
Cont’
▪ Treat with a silane coupling agent to facilitate
chemical bonding of the composite cement
▪ Clear plastic matrix strips may be applied in each
affected proximal area and wedged
▪ The inlay/onlay can be tried in again and checked
for fit
 Cont’

▪ The preparation surfaces are etched and treated with the

components of an appropriate bonding system
▪ The internal surfaces of the restoration also are coated with
the composite cement and the inlay is immediately inserted
into the prepared tooth, using light pressure.
▪ A ball burnisher applied with a slight vibrating motion is
usually sufficient to seat the restoration
▪ Excess composite cement is removed with thin-bladed
composite instruments, brushes, or an explorer
▪ The cement is now light-cured from occlusal, facial, and lingual
directions for a minimum exposure of 60 seconds from each
direction
FINISHING AND POLISHING
PROCEDURES
Alhamdulilahirabbil
alamin