Porcelain Inlay and

Onlay

Preparation and Restoration

Dr. Ignatius Lee

 Restorative Options -
Direct
 1970’s  2000’s
– Posteriors: – Posteriors:
amalgam amalgam
– Anteriors: (material
composite specific),
composite
(lesion
specific)
– Anteriors:
composite
 Evolution of Cavity
Preparation Design for
Posterior Composite
 Taking into consideration the differences
in the physical properties between the two
materials (amalgam vs composite); and based
on the rationale of the cavity preparation
design for amalgam
 Questions were asked: Do we need convergent
walls? retention grooves? Worry about
unsupported enamel? Extension for
prevention? Do we need bulk?
 New cavity preparation design for posterior
composite was created; it was based on
specific characteristic of the material.
 Why are we talking
about
amalgam/composite
 Example of utilizing the skill/knowledge we
acquired in using a specific material/procedure
(amalgam restoration) and applying it on a new
material/procedure (composite restoration)
 Preparation skills should be easily
transferable.
 Knowledge on the rationale of cavity preparation
will allow us to adapt to the new material based
on the material’s specific characteristic.
 Answer to your question on “why are we still
teaching cast gold inlay/onlay”? - when only a
few dentists are doing these kinds of procedures
in their offices.
 Restorative Options -
Indirect
 1970’s  2000’s
– Cast gold – Cast gold
inlay/onlay, inlay/onlay,
3/4 crown, full 3/4 crown, full
cast crown, PFM cast crown, PFM
– Porcelain/compo
site
inlay/onlay
 Differences between
gold and porcelain

restorations
Physical properties - porcelain more
brittle
 Mode of retention - bonding vs mechanical
retention
 Concept of margin

Based on these differences, can we design a

cavity preparation for using porcelain
intra-coronally??
 Starting with cavity preparation design for cast
gold inlay/onlay, what features do we have to
modify for porcelain????
 Physical Properties
 What cavity preparation
features do we need to
modify?

– Bulk - more occlusal clearance

– Reinforcement - bonding
– Bevels contraindicated
 Mode of Retention
 Cast gold preparation rely on
6 to 7 degree of divergent
walls and sharp internal line
angles.
 Porcelain rely on the bonding
process, no need for 6 to 7
degree divergent wall and
sharp internal line anlges.
 Marginal Adaptation
 Cast gold -  Porcelain - rely
rely on close on the adhesion
between tooth
adaptation structure/resin
(20u); lack of cement/procelain
adhesion to create a gap
between tooth free continuous
structure/cemen margin.
t/gold  No gingival bevels
needed to minimize
interface
the gap.
 Empress Procelain
System
 All procelain
restoration used for
inlay, onlay, full
crown
 Castable
 Adequate marginal fit
 Better wear
characteristic than
conventional procelain
 Similar to cast gold
inlay/onlay in terms
of cavity preparation
design
 Porcelain Fused to
Metal Crown vs
Empress: Similarities
 Highly esthetic
 Wear
 Brittle - reinforced through
the bonding process
 Composite vs Empress:
Similarities
 Mode of retention - dentinal
bonding agent
 Apply skills you learn for
composite on the bonding
process.
 Mechanism of Adhesion
 Porcelain
etched with
Etched Etched hydrofluoric
Porcelain Tooth
acid
(micromechanica
l)
 Bond between
Silane
Coupling
agent Dentinal Resin Dentinal
etched tooth
Bonding
Agent
Adhesive Bonding
Agent and DBA -
identical to
 Summary of
Characteristics
 Highly esthetic
 Acceptable marginal fit
 Conservation of tooth
structure
 Less occlusal wear
 Highly technique sensitive
 Indications
 High esthetic demand
 Replace moderate to large existing
restoration
 Fractured tooth/restoration
 Moderate to large primary caries

Contraindiations
 Unable to adequately isolate the field
 Parafunctional habits - bruxing,
clenching, excessive wear
 Empress vs Gold
Inlay/Onlay
Advantages Empress
 ESTHETIC
 Conservation of tooth structure (gold
onlay vs porcelain inlay)
 Less complicated cavity design??

Disadvantages
 Expensive
 Technique sensitive - bonding process
 Abrasive to occluding dentition
 Empress vs PFM
Empress
Advantages
 Conservative cavity preparation
 Foundation restoration may not be
necessary
 Less abrasive to occluding dentition
 No metal collar

Disadvantages
 Expensive
 Technique sensitive
 Cavity Preparation
Design
1. Occlusal Depth/Cusp Reduction
Occlusal Depth = 1.5 to 2.0 mm
Cusp Reduction:Functional cusp =
1.5-2.0mm
Nonfunction cusp = 1.5 mm

2. Internal/External Line Angles

Rounded
 Cavity Preparation
Design
3. Draw
Degree of draw = approximately
12 to 15 degree

4. Bevel
No bevel
 Mn first
premolar- DO
amalgam with
fractured lingual
cusp, deep pulpal
floor

Existing
amalgam removed,
making all walls
divergent,
smoothed all
cavosurface
margins
 Mx first molar -
MOD amalgam with
deep pulpal floor
(4mm)

Existing amalgam
removed
 Proximal walls and
gingival seats
extended, occlusal
wall divergent,
clinical judgement
was made to cover
DL cusp (with
shoulder)

No cavosurface
bevel on
shoulder
 MOB amalgam on Mx
first molar with
deep pulpal floor

Existing amalgam
removed, make all
walls divergent
and smoothed all
cavosurface
margins
 Occl amalgam on Mn
first molar, normal
pulpal depth;
patient complaining
about pain on
function- Dx: DB
cusp fractured

Patient’s
occlusion
 Existing amalgam
removed, DB cusp
reduced by 2mm, all
walls divergent

No shoulder on DB
cusp - WHY???
 MOD amalgam on Mn
second molar with
fractured Li cusp.
Normal pulpal
depth; all amaglam
removed

Proximal box
divergent, Li
cusp - smoothed
cavosurface
margin
 MOD amalgam on Mn
first molar -
occlusal fractured

Shade selection
BEFORE rubber dam;
need dentin shade
(match shade at
gingival third)
and overall shade
 Finished
preparation; rubber
dam removed; ready
for impressioning;
proximal box
divergent, cusp
reduction, buccal
cusp with heavy
bevel (no shoulder)

Buccal view
 Wax up on working
cast

Special die for

shade
matching/staining -
reason for taking
the dentin shade
Restoration on die/working cast
Trying in under rubber
dam; adjust proximal
contact; do not adjust
occlusal contact
 Cementation under
rubber dam using
resin cement;
excess cement
removed using
cotton tip

Excess resin cement

removed from
proximal/gingival
margins using an
explorer
 Rubber dam
removed following
cementation

Adjust occlusion
using fine diamond in
high speed hand piece
boratory Exercise - Mn first molar

D onlay preparation for porcelain

inished Preparation - MOD porcelain onlay preparati
Restoration on
die, back from
laboratory
 Restoration
seated under
rubber dam

Bu view after
cementation
 Restoration on
die, back from
laboratory

Restoration seated
under rubber dam