INLAY -

CLINICAL
ASPECTS
DR ANN MARIYA
3rd YEAR PG
 DEFINITION
The class II inlay is an intra coronal cast metal
restoration that involves the occlusal and
proximal surfaces of the posterior teeth.

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
 INDICATIONS
 LARGE RESTORATIONS
 SUPERIOR CONTACT AND CONTOUR
 ENDODONTICALLY TREATED TEETH
 DENTAL REHABILITATION WITH
CAST METAL ALLOYS
 POSTERIOR DIASTEMA CLOSURE
 OCCLUSAL PLANE CORRECTION
 REMOVABLE PROSTHODONTIC
ABUTMENT

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
 CONTRAINDICATIONS
 HIGH CARIES RATE
 YOUNG PATIENTS
 ESTHETICS
 SMALL
RESTORATIONS

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
 ADVANTAGES
 STRENGTH
 BIOCOMPACTIBILITY
 LOW WEAR
 CONTROL OF CONTOURS AND CONTACTS

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
 DISADVANTAGES
 NUMBER OF APPOINTMENTS AND HIGHER CHAIR TIME
 TEMPORARY RESTORATIONS
 COST
 TECHNIQUE SENSITIVITY
 SPLITTING FORCE

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
BASIC CONCEPTS
PATH OF DRAW

Preparation should have single insertion path opposite to the occlusal load and parallel to the long
axis of tooth.
This helps in retention of the restoration and minimizes any rocking during function.
 INLAY TAPER

Slight diverging walls from gingival to occlusal surface.

If possible, walls should be parallel to long axis of tooth - preparation develops a line of withdrawal.

Optimal taper - 2° to 5° per wall.

If longitudinal walls are short - a maximum of 2° taper is given.

If longitudinal height is more - taper is also increased (but should never exceed 10°)
Taper of one wall of preparation should not be more than the other because it can result in more than
one path of insertion.

For shallow preparations - axis of taper is parallel to long axis of the tooth
For class V preparations - axis of taper is perpendicular to long axis of the tooth.
CIRCUMFERENTIAL TIE
The design of cavosurface margin.
This junction between tooth, cement and inlay is the weakest part of the cast metal
restoration.
For success of the restoration, margins of restoration should be designed so as to
achieve its maximum adaptation to tooth structure.
Cavosurface margins of an inlay preparation can be of two types:
1. Bevels
2. Flares.
 BEVEL
Defined as plane of cavity wall or floor directed away from cavity
preparation.

Wax pattern and casting - precise adaptation to the margins of tooth.

Objective - metal wedge of 30° to 35° - enhancing the chance to

achieve closure at the interface of cast gold and tooth by burnishing.

Strong enamel margin with an angle of 140° to 150° can be produced.

 TYPES OF BEVEL

Ultrashort or partial bevel Short bevel

Less than two-third of the total enamel thickness. Full thickness of enamel wall
Type I casting alloys. Type I and II casting alloys.

Long bevel
Full thickness of enamel and half or less than half thickness of Full bevel
dentin. Full enamel and dentinal wall.
Preserves - internal ‘boxed up’ resistance and retention Deprives the preparation of its internal resistance
features. Should be avoided except in cases where it is a must.
Types I, II and III of cast gold alloys.
 Hollow ground (concave) bevel
Concave in shape and not a bevel in true sense.
Rarely used.
Reverse or inverted bevel in anterior teeth:
Beveling in the reverse or inverted shape given on the gingival
seat in the axial wall toward the root in anterior teeth.

Counter bevel
Used when capping of the cusps is done to protect and
support them.
Opposite to an axial wall of the preparation on the facial
or lingual surface of the tooth.

Reverse or inverted bevel in posterior teeth:

In posterior teeth (in MOD preparations for full cast metal
restorations), it is used to prevent tipping of cast restoration in
the directions shown with the arrows and to increase the
resistance and retention
 FUNCTIONS OF BEVELS
Weak enamel is removed.
Obtuse angled tooth margins - Resultant cavosurface angle of 135° to
140° forms the strongest and the bulkiest configuration.
Acute angled metal margins (35°-45°) - Allow the metal margins to
be burnished against tooth surface
Increases retention, resistance, esthetics and color matching for
composite resin restoration.
Improves junctional relationship between the restorative material and
tooth.
Bevels are the flexible extensions - they allow inclusion of faults, wear
facets, etc. without overextending the preparation margins.
Gingival margins - finishable and cleanasable because of gingival bevels.
Counter bevel - increases the resistance form to remaining tooth structure.
Gingival margin has a lap sliding fit which provides better fit at this
region.
 FLARES
Flares are concave or flat peripheral portions of the facial or lingual
proximal walls. They are of two types:
Primary flare
It is basic part of circumferential tie.
It is like a long bevel directed 45° to the inner
dentinal wall proper
Primary flare is indicated when normal contacts
are present. When there is minimal extension of
caries in buccolingual direction.
Secondry flare
It is a flat plane superimposed peripherally to
the primary flare
It may have different angulations, involvement
and extent depending upon requirement.
Secondary flare is not given in the areas where
esthetics is more important.
 TOOTH PREPARATION

Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
INITIAL PREPARATION
Occlusal Step
1. Orienting the bur
2. Occlusal punch cut
3. Occlusal extention
4. Dovetail retention
5. Occlusal outline form
PROXIMAL BOX
1. Proximal ditch preparation
2. Proximal box preparation
3. Planing the walls
4. Placement of retention grooves
FINAL PREPARATION
Removal of infected Carious Dentin and Pulp Protection
1. Inspection
2. Removal of infected caries and old restorative material
3. Pulp protection with light cure GIC
4. Lining with calcium hydroxide (if required)
Conclusions
Lithium disilicate- and
zirconia dioxide based inlays
exhibited comparable clinical
performance. However, the
colour and translucency match
was superior for the lithium
disilicate restorations.
REFERENCES
 Stuedevant’s art and science of operative dentistry, 2nd south Asian Edition
 Aljuhani A, Algouzi A. Fracture resistance of various direct and indirect restorations of
endodontically treated teeth; A narrative review.
 Behera R, Mishra L, Divakar DD, Al-Kheraif AA, Singh NR, Lukomska-Szymanska M.
The One-Year In Vivo Comparison of Lithium Disilicate and Zirconium Dioxide Inlays.
Materials. 2021 Jun 5;14(11):3102.
 Beier US, Kapferer I, Burtscher D, Giesinger JM, Dumfahrt H. Clinical performance of
all-ceramic inlay and onlay restorations in posterior teeth. Int J Prosthodont. 2012 Jul
1;25(4):395-402.
THANK YOU