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Οnlays & Overlays
Aesthetics for the Posterior Teeth
Role of Inlays & Overlays in smile makeovers
In tooth-wear cases inlays and onlays are used to increase the height of the posterior teeth on a fully non-invasive approach, thus facilitating lengthening front teeth.
Even in intact dentitions, onlays can be adhered to the posterior teeth to help provide space for longer front teeth , without compromising (eg drilling) healthy tissues.
Οnlays & Overlays – Indications
When a tooth of any of these groups is excessively decayed, damaged or fractured, a direct restoration (a build-up) of conventional composite filling is often not applicable. In such cases, inlays & onlays made of porcelain or synthetic resins support the tissues successfully and with a long-term prognosis. The fabrication of those restorations provide a highly aesthetic outcome along with utmost ideal durability and strength.
The alternatives to such cases would be a crown, or root canal therapy and a post, all considered none-the-less outperformed and over-treating procedures.
Fabrication
Inlays & Onlays are fabricated with a CAD/CAM setup, that means a precise impression of the teeth is taken and the fabrication is custom made for the patient in the dental laboratory, while a temporary is in place.
Sophisticated synthetic resins (ie composites) exhibit outstanding mechanical and aesthetic properties, that almost confront ceramics. They are by default considered material of choice for the fabrication of inlays/onlays, unless contra-indications present.
They are coatings made of special, reinforced dental porcelain (porcelain veneer). They are placed on the front surfaces of the teeth. They are partial-coverage prostheses (the entire tooth is not covered) as opposed to crowns, which are full-coverage prostheses. Porcelain veneers are manufactured on high-precision machines (CAD/CAM) and are bonded to the front surface of the teeth using a special bonding technique. Their role is to treat discolouration and restore the shape and form of the teeth. Nowadays, the well-known sockets (see Prosthetic sockets) are considered very invasive, because they are full-coverage restorations (the teeth are grinded as a whole). Their use has been “displaced” almost completely by porcelain veneers and veneers & overdentures (See Veneers & Overdentures). Porcelain veneers require minimal or no cutting (hyper-conservative restorations) of teeth.
- when we want to close spaces between the teeth that are sparse (spacing).
- to correct the position of front teeth – if orthodontic treatment is excluded – e.g. in a crowd
- when we want to restore the shape of the teeth. This applies to patients whose teeth are worn down (abrasions) or who have broken teeth
- to cover teeth, which bear extensive fillings
- when we want to “reposition” a tooth in its correct position, which is located “further in” than the rest.
- to “whiten” the teeth permanently in combination with chemical teeth whitening techniques
- when we want to “fill” the unruly lips and cheeks
- They are partial coverage restorations and therefore absolutely conservative compared to other full coverage prosthetic restorations (crowns – sockets) (See Prosthetic sockets)
- They give more homogeneous surfaces on the teeth, better gloss, as well as very good macro- and micro-morphology.
- Unparalleled mechanical properties (hardness, compressive and tensile strength). Under certain conditions a porcelain face can increase the resistance of the tooth to compressive and tensile forces (lateral).
- Excellent optical properties
- They are the solution of choice in all cases where resin veneers cannot be placed. (see Resin Veneers)
- They can restore larger deficiencies than synthetic resin facings.
- They are bonded to the enamel and dentin (bonding technique) and therefore do not affect the structural integrity of the tooth(s)
- They are fully biocompatible and “friendly” with the periodontal tissues (gums)
- Require intermediate steps and additional costs (laboratory etc.)
- The bonding of porcelain veneers is a delicate and time-consuming process, as it requires absolute control of humidity (use of a dental buffer)
- Very specific preparation and delicate handling is needed to maintain as much of the enamel surface as possible. Therefore the use of a surgical microscope or surgical loops is necessary) (see Office Equipment)
- Because the thickness of the veneers is small, they are not suitable for covering discoloured teeth
- A prerequisite for the selection of all-ceramic views is its proper evaluation:
- the patient’s periodontal condition (gum and bone),
- occlusion (the way the teeth come into contact with each other)
- and the possible need for individual special treatments (cosmetic surgery).
The incident is examined and analysed. (appointment 1) The teeth that will receive the porcelain veneers are selected according to the aesthetic analysis of the smile and face (see Digital Smile Design). The proposed design is transferred onto the natural teeth with personalized guides and thus a direct simulation is made. (appointment 2) The final result is visualized in just 3 minutes without touching the teeth (appointment 2) The patient leaves and tries the simulation in the mouth for 2-3 days He returns to the office and if everything is ok, the shape is copied on the final porcelain veneers using special navigators. (appointment 3) The veneers are fabricated one by one on a special CAD/CAM guided design device.
The manufacturing stages of porcelain veneers include:
- preparation of the front surfaces of the teeth
- construction of transitional-temporary restorations
- impression of the teeth
- construction of final restorations of feldspar (feldspathic) or lithium bipyrite (e-max)
- and their final welding in place
They can be done without grinding under certain conditions; e.g. when the tooth is not discoloured and is not “chipped”. However, if we have dyschromic or ‘chipped’ teeth, the veneers need more thickness and grinding In these cases, where we do not have the option of non-grinding, a simple delineation is made on the tooth so that there is a specific position of placement (direction of insertion) of the veneer. This light “scraping”-demarcation is done without anesthesia. This creates an imperceptible socket, but it is able to prevent the porcelain veneer from being bonded to the tooth. In any case, even this light grinding is not considered harmful to the tooth and is done without anaesthesia
Usually, if there are no other aggravating factors (e.g. teeth clenching), they can stay in the mouth for 8-15 years. They have a longer life expectancy than composite resin veneers and deliver more stable aesthetic results. They are replaced when their border to the gums starts to become discoloured. They are again replaced with new porcelain veneers.
Prices for porcelain veneers range from 400 – 600 euros. They depend on the difficulty of each case (e.g. covering discoloured teeth, teeth grinding and clenching, etc.)