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Inlays / Onlays Cancun Mexico

Same day Dental inlays and Onlays with the Cerec Cad/Cam and E.max porcelain!

Inlays and onlays are examples of what we call an ‘indirect’ restoration i.e. one made outside the mouth and stuck in; as opposed to a filling that is done directly in the mouth. They have a number of advantages because they are ‘made’ and are a very effective way to restore your tooth, particularly if a large amount of tooth has been lost.

Definitions:

  • An inlay- As the name suggests, this restoration sits inside the tooth.
  • An onlay- In contrast is bonded on top of the tooth, replacing some or all of the cusps of the tooth.

The amount of decay or existing filling being replaced will determine the shape and type of the restoration. It is therefore common to have a restoration that is actually part inlay and part onlay, rather than an inlay or an onlay in the strictest sense of the word. They are generally only used on posterior (back teeth), that is your premolars and molars (teeth numbers 4-8).

How long do porcelain Onlays or Inlays last?

Dental onlays or dental inlays can last for a couple decades however, it depends on a number of factors. The factors can include oral hygiene, forceful chewing, dentist’s ability, material quality. The material used for our porcelain Inlays or Onlays are E.max porcelain.

Why would I need a Inlay / Onlay?

Inlays and onlays can be a useful restoration in a number of situations, the main ones are

  • To restore a large cavity and weakened tooth
  • Instead of a filling
  • Instead of a crown
  • To avoid a root canal, post and crown.

To Restore a Large Cavity and Weakened Tooth

This could be a result of

  • Dental caries (tooth decay): If a tooth has a very large amount of decay, then a crown or an inlay/onlay becomes a more dependable long-term solution, compared to just having a filling.
  • Failed fillings: Sometimes you may have had a large filling that has failed or another piece of that tooth that breaks away. It may be possible to repair the tooth or to replace the filling, but it is likely that at some point this will fail again and you will have to proceed to an inlay/onlay, or a crown. Often it is more sensible and actually more economical to proceed sooner to one of these indirect long-term treatments.
  • Cracked teeth: If part of a tooth fractures under heavy biting forces (generally in people who have a grinding or clenching habit), inlays/onlays can be used to restore the part of the tooth that has broken.

The Advantages of an Inlay/ Onlay

  • Appearance. They have a very attractive natural appearance, unlike silver amalgam and are much less prone to picking up stain and discolouring than white filling materials. The porcelain can not only be shaped to mimic the original tooth, but the patterns of the biting-surface are naturally recreated- with a little staining for added effect.
  • Strength. They are not as destructive to the remaining tooth as crowns and by preserving much of the natural tooth, they increase the strength of the tooth.
  • Wear. The materials used to make the inlays/ onlays are extremely durable and will wear like fillings, even under the stress of grinding.
  • Decay.They are less prone to decay at the margins because of the custom fit and the good seal they achieve.
  • Durable. They are more durable and last longer than fillings.
  • Hygiene. Because they are custom- made for individual teeth, they do not trap plaque in the same way that poorly done fillings can and thus are easier to keep clean.
  • Expansion. They don’t expand and contract in the same way as filling materials reducing the stresses on the tooth.

The Disadvantages of an Inlay/ Onlay

  • Wear. Whilst they do not actually wear-out themselves, some of the harder porcelain materials (such as zirconia) run the risk of wearing the opposing natural tooth especially if the glaze is removed, when the dentist adjusts the bite. This isn’t a risk if the inlay/onlay bites on a filling or crown.
  • Failure. They can, of course, fail. Generally, this would be a bonding issue and while the cements used are super strong, occasionally they can come off; in which case most of the time, they can simply be re-bonded (provided you still have it!). It is, as with any restoration (crowns, veneers, fillings) also possible for the tooth to get decay at the margins, if there is a problem with the fit or you are not doing your part and keeping it clean.

Types of Inlay and Onlay

Porcelain Inlays

The type of porcelain used affects the colour and in areas where a really good match is needed, it is much better to have a restoration built up by hand and fired in the furnace.
Those milled out of a solid block of porcelain of a particular shade can have less of a natural appearance and are more difficult to match to neighbouring teeth- which may have a variety of shades. The laboratory can get very ‘arty’- adding stains and tints to make the tooth as life-like as possible.

Is a relatively new type of technology that can allow an inlay/ onlay or crown to be made and placed in a single visit, thus avoiding the need to come back and spend a week with a temporary.
The machine itself is based on a CAD- CAM computer, where an impression is taken of the tooth with a special 3D sensor- the tooth shape and contacts are designed on the computer, then it is milled from a block of porcelain in an attached machine, ready to be put into the mouth. Because of the cost ($70,000+) of the machine, not all private dentists have this facility.

Gold Inlays

Gold is a fantastic material, but due to rising prices and the desire for natural looking teeth, it is becoming much less widely used. However, when done properly, it is regarded as the ultimate restoration, with extremely high strength, toughness, durability and resistance to wear, even in thin sections. This means a minimum amount of tooth preparation is necessary. Quality gold restorations can last over 30 years and often look as good as the day they were put in.

Lots of the older dentists really love gold, and if they need work done, will choose this over the other materials because of it’s superior qualities.

Composite Inlays

An indirect composite, (one that is made ‘outside’ of the mouth) is also a useful alternative. Its advantage is that can often complete the procedure in a single visit.It doesn’t require the lab to make it, so it is cheaper, plus the composite causes less wear on opposing teeth when compared to porcelain. It also can be added to more easily if there is a problem. Some dentists like them and do lots of them, but the majority of dentists probably prefer the other options.

Setting the composite outside the mouth and cementing it in, reduces the amount of shrinkage that is seen. This means the inlay/onlay doesn’t stress the tooth in the way that placing a composite fillingdirectly into the cavity would.

Like composite fillings, the material still has a tendency to pick up some stain at the margins. They will discolour and wear more over time than their porcelain and gold counterparts.

Procedure for an Inlay / Onlay

Here at Ocean dental Cancun we count with the Cerec Cad/Cam dental machine. It produces in office ceramic dental restorations using a computer assisted technology that includes 3d pictures and Cad/Cam. With the Cerec (Chair side Economical Restoration of Esthetic Ceramics) we can restore your teeth in a single sitting with the patients, rather than multiple sittings that require other techniques.

As with any treatment, an examination or consultation is required. The dentist first needs to look at the tooth in question and discuss the different treatment options with you. When considering an inlay or onlay, an X-ray is needed to check the following things:

  • Has it been root filled? If yes, the success of this must also be assessed.
  • Are there any signs of infection around the end of the root indicating the tooth needs a root canal treatment?
  • How does the periodontal support of the tooth look?
  • What is the extent of the decay, if there is any? Is the tooth restorable? If the decay or cariesextends deep under the gum, the tooth may not be able to be saved and need an extraction
  • How close it gets to the nerve chamber is also important in predicting future problems and deciding whether or not to perform a root canal. Special tests will also help in determining the most appropriate treatment.
  • Numbing the tooth that is to be restored (giving local anaesthetic).
  • Taking impressions of the opposing set of teeth so the lab can get the bite right.

Removing any decay and existing filling to get down to natural tooth and then shaping the remaining cavity so the dentist can easily take an impression of it. It is important not to have any undercuts, so the restoration can easily be cemented or bonded- in. The dentist will also remove any weak pieces of tooth to prevent the possibility of fracture in that area in the future.

The dentist will then try out the inlay/onlay and check the fit and contact with the neighbouring teeth. If it is too tight, it might require a bit of adjustment until it sits down properly. On rare occasions, the fit may be sufficiently different for a new impression and a re-make to be needed.

The restoration will differ depending on the type of inlay/onlay material and the dentist’s choice of cement or bond. It may involve one simple step and set chemically or require curing with the ‘special blue dental light’. Other materials have multiple steps and involve preparing the tooth and the inside of the porcelain and then bonding them together. Whatever the technique, it is very important that the area remains dry and is not contaminated with saliva. For this reason it may be done under rubber dam (a protective latex sheet), or by padding you out with dry tips and cotton wool rolls and a salivary ejector.

  • The dentist must ensure that floss can be passed through the contacts and that all excess cement material has been removed.
  • Finally the bite will be adjusted so it feels comfortable and all your other teeth should be meeting normally.

Generally there are very little side effects after having an inlay/ onlay and you are able to chew as normal and return to work pretty much as soon as you leave the dentist.

Anaesthetic will take a few hours to wear off, so just be careful during this period.

Success Factors

A number of factors will determine how long your inlay/onlay will last- the most important are a:

  • Good dentist
  • Good lab technician
  • Quality impression
  • Suitable choice of inlay/onlay material
  • Suitable choice of cement to bond it in with
  • Good dry technique to stick it in.

All these factors will all impact on how successful your inlay/onlay is and how long it will last.

  • How you look after it (oral hygiene)
  • The amount of good tooth remaining
  • The shape of the cavity
  • The design of the restoration
  • How you bite together.

What are the Risks, Potential Complications and Possible Side Effects?

The potential risks and complications of having a filling are the same for inlays and onlays. As with any restoration, the nerve could potentially play up if the cavity was very deep and the inlay (though it is unlikely if bonded correctly) could potentially come out. As mentioned before, as long as you have it, should this happen, it can generally just be stuck back in.

Dental Inlay / Onlay FAQ

The place of an inlay/onlay generally lies in between getting a filling and having a crown. Small cavities are generally best restored by fillings and very broken down teeth and root-filled posterior teeth, by crowns. Inlays and onlays are great options to restore and strengthen medium to large holes in teeth, giving you back very strong and natural looking teeth. A more detailed discussion of the situations in which they can be used is given in the previous chapter- Why would I need an inlay?

Not really, sometimes a bit of soreness from the gum or perhaps a bit of sensitivity if the tooth hasn’t had a root canal filling. Everything should be back to normal within a couple of days.

The alternatives to getting an inlay/onlay are:

  • A Filling
  • A Full Crown

If the dentist needs to temporise the tooth, whilst the inlay is being made in the laboratory, to stop it from being sensitive and to prevent bacteria getting into the tooth, then I advise the same precautions as for a temporary crown:

  • Take it easy on that side.
  • Appreciate that you have a temporary and that it is much weaker than a normal tooth so treat it with care.
  • Often just being aware and conscious that you have a temporary on that side will do the trick and prevent you from chewing anything too hard.
  • Where possible consider chewing on the other side.
  • Pull the floss through when you are flossing rather than pulling it back up which may dislodge the temporary. Some dentists will advise avoiding flossing around that tooth altogether.

Generally there are very little side effects after having an inlay/ onlay and you are able to chew as normal and return to work pretty much as soon as you leave the dentist.

Anaesthetic will take a few hours to wear off, so just be careful during this period. See- How long will the anaesthetic take to wear off? for more information.

Sometimes the numbness can make it a bit difficult to get you to bite in your natural position and so if after a few days it doesn’t feel normal again, return to your dentist who will make the necessary adjustments and polish it down to the right height in your bite.

It is also possible the inlay/onlay feels a little rough once the anaesthetic has worn off. Often this will smooth down naturally after a couple of days of normal eating and chewing. If it persists, just pop back to your dentist; there may be a little excess cement remaining.

It is a good idea to reflect briefly on why the treatment was necessary in the first place. If it was because the tooth was heavily broken down- ask yourself how could you have taken steps to prevent dental treatment in the first place. For example, if it was a cracked tooth because you were grinding – then you should get a night splint made. If it was because of a very heavily filled tooth, then the chances are the cause was decay. Frequent dental visits, better brushing, flossing good diet and fluoride are key to preventing it from happening again.

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SAVE UP TO 70% WE CAN HELP YOU!

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