Porcelain Inlays/Onlays

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Smilemaker100

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I just wanted to get an idea in regards to how many people in this forum routinely do porcelain inlays/onlays and what their experiences have been with them because the practice I just joined does quite a number of them. As a dental student and resident, I haven't come across many opportunities to actually do them.

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Smilemaker100 said:
I just wanted to get an idea in regards to how many people in this forum routinely do porcelain inlays/onlays and what their experiences have been with them because the practice I just joined does quite a number of them. As a dental student and resident, I haven't come across many opportunities to actually do them.

First off, congrats on entering the wonderfull world of making some $$ in private practice! 👍 As for porcelain inlays/onlays, frankly I rarely do them. Here's why I choose to practice this way.

#1 If I'm seriously considering treatment planing an inlay and especially an onlay, I'll often go right to a full coverage crown. Yes its more aggressive, but it's definately easier to prep and temp, and after having been in the business a few years now, I'm seeing a higher rate of seocndary decay around the inlay/onlay than with a full coverage crown - so I've had more than a few 5 year old inlays/onlays that I've then had to go and do a full coverage crown on, and to me thats a bit inefficient.

#2 I'm lazy in a sense, and this relates a bit back to part of reason #1. Lets be honest, temporizing an inlay/onlay is often a beast, and then more times than not, the temp will need to be recemented multiple times while the restoration is made, or you end up having to cut the temp off, all the while hoping not to "wound" your prep, thus leaving you a situation where your depending more on the resin cement, and less on your prep to keep things bonded. Often if I'm in a situation where I'd consider an inlay, I'll end up placing a direct composite, and if I'm considering an onlay, then my first preference would be a full coverage crown, followed by a "big 'ol composite"

#3 Cementing the inlay/onlay can be a pain in the A$$. Even with the glue stick applicators to hold them as you transfer them from your assitants pad of cement into the prep 😡 Some of this is I'm a big guy(6' 3"), with big fingers (XL gloves are a bit snug on me), so holding a little inlay and properly positioning it into the prep all covered with resin cement isn't the easiest thing for me to do. Hey, I'm being honest with you about this one

Just my opinion, and I will say that in the PROPER patient with a good lab tech doing the work, they look great and can function for a long, long time. On that esthetic note, by far and away, the best looking ceramics Ive seen (and the lab tech I use who'll come to my office to do custom staining as needed and sees a ton of porcelain work will agree) is IPS EMPRESS. In lighter shade teeth (Vita A2 or Vita 3-D 2M2 or lighter) and especially anything needed restoration with a high degree of translucency, this porcelain in the hands of a good lab tech looks absolutely amazing (I'm talking patients can't stop raving about it - and you - to their friends)
 
I never really understood the point of doing onlays or 3/4 crowns. The technology for crowns is so good lately that it is not really worth investing all the resources doing all these kind of half assed procedures... but then again, im only a fourth year, I dunno, i may be wrong.
 
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One of the practices I'm in likes doing a lot of gold inlays/onlays. They do look good and I haven't really seen any decay around them in the recall patients I see in this office. I've seen a bunch of gold onlays where an FCC could have been very easily done, but the margins are so much easier to see & clean with the onlay.

Of course, I will not get a chance to actually do any of them, that is not why the office hired me. 🙁
 
Personally having several inlays/onlays here is my opinion. Looking into my mouth the inlays and onlays are beautiful restorations, literally unnoticable compared to the 1 crown I have. Honestly on a scale of 1 to 10 I would give my inlays/onlays 8-9 and my one crown a 4. Now i'm sure there are better crowns out there but my dentist always favors saving as much virgin tooth structure as possible which I totally agree with 🙂. I do agree with you guys however that the temps are a bitch (several of mine came out multiple times) so I had to make a trip back to the office for it to be recemented (but in the long run it was worth it.
 
I remember seeing pictures (on some dental website) of gold inlays placed in the 40's!
 
DrJeff said:
First off, congrats on entering the wonderfull world of making some $$ in private practice! 👍 As for porcelain inlays/onlays, frankly I rarely do them. Here's why I choose to practice this way.

#1 If I'm seriously considering treatment planing an inlay and especially an onlay, I'll often go right to a full coverage crown. Yes its more aggressive, but it's definately easier to prep and temp, and after having been in the business a few years now, I'm seeing a higher rate of seocndary decay around the inlay/onlay than with a full coverage crown - so I've had more than a few 5 year old inlays/onlays that I've then had to go and do a full coverage crown on, and to me thats a bit inefficient.

#2 I'm lazy in a sense, and this relates a bit back to part of reason #1. Lets be honest, temporizing an inlay/onlay is often a beast, and then more times than not, the temp will need to be recemented multiple times while the restoration is made, or you end up having to cut the temp off, all the while hoping not to "wound" your prep, thus leaving you a situation where your depending more on the resin cement, and less on your prep to keep things bonded. Often if I'm in a situation where I'd consider an inlay, I'll end up placing a direct composite, and if I'm considering an onlay, then my first preference would be a full coverage crown, followed by a "big 'ol composite"

#3 Cementing the inlay/onlay can be a pain in the A$$. Even with the glue stick applicators to hold them as you transfer them from your assitants pad of cement into the prep 😡 Some of this is I'm a big guy(6' 3"), with big fingers (XL gloves are a bit snug on me), so holding a little inlay and properly positioning it into the prep all covered with resin cement isn't the easiest thing for me to do. Hey, I'm being honest with you about this one

Just my opinion, and I will say that in the PROPER patient with a good lab tech doing the work, they look great and can function for a long, long time. On that esthetic note, by far and away, the best looking ceramics Ive seen (and the lab tech I use who'll come to my office to do custom staining as needed and sees a ton of porcelain work will agree) is IPS EMPRESS. In lighter shade teeth (Vita A2 or Vita 3-D 2M2 or lighter) and especially anything needed restoration with a high degree of translucency, this porcelain in the hands of a good lab tech looks absolutely amazing (I'm talking patients can't stop raving about it - and you - to their friends)

Thanks, as always, for the lenghty well thought replies, Dr Jeff. 🙂

Yes, I am finally in the "real world" of dentistry and loving every minute of it ! 😍 I feel so blessed :luck: for joining this mega practice recently. The owners of the clinics (own 3) are fantastic clnicians AND very good businessmen. Their organizational skills are phenomenal. I have come to know many dentists and practices over the years and I must say, these guys truly impress me. :clap:

I have a lot to learn from these dentists in regards to the clinical and business aspect of dentistry. They let me to shadow them for a while. They are really the "jack of all trades". They aren't just "drill and fill" dentists. Name the procedure and they can do it...periodontal surgery, implant placement and restoring, wisdom teeth extractions/surgical extractions, full mouth dental rehab cases, cosmetic makeovers etc....AWESOME! 😀

In regards to your reply, I am a very conservative person and I think it is better to be conservative whenever possible hence- remove the less tooth substance as possible .There are risks of secondary decay not only with the onlays but crowns too. There is a way to diminish this risk for onlays/inlays. The dentist I saw placing onlays had a little trick. After cementing the onlay, he placed a flowable resin around the margins.

In regards to temporazing porcelain onlays or inlays preps, there is a product which is easier to manipulate than the standard materials you mentioned. There is a resin called FERMIT which is light cured and is not so hard to manipulate and isn't hard to remove either.

Nice hearing from you! 🙂
 
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