CONSERVATIVE

ETHETIC
APPROACHES
Presented by:
Yasmin shebl
Abd elrahman mostafa
Noura mokhtar
Ramez micheal

CONSERVATIVE ETHETIC APPROACHES:

Dental care can be defined by the health, function and

aesthetic (HFA) triad.
It is important to realize the hierarchy of this triad,
attainment of health, followed by function, followed by
aesthetics.
One can achieve health without function or aesthetics,
and both health and function are possible without
aesthetics.
However, aesthetics are not possible if the first two,
health and function, are absent

One of the aspects in dentistry involves the conservation of tooth

structure; that is, we always want to restore the tooth in question by
removing only the decay, existing defective restorations, and
undermined tooth structure, while maintaining the integrity of the rest of
the tooth.
Conservative dentistry is preservation of tooth structure.
Conservative dentistry includes non-restorative such as: bleaching,
micro and macro abrasion or by restorative techniques: laminate
veneers, onlay and inlays, resin bonded bridges and endocrowns.

NON-METALLIC INLAY ONLAYS FOR VITAL AND

NON-VITAL
TEETH
INLAY
Is an indirect intra-coronal restorations that replace the carious tooth
structure removed consisting of a solid substance (as gold, porcelain or
less often a cured composite resin) fitted to a cavity in a tooth and
cemented into place.

ONLAY
Is the same as an inlay, except that it incorporates a
replacement for a tooth cusp by covering the area where
the missing cusp would be

Materials for inlay and onlay May be:

-NON METAL
Porcelain
Indirect composite

-Metal
Such as gold

Gold material is considered the gold standard of

restorative dentistry due to:
high Strength
Biocompatibility
Low wear
No discoloration
Allow Control of contour and contacts
But its main deficiency is its color.

The main indications for constructing a

ceramic or composite inlay or Onlay:
-Ceramic inlay indications include most of the typical indications for
cast-metal inlays, with the added requirement for a tooth-colored
restoration.
-Ceramic inlays can be conservative of tooth structure, and permit
preservation of much coronal tissue.
They can be used instead of a metal-casting or amalgam restoration in
patients who require a class II restoration where buccal and lingual walls
remain intact, and offer a viable alternative where excessive isthmus
width may preclude the use of a direct posterior composite restoration.
-Ceramic inlays are stronger than direct posterior composite resins,
offering superior physical properties than the latter, as the limited degree
of polymerization conversion of direct posterior composites limits their
strength.
However, the advantage of the ceramic inlay over the composite resin
may be limited by the possible need for an additional appointment, the

greater skill level required to deliver the treatment, and the higher cost
associated with the materials used.
Contraindications for ceramic inlays exist in dentitions of patients with
poor plaque control or active decay.
-Since porcelain fracture has been reported as a primary reason for
ceramic inlay failure, heavy loading should be avoided.
Under those circumstances, the brittle nature of the ceramic makes these
restorations a higher risk. In the presence of an unfavorable occlusion, a
group-function occlusal arrangement, or in patients exhibiting evidence
of parafunctional activity such as bruxism or clenching, prudence is
advised.
-Consideration should be given to alternative restorations when faced

with the inability to maintain a dry field precluding proper luting

procedures.
Accordingly, preparations with deep cervical subgingival extensions,
and other clinical situations where excellent isolation is problematic,
may constitute a contraindication.
-Restoration wear which is frequently seen with posterior composite

resins.

Ceramic inlays as retainers

Inlays typically exhibit lower retention values compared to full-veneer

crowns, limiting their application as retainers for fixed partial dentures
subjected to higher loads.
Multiple studies have analyzed stress distributions of such FDPs using
finite-element analysis.

Such studies suggest that peak stresses in inlay-retained FDPs are

approximately 20% higher than in FDPs supported by complete
coverage retainers.
Indications and Contraindications
Inlay-retained FDPs are indicated
in patients with good oral hygiene and low susceptibility to caries,
who have a minimum coronal tooth height of 5 mm,
parallel abutments
maximum mesiodistal edentulous gap of 12 mm
Contraindications include:
severe parafunctions
the absence of enamel on the preparation margins,
extensive crown defects and abutment-tooth mobility

Preparation guidelines for ceramic inlays

Principles of cavity preparation differ from those of gold restorations
-Bevels and Retention form are not needed
-Resistance form only in large onlay restorations
-Retention form is not as critical due to the bonded nature of the restoration, and
bevels are contraindicated.
-Cavosurface angles of 90 are preferred, and the preparation must have smoothflowing margins to facilitate the fabrication of the restoration.
-Rounded internal line angles and the butt-joint cavosurface margins facilitate
many aspects of conventional laboratory or chair-side inlay fabrication

Cavity walls are flared 5 to 15 degress

Gingival floor prepared to a butt joint
Internal line angels are rounded
Min. isthmus width is 2 mm
Min. depth thickness is 1.5 mm

Non-working and working cusps are covered with

1.5 to 2mm of material
Options for ceramic onlay preparation:
1-The Hooding technique:
By which you decrease the cuspal tip to gain proper occlusal clearance.
Then form a heavy chamfer finish line on the facial surface of the cusp
for which it will receive its all-ceramic facing.
2-Remove the cusp:
When the cusp is heavily damaged and cant be restored the cusp is
flushed with cavity floor. And a shoulder or heavy chamfer finish line is
placed with an end cutting stone.
Challenges in preparation of ethetic inlay and onlay restorations:
1-Challenges with ceramic restorations include difficulties encountered in the
development of precise occlusal contact.
2- Often, it is most practical to bond the restoration in place prior to final
verification of the occlusion, which in turn can result in a compromised finish and
more irregular surface finishes on the ceramic restorations than can be achieved
when they are polished in the dental laboratory.