Inlays and onlays

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In dentistry, an inlay is a filling consisting of a solid substance (as gold or porcelain) fitted to a cavity in a tooth and cemented into place.

Inlays

An impression of a tooth prepared for restoration with a DO gold inlay on tooth #5. The "DO" designation indicates that the gold serves as a restoration for the distal and occlusal surfaces of the tooth. This tooth was prepared and the inlay will be fabricated according to the R.V. Tucker method of gold inlay preparation. Notice how the line angles of the impression for the inlay are very sharp and precise; this is achieved using carbon-tipped stainless steel instruments. The salmon-colored polyvinylsiloxane impression material is less viscous than the blue and is able to capture better detail for the tooth being restored.

Sometimes, a tooth is treatment planned to be restored with an intracoronal restoration, but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite, would compromise the structural integrity of the restored tooth by possibly undermining the remaining tooth structure or providing substandard opposition to occlusal (i.e. biting) forces. In such situations, an indirect gold restoration may be indicated, such as the gold inlay shown below. When gold is used, the tooth-to-restoration margin may be finished and polished to such a super-fine line of contact that recurrent decay will be all but impossible. It is for this reason that some dentists recommend gold as the restorative material of choice for pretty much any and all restorations. While these restorations might be ten times the price of direct restorations, the superiority of gold as a restoration in terms of resistance to occlusal forces, protection against recurrent decay, precision of fabrication, marginal integrity, proper contouring for gingival (tissue) heath, ease of cleansing and many other aspects of restorative quality offers an excellent alternative to the direct restoration. For this reason, some patients request gold restorations so they can benefit from its wide range of advantages even when an amalgam or composite will suffice. The only true disadvantage of gold is the higher cost.

An MO gold inlay on tooth #3, the "MO" designation indicating that the gold serves as a restoration for the mesial and occlusal surfaces of the tooth. This tooth was also restored according to the R.V. Tucker method. Notice how the gold appears to flow into the tooth structure, almost perfectly mimicking the natural contours and even allowing the specular reflection to continue over the margin from tooth to gold.

Onlays

Additionally, when decay or fracture incorporate areas of a tooth that make amalgam or composite restorations essentially inadequate, such as cuspal fracture or remaining tooth structure that undermines perimeter walls of a tooth, a gold onlay might be indicated. Similar to an inlay, a gold onlay is an indirect restoration which incorporates a cusp or cusps by covering or onlaying the missing cusps. All of the benefits of a gold inlay are present in the onlay restoration. The onlay allows for conservation of tooth structure when the alternative is to totally eliminate cusps and perimeter walls for restoration with a crown. Because onlays have a very long margin (i.e. the line of tooth-to-restoration contact is much longer than that of a crown because of the many turns and curves that an onlay makes in contacting the tooth), some dentists feel that an onlay is a fundamentally inferior restoration. This is because it is primarily the marginal adaptation of any dental restoration that will decide whether or not it will successfully remain in the mouth without exhibiting recurrent decay. The increase in marginal length consequently provides a further likelihood of failure.

Materials and fabrication

When inlays and onlays are made out of gold, they are fabricated using the lost-wax technique.

Inlays and onlays can also be made out of porcelain and some other forms of ceramic, and the use of CAD/CAM technology can also be implemented.

References

The Gold Inlay Instructional DVD, The Academy of R.V. Tucker Study Clubs, distributed by Jensen Industries.

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