In many dental cases to reduce further damage to the biting area or to provide an an increased support to the occlusal cusp areas the dentist makes use of the procedure of inlays and onlays.
A dental inlay or onlay is bigger than a filling and smaller than a crown. It is bonded or cemented into place.Inlays and Onlays can be made from porcelain, gold, or composite or ceramic resin, although porcelain is now becoming the material of choice because of its strength and potential to match the natural colour of tooth.
[In the first part of this article we are going to cover about Inlays.]
An inlay is similar to a filling and lies inside the cusp tips of the tooth. They are custom-made to fit the prepared cavity and are then cemented into place.
So,an inlay is similar to a filling, but it lies within the cusps (bumps) on the chewing surface of your tooth.
Inlays are typically prescribed when it will be difficult to restore a tooth to its proper shape and re-establish proper contacts with the adjacent teeth. Less tooth structure is removed than would be necessary for crowns or onlays. Inlays are very similar to fillings, except that they’re generally made in a lab, which adds cost and complexity to the procedure.
Before starting any procedure of inlay the dentist needs to make a through investigation regarding the over systemic health of the patient. for eg the patient might have suffered from bacterial endocarditis before or might be having artificial heart valves. So its always advisable to start with a batch of prophylactic antibiotics. This antibiotic pre-medication in many cases is of utmost importance.
In few extreme cases where the patient is over anxious and excited it is always better to paractice sedation dentistry or to use oral anti anxiety pills like valium.
The following description of the inlay procedure may vary from patient to patient, and dentist to dentist, depending on unique individual circumstances and preferences. However, the steps will generally resemble the following:
a) Before starting of the procedure the local area is thoroughly inspected . A rough work steps of the entire procedure should be prepared and should be explained to the patient.
b) The operative area is cleaned properly and local anaesthetic gel is applied . This helps in reducing the patients discomfort to a great extent. In most of the cases of inlay cavity preparation there is no need of injectable local anaesthesia . But i few cases where the need arises it should be administered.
c) Once the tooth or teeth are numb, the dentist or dental assistant may isolate the area with a rubber dental dam. Along with isolation of the operative field , they also prevent the patient from having to swallow bacteria-rich decay and any old filling material. They protect the tongue and oral mucosa from injury by dental instrumentation. It also prevents the accidental swallowing of any instruments by the patient.
d) When good isolation is achieved, the dentist will remove the tooth decay with a dental handpiece. The goal is to remove bacterially infected and weakened tooth structure.has been idealized to allow for insertion of an inlay, the dentist may use a “caries detection dye”, which will leave stain on areas of less obvious decay.
e) I case of deep cavities the pulp should be protected using a base.
f) An impression of the inlay preparation will be made, so that a stone replica of the prepared tooth (i.e. a cast of the tooth) can be produced.
A record of the way your teeth fit together will be obtained, using a fast-setting, elastic bite registration paste.
g) If the inlay is going to be prepared in the laboratory then a temporary restorative material is to be placed.
If inlay is being made in the office then the patient is asked to wait.
h) Before the final delivery of the inlay proper occlusion and bite registration should be carried out. Any rough edges and high points should be reduced.
Poor fitting inlays can lead to fractured teeth.
Poor fitting inlays can leak, causing recurrent decay.
Inflammation of the tooth pulp (“pulpitis”), which may be temporary (reversible), or irreversible. If your tooth sensitivity does not resolve, the tooth may require endodontic (root canal) therapy. If the tooth requiring endodontic treatment is a back tooth, it may also require a crown.