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Dental Inlays And Onlays
In dentistry, an inlay is an indirect restoration (filling) consisting of a solid substance (as gold or porcelain) fitted to a cavity in a tooth and cemented into place.[1] An onlay is the same as an inlay, except that it extends to replace a cusp. Crowns are onlays which completely cover all surfaces of a tooth.
Inlays
Sometimes, a tooth is 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 or provide substandard opposition to occlusal (i.e., biting) forces. In such situations, an indirect gold or porcelain inlay restoration may be indicated. When an inlay 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. While these restorations might be ten times the price of direct restorations, the superiority of an inlay in terms of resistance to occlusal forces, protection against recurrent decay, precision of fabrication, marginal integrity, proper contouring for gingival (tissue) health, and ease of cleansing offers an excellent alternative to the direct restoration.
Onlays
When decay or fracture incorporate areas of a tooth that make amalgam or composite restorations inadequate, such as cuspal fracture or remaining tooth structure that undermines perimeter walls of a tooth, an onlay might be indicated. Similar to an inlay, an onlay is an indirect restoration which incorporates a cusp or cusps by covering or onlaying the missing cusps. All of the benefits of an inlay are present in the onlay restoration. The onlay allows for conservation of tooth structure when the only alternative is to totally eliminate cusps and perimeter walls for restoration with a crown. Just as inlays, onlays are fabricated outside of the mouth and are typically made out of gold or porcelain. Gold restorations have been around for many years and have an excellent track record.
In recent years, newer types of porcelains have been developed that seem to rival the longevity of gold. If the onlay or inlay is made in a dental laboratory, a temporary is fabricated while the restoration is custom-made for the patient. A return visit is then required to fit the final prosthesis. Inlays and onlays may also be fabricated out of porcelain and delivered the same day utilizing techniques and technologies relating to CAD/CAM dentistry.
Dental Crowns, Dr. Alejandro Mora
| Costa Rica Porcelain Crowns – Dr. Alejandro Mora LassoCrowns are dental restorations also known as “caps,” made of natural looking porcelain that fit over the teeth. Crowns may be necessary because of broken fillings, fractures or chips, or sensitive teeth. Many Costa Rica porcelain crowns patients also receive crowns to improve the appearance of natural teeth that are malformed, misaligned or discolored.
Attention to detail is considered whether the crowns are all porcelain or an underlying metal substructure is required for strength and stability. As a leading Costa Rica dental crowns specialist, Dr. Alejandro Mora Lasso uses the latest and most advanced technology to provide patients with the highest-quality results possible. |
Porcelain Veneers – Dr. Alejandro Mora
| Costa Rica Porcelain Veneers – Dental Cosmetics Costa RicaPorcelain veneers are one of the primary tools in cosmetic dentistry. They are paper-thin, custom made shells of porcelain, which are bonded onto the front and side surfaces of your tooth. At Dental Cosmetics Costa Rica, Dr. Alejandro Mora Lasso and his team of dental professionals have years of experience helping Costa Rica porcelain veneers patients achieve their ideal smile.
If you ever wished you could radically redesign your smile, veneers could be just the solution for your teeth. Veneers are recommended for patients seeking:
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Dental Briges
A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth or dental implants.
There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin.
A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante’s Law: “The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics”.
The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.
When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or “dummy tooth”, the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.
Case selection and treatment planning
When a single tooth requires a crown, the prosthetic crown will in most instances rest upon whatever tooth structure was originally supporting the crown of the natural tooth. However, when restoring an edentulous area with a bridge, the bridge is almost always restoring more teeth than there are root structures to support. For instance, in the photo at right, the 5-unit bridge will only be supported on three abutment teeth. To determine whether or not the abutment teeth can support a bridge without failure from lack of support from remaining root structures, the dentist employs Ante’s rule—which states that the roots of abutment teeth must have a combined surface area in three dimensions that is more than that of the missing root structures of the teeth replaced with a bridge. When the situation yields a poor prognosis for proper support, double abutments may be required to properly conform to Ante’s rule.
When a posterior tooth intended for an abutment tooth already possesses an intracoronal restoration, it might be better to make that bridge abutment into an inlay or an onlay, instead of a crown. However, this may concentrate the torque of the masticatory forces onto a less enveloping restoration, thus making the bridge more prone to failure.
In some situations, a cantilever bridge may be constructed to restore an edentulous area that only has adequate teeth for abutments either mesially or distally. This must also conform to Ante’s rule but, because there are only abutments on one side, a modification to the rule must be applied, and these bridges possess double abutments in the majority of cases, and the occlusal surface area of the pontic is generally decreased by making the pontic smaller than the original tooth.
Tooth preparation
As with preparations for single-unit crowns, the preparations for multiple-unit bridges must also possess proper taper to facilitate the insertion of the prosthesis onto the teeth. However, there is an added dimension when it comes to bridges, because the bridge must be able to fit onto the abutment teeth simultaneously. Thus, the taper of the abutment teeth must match, to properly seat the bridge. This is known as requiring parallelism among the abutments.
When this is not possible, due to severe tipping of one of more of the abutments, for example, an attachment may be useful, as in the photo at right, so that one of the abutments may be cemented first, and the other abutment, attached to the pontic, can then be inserted, with an arm on the pontic slipping into a groove on the cemented crown to achieve a span across the edentulous area.
Restoration fabrication
Full dental bridge being machined using WorkNC Dental CAD/CAM software.
As with single-unit crowns, bridges may be fabricated using the lost-wax technique if the restoration is to be either a multiple-unit FGC or PFM. Another fabrication technique is to use CAD/CAM software to machine the bridge.[2] As mentioned above, there are special considerations when preparing for a multiple-unit restoration in that the relationship between the two or more abutments must be maintained in the restoration. That is, there must be proper parallelism for the bridge to seat properly on the margins. Sometimes, the bridge does not seat, but the dentist is unsure whether or not it is only because the spatial relationship of the two or more abutments is incorrect, or whether the abutments do not actually fit the preparations. The only way to determine this is to section the bridge and try in each abutment by itself. If they all fit individually, it must have simply been that the spatial relationship was incorrect, and the abutment that was sectioned from the pontic must now be reattached to the pontic according to the newly confirmed spatial relationship. This is accomplished with a solder index.
The proximal surfaces of the sectioned units (that is, the adjacent surfaces of the metal at the cut) are roughened and the relationship is preserved with a material that will hold on to both sides, such as GC pattern resin. With the two bridge abutments individually seated on their prepared abutment teeth, the resin is applied to the location of the sectioning to reestablish a proper spatial relationship between the two pieces. This can then be sent to the lab where the two pieces will be soldered and returned for another try-in or final cementation.
Porcelain Veneers
In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two main types of material used to fabricate a veneer, composite and dental porcelain. A composite veneer may be directly placed (built-up in the mouth), or indirectly fabricated by a dental technician in a dental laboratory, and later bonded to the tooth, typically using a resin cement such as Panavia. In contrast, a porcelain veneer may only be indirectly fabricated.
History of Porcelain Veneers
Veneers were invented by a California dentist named Charles Pincus. At the time, they fell off in a very short time as they were held on by denture adhesive. They were, however, useful for temporarily changing the appearance of actors’ teeth.
Research started in 1982 by Simonsen and Calamia revealed that porcelain could be etched with hydrofluoric acid, and bond strengths could be achieved between composite resins and porcelain that were predicted to be able to hold porcelain veneers on to the surface of a tooth permanently. This was confirmed by Calamia in an article describing a technique for fabrication, and placement of Etched Bonded Porcelain Veneers using a refractory model technique and Horn describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique.
Today, with improved cements and bonding agents, they typically last 10-30 years. They may have to be replaced in this time due to cracking, leaking, chipping, discoloration, decay, shrinkage of the gum line and damage from injury or tooth grinding. The cost of veneers can vary depending on the experience and location of the dentist. In the US, costs range anywhere from $1000 a tooth upwards to $2500 a tooth as of 2009. Porcelain veneers are more durable and less likely to stain than veneers made of composite[14].
Indications
Veneers are an important tool for the cosmetic dentist. A dentist may use one veneer to restore a single tooth that may have been fractured or discolored, or multiple teeth to create a “Hollywood” type of makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, provide a uniform color, shape, and symmetry, and make the teeth appear straight.
The problem of overuse of porcelain veneers by certain cosmetic dentists has been profiled in the book, ‘Confessions of a Former Cosmetic Dentist’. The author suggests that the use of veneers for ‘instant orthodontics’ or simulated straightening of the teeth is harmful, especially for younger people with healthy teeth. Many cosmetic dentists agree that porcelain veneers can be used improperly and can exploit patients [16]
Alternatives
In the past, the only way to correct dental imperfections was to cover the tooth with a crown. Today, in most cases there are several alternatives: crown, composite resin bonding or porcelain veneer or even cosmetic contouring or orthodontics
Non-permanent dental veneers are available. These dental veneers are molded to existing teeth and are removable and reusable and are made from a flexible resin material. Do it yourself at home kits are also available for the impression-taking process. Actual veneers are made in the lab and sent to the wearer through the mail.
Advanced Dental Implantology
A dental implant is a “root” device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.
Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root (and thus possess a “root-form”) and are placed within the bone (endo- being the Greek prefix for “in” and osseous referring to “bone”). The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. This is what makes the implant resemble the look and feel of a natural tooth. Since dental implants fuse with bone and lack the periodontal ligament, however, they will feel slightly different than natural teeth during chewing.
Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws.
Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures. They can also be used as anchorage for orthodontic tooth movement. The use of dental implants permits undirectional tooth movement without reciprocal action.
Dental Cosmetics Costa Rica
Costa Rica Cosmetic Dentist – Dr. Alejandro Mora Lasso
At the state-of-the-art facilities of Dental Cosmetics Costa Rica, cosmetic dentistry patients are offered a wide variety of restorative and cosmetic dentistry treatments at very affordable prices. Dr. Alejandro Mora Lasso, a highly experienced Costa Rica cosmetic dentist and founder of Dental Cosmetics Costa Rica, is dedicated to helping each of his patients achieve bright, radiant teeth that transform their smiles and help them regain their self-confidence.
As leading Costa Rica cosmetic dentistry providers, we specialize in oral rehabilitation and cosmetic dentistry. Our team of Costa Rica cosmetic dentistry specialists offer a large variety of dental services, including laser teeth whitening, dental implants, porcelain veneers, full porcelain crowns and bridges, comfortable dentures and TMJ disorder treatment among others
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