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Onlays in dentistry: A comprehensive guide

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Find out everything about onlays - from the definition, types, materials and areas of application to care.

1. Onlays

Onlays represent a significant advance in restorative dentistry by offering a more conservative alternative to traditional crowns. They play a key role in restoring the function and esthetics of damaged teeth. This article provides a comprehensive overview of onlays, their types, materials, manufacturing processes and areas of application, as well as their advantages and disadvantages. The aim is to provide an in-depth understanding of this important dental treatment.

1.1 Definition of onlays

Onlays are dental restorations that are used to restore a damaged tooth. They not only cover the chewing surface, but also at least one tooth cusp or lateral parts of the tooth. In contrast to inlays, which are limited to filling the occlusal surface, onlays offer more comprehensive coverage and are firmly bonded to the tooth.

1.2 Types of onlays

Onlays can be divided into different types according to their coverage and the affected tooth area. Each type is selected according to the extent of tooth decay and the specific requirements of the patient.

1.2.1 Partial onlays

Partial onlays focus on repairing smaller defects on the tooth. This type of onlay only covers part of the tooth surface, often limited to the cusps or one side of the tooth. They are typically used when the damage to the tooth does not cover the entire chewing surface, but is limited to smaller, specific areas. The most notable advantage of partial onlays is their minimally invasive approach. Compared to more extensive restorations, their application requires the removal of a smaller amount of tooth structure, which is a more conservative form of treatment. This approach is not only gentler on the natural tooth, but also facilitates the maintenance process. Various options are available when choosing the material for partial onlays, including ceramic, composite and metal, with gold as the preferred option, non-precious alloys or titanium also possible. The choice of material depends on various factors, including the patient's esthetic preferences and the functional requirements of the tooth.

1.2.2 Complete onlays

Full onlays, on the other hand, are designed for the comprehensive restoration of a tooth. Unlike their partial counterparts, they cover almost the entire chewing surface of the tooth, including all cusps and margins. This type of onlay is primarily used for extensive defects or severely worn teeth, especially when a significant portion of the occlusal surface needs to be restored. A major advantage of complete onlays is their ability to fully restore the functionality of the tooth. They help to distribute the chewing pressure and can therefore extend the life of the treated tooth. The choice of material for full onlays also varies depending on the specific needs and wishes of the patient. Ceramics, composites and gold are also offered as material options, with each material having its own advantages in terms of durability, esthetics and biocompatibility.

Both partial and full onlays play an important role in restorative dentistry. They offer customized solutions to restore the function and appearance of damaged teeth, with a focus on preserving the natural tooth structure.

1.3 Materials

A variety of materials are used in the manufacture of onlays in dentistry, with each material offering specific properties and advantages. Choosing the right material is crucial for the longevity, functionality and esthetics of the onlay. Here are the most common materials and their properties:

1.3.1 Ceramics

Ceramic is one of the most popular materials for onlays. It is characterized by its aesthetic quality, as it comes very close to natural teeth in terms of color and translucency. This makes ceramic particularly suitable for onlays in the visible area of the mouth, where a natural appearance is crucial. In addition to its esthetic advantage, ceramic is also known for its biocompatibility - it is well accepted by the body and rarely causes allergic reactions. One disadvantage of ceramic could be its relative brittleness, which can make it more susceptible to fracture under high pressure, such as that exerted on molars.

1.3.2 Composite

Another common material is composite, a composite material consisting of fine ceramic and glass particles embedded in a matrix. Composite materials are versatile and can be molded and cured directly in the patient's mouth, making them a popular choice for many dental applications. They are less expensive than ceramics and can be more easily repaired or customized. However, they tend to discolor over time and may not be as durable as other materials.

1.3.3 Gold

Gold remains a traditional and proven material in dentistry, particularly valued for its durability and strength. Gold onlays are particularly suitable for areas of the mouth where aesthetics play a subordinate role but durability and functionality are crucial, such as the back molars. Gold is extremely durable, compatible and resistant to abrasion. Its biocompatible nature makes it a safe choice, especially for patients who may be sensitive to other materials.

1.3.4 NEM (non-precious metal)

In addition to ceramic, composite and gold, non-precious metal (NPM) alloys, including titanium, are another option for the production of onlays. Due to the high cost of gold alloys, which are often not covered by health insurance, non-precious metal alloys are a cost-effective alternative.

Non-precious metal alloys are characterized by their hardness, which makes them even harder than precious metal (EM) alloys. This increased hardness can be an advantage in certain clinical situations, as it offers high resistance to abrasion and deformation. However, a disadvantage of non-precious alloys is their aesthetic effect: as they are silver in color, they can be perceived as less appealing in visible areas of the mouth than, for example, ceramics, which offer higher aesthetics due to their color matching to natural teeth.

Despite their esthetic disadvantages, non-precious alloys are a viable solution for areas of the mouth where esthetics play a subordinate role. Their durability and cost-effectiveness make them an attractive option for many patients and dentists looking for a long-lasting and economically viable solution for dental restorations.

The choice of material for an onlay depends on a number of factors, including the position of the tooth in the mouth, esthetic requirements, the chewing force acting on the tooth and, of course, the patient's personal preferences and budget.

1.4 Treatment procedure and fabrication of onlays

1.4.1 Traditional method

Preliminary examination and diagnosis: The process begins with a thorough examination of the affected tooth by the dentist. This examination usually includes x-rays and an assessment of the condition of the tooth and the surrounding tissue.

Preparation of the tooth: The tooth is prepared for the onlay. This includes the removal of damaged tooth tissue or old fillings. The dentist then shapes the tooth to create an ideal base for the onlay.

Impression: Once the tooth has been prepared, a precise impression of the tooth is taken. This is traditionally done with an impression material, which is fitted exactly into the patient's mouth and removed after hardening.

Fabrication in the dental laboratory: The impression is sent to a dental laboratory. There, a dental technician fabricates a model and the onlay based on the impression and the patient's specific requirements. The onlay is made from the selected material, such as ceramic or gold.

Fitting and insertion: After the onlay has been completed in the laboratory, it is fitted to the patient's tooth by the dentist. It is carefully checked to ensure that it fits perfectly and does not impair the bite function.

1.4.2 Modern method with CAD/CAM technology

Digital preliminary examination and planning: As with the traditional method, the process begins with a comprehensive examination. Modern techniques can include additional diagnostic methods such as 3D imaging.

Digital impression: Instead of the traditional impression material, an intraoral scanner is used to create a digital 3D image of the prepared tooth. This process is often faster and more comfortable for the patient.

Design and fabrication of the onlay: The digital image is used in special CAD/CAM software to design the onlay. The onlay is then produced directly in the dental practice or laboratory using a milling machine from a block of the selected material such as glass or composite.

Immediate fitting and insertion: In contrast to the traditional method, where the fabrication of the onlay can take days or weeks, CAD/CAM technology often makes it possible to fabricate and insert the onlay in just one session.

1.5 Areas of application for onlays

Onlays are used in dentistry in a variety of applications defined by the specific needs and conditions of a patient's teeth. These areas of application reflect the versatility and effectiveness of onlays in the treatment of various dental problems.

The main indications for the use of onlays include the treatment of tooth fractures and caries, especially in cases where conventional fillings are no longer sufficient to ensure optimal restoration of the tooth. Onlays are ideal when a large part of the chewing surface of a tooth needs to be restored without the need for a full crown. This makes them a preferred choice for restoring molars that need to withstand high chewing loads. The robust structure of onlays helps to maintain the integrity of the tooth and optimize the distribution of masticatory pressure, which helps to prevent further damage to the tooth. In addition, onlays are often used as an alternative to crowns when the aim is to preserve as much natural tooth structure as possible. Compared to crowns, which cover the entire tooth, onlays are less invasive as they only cover the damaged or worn part of the tooth.

This more conservative approach helps to ensure the long-term health and stability of the tooth. Another important application of onlays is their ability to improve the aesthetics of the tooth. Especially when esthetic materials such as ceramic are used, onlays can effectively help to restore or even improve the natural appearance of the tooth. This is particularly beneficial for visible teeth, where a natural appearance is crucial.

1.6 Advantages and disadvantages of onlays

1.6.1 Advantages

•    Preservation of the natural tooth structure: A major advantage of onlays is their conservative approach. They allow a greater amount of natural tooth structure to be preserved compared to crowns, as only the damaged part of the tooth is treated.
•    Longevity and durability: Onlays are known for their longevity and durability. Especially if they are made of robust materials such as ceramic or gold, they can last for many years.
•    Improved esthetics: Modern onlays, especially those made of ceramic, offer excellent esthetic results. They can be made to match the color of the surrounding teeth and achieve a natural appearance.
•    Strengthening the tooth: Onlays help to strengthen the structure of the treated tooth. They distribute the chewing pressure evenly over the tooth, which reduces the likelihood of further damage.
•    Tolerance: Many of the materials used for onlays are biocompatible and rarely cause allergic reactions or intolerances.

1.6.2 Disadvantages

•    Cost: Onlays can be more expensive than traditional fillings or some other restorative methods. In particular, high-quality materials such as gold or ceramic can increase the cost.
•    Potential susceptibility to fracture: Although onlays are generally durable, they can fracture under extreme pressure or if used improperly, especially if they are made of ceramic.

1.7 Care and longevity

The care and longevity of onlays in dentistry are crucial aspects for the long-term success of this form of treatment. To ensure that onlays continue to function for many years, both appropriate care measures and regular dental check-ups are necessary.

•    Regular and thorough oral hygiene: One of the most important measures for preserving onlays is maintaining good oral hygiene. This includes brushing twice a day with a fluoride toothpaste to prevent plaque build-up and protect the tooth and onlay from decay. The use of a soft toothbrush is recommended to avoid damaging the onlay surface.
•    Use of dental floss and interdental brushes: Cleaning the spaces between the teeth is also crucial. Floss or interdental brushes should be used regularly to remove food debris and plaque that can build up in these areas.
•    Avoid hard and sticky foods: To avoid jeopardizing the integrity of the onlay, patients should avoid eating hard, sticky or chewy foods, as these could damage or detach the onlay.
•    Avoiding teeth grinding: Patients who grind their teeth at night may need to wear a splint to protect the onlays from excessive pressure and premature wear.
•    Regular dental check-ups: Regular visits to the dentist are crucial to monitor the integrity and functionality of the onlay. The dentist can detect and treat problems at an early stage, which helps to extend the life of the onlay.
•    Professional cleaning: Professional dental cleanings by a dentist or dental hygienist are recommended to remove stubborn plaque and promote overall oral health.
•    Average durability: The durability of an onlay can vary depending on the material, the quality of the fabrication and the patient's oral hygiene. In general, with proper care and favorable conditions, onlays can last for many years, sometimes even decades.

1.8 Conclusion

In summary, onlays are an essential part of modern restorative dentistry and offer an effective solution for restoring damaged teeth. Not only are they a more conservative alternative to conventional crowns, but they also offer advantages in terms of esthetics, durability and tooth structure preservation. The availability of different materials such as ceramic, composite and metal allows for customized treatments that meet the patient's requirements both functionally and aesthetically. While the fabrication processes of onlays, whether by traditional methods or using modern CAD/CAM technology, can be complex, they ensure a high accuracy of fit and quality of the restoration.

Discover the future of onlay production with imes-icore. As a leading provider of modern CAD/CAM systems, imes-icore enables dentists and dental technicians to produce onlays efficiently and precisely. With these advanced technologies, you can increase the quality of your dental restorations and optimize your workflows in a highly efficient manner. Find out how you can take your practice or laboratory to the next level with imes-icore's innovative solutions and get in touch with us.