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What exactly are inlays and onlays?

Inlays and onlays are an old fashioned, traditional method of restoring teeth that are not commonly used by dentists these days. They are known as indirect fillings. When the biting surface of the tooth is damaged and regular fillings are not adequate, inlays and onlays are used to fill crevices or repair extensive damage.

The difference between dental fillings and inlays and onlays is that dental fillings are directly done on the spot: they are placed in the tooth during your visit to the dentist, on the other hand, inlays and onlays have to be made in a dental laboratory; these are then subsequently fitted and chemically bonded to the damaged tooth by the dentist. Hence the name:Indirect fillings. Sometimes, inlays and onlays are used in place of full dental coverage crowns. As compared to full dental coverage crowns, they are better fitting, last longer, and look better.

The difference between inlays and onlays:

When the material is bonded within the center of the tooth, it is called an inlay. If the damage is more widespread and the new structure covers the whole chewing surface including one or more tooth cusps, the procedure is called an onlay.

The Benefits of using inlays and onlays:

Inlays and onlays are methods of repairing comparatively wide-ranging tooth decay or damage without really needing to replace the entire outer portion of the tooth as one would need to do with a crown. The amount of tooth material required to be removed is less, so inlays and onlays tend to be more conservative and esthetic as compared crowns.

The inlay and onlay procedures strengthen a tooth’s structure as compared to fillings where the structure may be weakened due to removing too much tooth material. Inlays and onlays are also likely to last longer than a regular filling, because the inlay or onlay material is custom made and bonded or fused to the tooth.

They offer a superior fit as compared to crowns, as the procedure tends to preserve as much of the healthy tooth as possible. This also safeguards the structure of the basic tooth and does not weaken it further and this in turn offers strength and stability to the teeth. An onlay can actually protect the weak areas of the tooth as the procedure does not require the complete reshaping of the tooth.

Esthetically, tooth color is retained offering better visual appeal, because inlays or onlays will not discolor as resin fillings usually do. Due to the fact that inlays and onlays are custom made and they fit better and do not shrink or change size during the curing process, this makes it a lot easier for you to clean or brush your teeth. Inlays seal the tooth better as compared to regular fillings and thus they keep out bacteria ensuring that there is no further decay taking place inside the tooth, under the filling.

The Procedure used for Inlays and Onlays:

Generally speaking an inlay or onlay procedure usually requires two or three dental visits to complete it.
In the first visit, the dentist makes a mold of your teeth as they exist in your mouth. This gives the dentist a basic structure to work from. A temporary sealant is placed on your damaged tooth. The mold is then sent to the laboratory where the technician will proceed to make an inlay or outlay as advised by the dentist, depending upon the extent of damage. The material to be used for the inlay or onlay is also selected in this visit.

The material selected to make the inlay or onlay depends on many factors such as the location and visibility of the tooth- if the tooth is situated at the back of the mouth and will not be visible when you smile or speak, then gold may be recommended as the material to be used, as this is long lasting, offers better protection and is smooth causing less abrasion to the opposing tooth. Whereas if you require an inlay or onlay for your front teeth, or teeth that will be exposed when you smile or speak then porcelain will be recommended as the best material as this can be made and colored to match your existing healthy teeth and will thus blend in better. If are a person who habitually grinds your teeth or have a very strong bite or chew heavily, or if you have malocclusion where your jaw is misaligned,then resin could be the best material for you. The dentist will help you make your best choice.

In the second visit, sometimes a temporary inlay or onlay could be fitted, if the final inlay or onlay is not yet ready. The final fitting would require a third visit. If the final inlay or onlay is ready, this will be fitted in the second visit. The temporary sealant will first be removed. When fitting the inlay or onlay the dentist will ensure that the restoration fits perfectly with all adjacent teeth, that there are no problems with malocclusion that might affect the fit of the inlay or onlay. When the inlay or onlay is fitted, it will be bonded to the tooth and then polished.

What lies in store for Inlays and Onlays?

Inlays and onlays as a restorative procedure are here to stay. They offer a fantastic amalgamation of excellent functional longevity and esthetic naturalness in addition to the fact that the materials used for making inlays and onlays continue to evolve, improve and become better, the procedure is not likely be replaced by another.

Factors to consider when selecting a Dentist for an Inlay or Onlay:

Not many dentists use the inlay and onlay procedure as there is no formal training for this procedure that any dental school offers. Dentists can get trained in the inlay and onlay procedure while working in close collaboration with the laboratory technicians. Sometimes the laboratory technician can be a part of your consultation or visit to the dentist offering his advice if the doctor has the technology of a video conference where the image of your teeth can be seen in real time by the dentist and the technician. Often the technician may be part of the fitting procedure, assisting the dentist, using the same conferencing technology.

What does the Inlays and Onlay procedure cost?

The expenses of the inlay and onlay procedure vary and depend upon many factors such as :

The fees of the dentist you have chosen. Renowned and experienced dentists may be more expensive as compared to a dentist who is just starting out and setting up his / her practice.
The location of the teeth that require the inlay or outlay in your mouth: For example, teeth in the front of the mouth are easier to prepare and work on as compared to molars or teeth located at the back of the mouth.
The size of the inlay or onlay required- smaller inlays or outlays are cheaper as compared to bigger ones.
The material that you select for the inlay or outlay- it goes without saying that a gold inlay or onlay will be more expensive as compared to porcelain. Conversely, porcelain inlays or onlays might require more craftsmanship and this might cost more in terms of labor than material.
Another factor influencing the price of inlays or onlays is your geographic location. If you live in a place where this technology is not available, you may need to travel to a place where it is. Or there may not be a local technician to fabricate the inlay or onlay, in which case it will need to be sent to a place where it can be fabricated and this will add to the cost.

Does Dental Insurance cover Inlays and Onlays?

The insurance policies and procedures differ from company to company. Inlays and onlays could be classified under ‘basic’ or ‘major’ service by the insurance company.

In the basic category the usual procedures such as dental cleanings, dental fillings, and routine services may be covered. Some insurance companies might have a pre-set limit for these services. You will have to verify from the company what these are. In case the dental insurance company that you have selected classifies the inlays and onlays procedure in the major category as they do for full coverage crowns, then it is possible that you will be compensated at the 50 percent coverage rate.

Again as this is variable, it is best that you verify with the insurance company that you have selected. In event you wish to be really sure how much compensation you will receive, you could ask your dentist for an estimate of the cost, and submitting this to the company, you can ask at what rate you will be compensated. That way you will have a clear idea of the cost and reimbursement that you will have to prepare for.

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A Denture is a Prosthodontic device which replaces missing teeth in the oral cavity. There is no need for you to get a denture if you take good care of your teeth and prevent subsequent tooth loss. The Dentures are custom made for the patients who have partial or completely missing teeth and classifying them on that basis, they are of two types: Complete and Partial Dentures.

There have been admirable advances in the field of Prosthodontics enabling production of dentures that feel, function and appear nothing but natural. They have appealing aesthetics too and you can avoid any possible embarrassment with the help of these modern dentures.

This however does not imply that there are no issues with modern dentures. Although dentures replace teeth, there never has been a just replacement for natural teeth. It will take time for your mouth (and brain) to acclimatize to the new foreign substance in the mouth. Everyday actions such as talking and eating will require practice and can take some time to get the hang of. For some people it might become extremely difficult for the brain to accept the denture and they constantly get gag reflex. Such people might have to consider implant supported palateless denture or hypnosis therapy.

The two types of Dentures are:

Complete Dentures

These are dentures made to cover the entire arch and employed in patients who have lost all their teeth either in the maxillary arch or mandibular arch or even both. Complete Dentures in lower jaw are difficult to manage than the upper jaw as they tend to get displaced easily due to the absence of suction.

An overdenture is a slight modification of complete denture in which a few teeth remain which are shortened and the denture fits Over it (and hence the name Overdenture). An Overdenture has a few advantages like:

The remaining natural teeth preserve the bone.
The natural teeth also share some of the bite force during biting.
The stability of the denture is improved.

But an OverDenture is expensive and demands regular maintainance to prevent decay and gum disease.

Partial Dentures

Partial dentures cover a few missing teeth but not the entire jaw. They are of two types: Fixed and Removable.

Removable Partial Denture:

As the name suggests, these are the partial dentures which can be removed and snapped back as and when desired. They consist of metal framework along with artificial teeth and metal clasps which hold the denture in position.

Fixed Partial Denture

Fixed Partial dentures often referred as “Bridges” are cemented in the appropriate position. Bridges are preferred over removal partial dentures as they are comfortable and better resemble natural teeth but they require healthy teeth for their support and are expensive.

Other special types of removable dentures are the Flipper denture and Nesbit Denture.

Alternatives to Partial Dentures

Dental Implants are fast becoming a preference over the conventional bridges. These are single artificial teeth which are fixed in to the jaw. They mimic the natural teeth very well but they cost more than the bridges.

Steps in Denture Processing

A finished denture might appear a simple device but requires a lot of work for its processing. The Denture manufacturing process consists of multiple steps extending over a period of 3 weeks to 2 months involving several visits to the dentist.

The manufacturing process of the denture is specific to the kind of denture that is being made but the general steps are

Taking an impression of your mouth.
Creating temporary models in the form of wax or plastic which resemble the measurements of the final denture. This is tried on your mouth and necessary adjustments are made depending on how it fits in to your mouth
After all the required trials, a final denture will be cast.
The final denture will be placed in your mouth and any required changes will be made.
You will be required to give a visit to your dentist after a day or two just to check the response of your mouth to the denture.

Adjusting to a Denture

Although, modern dentistry has enabled us to create efficient and tooth resembling replicas which we can fit in our mouths, there is no comparing them to natural teeth. Hence, we should always strive to maintain our Dental health. Adjusting to Dentures can be tricky and here are some of the common problems you will face with your new denture.

Denture Fit

Initially, the denture might feel loose and this occurs mainly to mandibular dentures due to absence of suction which the maxillary dentures enjoy. Your mouth will learn to retain them over a period of time. There might be areas that need to be worked on which only your dentist can do. You might also experience denture sores initially due to tight fitting of the denture.

Eating with a Denture

Eating with a denture requires practice and it’s just not the same as natural teeth. Don’t exert too much pressure on the denture and it might be seen that some of the patients can chew almost any thing with a denture while others may have some limitations. It is also suggested to use a sidewise grinding motion while chewing with a denture rather than the natural up-down motion you used when you had natural teeth.

Speaking with a Denture

You might find pronouncing some words or even trying to talk difficult. This again requires practice on your part and you should try to pronounce the “trouble” words aloud.

Removable Denture Care

Take out your denture before sleeping as this effectively lets your mucosa and gums to take some rest as well.
Remove the denture and rinse your mouth with a mouth wash once daily to keep infections at bay
Do clean your denture frequently with your denture toothpaste.
Visit your dentist when you develop sores or experience sudden difficulty in speaking or eating.
Make sure you get your denture reevaluated at every 6 months interval by your dentist.