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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 Root Canal Treatment (RCT) is carried out to repair and restore a tooth which has been badly decayed or infected and comes under a branch of dentistry called as Endodontics. The RCT actually focuses towards elimination of any infection to the Pulp Chamber of the tooth.

Root Canal Treatment is the last option to save the tooth failing which the tooth has to be extracted. After the RCT the tooth is basically dead as the entire pulp inside the tooth is removed and filled with an inert material.

When is RCT Required?

When tooth decay occurs and is detected, a normal filling procedure is carried out .However, if this tooth decay is not detected, it progresses to deeper layers and finally reaching the pulp chamber. When the tooth decay reaches the Pulp chamber, there is no alternative but to perform a Root Canal Treatment. This is because, the infection in the pulp chamber must be removed else it will progress further.

What is the Pulp Chamber?

The pulp chamber is the inner most layer of the tooth. It is present at the center of the tooth and consists of nerves, connective tissue and blood vessels. It is through these blood vessels the tooth receives nutrition. The cells in the pulp chamber are predominantly odontoblast cells (cells which form dentin) apart from other cells.

The pulp chamber is broad at the center and narrows to a very thin root canal which runs towards the root.

What if I don’t undergo an RCT?

It is essential for you to undergo the Root Canal Treatment to save your tooth failing which you might loose your tooth. The bacterial infection in your pulp can cause tooth abscess, bone loss around root tip and swelling which can spread to your face and neck.

Why has been my Pulp Infected?

You might be thinking why did the infection to the pulp occur in the first place. There can be quite a few causes for this such as:

Tooth Decay which wasn’t detected and it spread to your pulp chamber.
Large fillings
Secondary Caries after tooth filling which lead to further decay progressing to your pulp.
Physical trauma to the tooth by accidental blows.
Spread of infection from periodontal pockets to the pulp

RCT Procedure

The Root Canal Treatment procedure should ideally be carried out by an endodontist. An Endodontist is a dentist who specializes in treating diseases and injuries of the pulp and tissues surrounding the root of the tooth. The RCT procedure can be completed in one or more visits.

Root Canal Treatment

An X-ray will be taken to examine your tooth and detect the presence of infection in the surrounding bone.

The area surrounding the tooth is numbed using a local anesthetic which desensitizes the patient to any pain.
The tooth to be worked upon is isolated by placing a rubber dam around it.
The drill is employed to make an access hole to the pulp chamber and the pulp along with decayed tissue and debris is removed. The entire pulp chamber including the root canals is cleaned and disinfected.
If the Root Canal Treatment is to be spread over multiple visits and some dentists prefer this, the empty pulp chamber is filled with disinfecting agent. This is covered by a temporary filling which is removed in subsequent visits and replaced by a permanent filling.
The next step is filling of the pulp chamber with an inert material as the tooth is effectively dead. Gutta percha (along with Zinc Oxide eugenol) is generally used to fill the empty pulp chamber and root canals.
A permanent filling (similar to the filling for treating cavities) is carried out on the tooth and a crown is placed over the tooth. A crown is required in most cases as the tooth becomes brittle due to absence of pulp.
If your RCT procedure is spread over more than one appointment, minimize the chewing on the affected tooth till the procedure is entirely completed. This will prevent recontamination of the pulp chamber and will also reduce the risk of fracturing or damaging your tooth

Failed Root Canals

The RCT is a very effective procedure and enjoys a 90% success rate. However, complications can and do arise leading to the failure of root canal. A failed root simply means you have get Root Canal Treatment procedure done again or get the tooth extracted by the dentist.

Causes for Failure of Root Canals

Extra Canal: Some teeth may have an extra root canal which might not be apparent to the dentist. Hence, the failure to remove the pulp from this root canal causes the failure of the treatment

Some patients have irregularly shaped root canals and its not possible to remove the pulp from such root canals.

Now, you can probably guess the main reason for the failure of root canal treatment. Any infected pulp left behind leads to the failure of the root canal treatment.

Hypersensitivity to material: Some patients are allergic to the material used in the root canal treatment and hence leading to failure of the procedure.

Defective or inadequate restoration: If a restoration is inadequate or defective, bacteria are able to creep past the restoration causing reinfection.

Instrument left in the root canal: The files used to remove the pulp are quite brittle and often chip inside the root canal and cannot be retrieved. This may cause the failure of the treatment.

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method

What exactly are inlays and onlays?