Metal-Inlay/Onlay/Overlay

Preparation
Part 2

Dr. Júlia Nemes

 DECISION
Inlay/Onlay/Overlay
/indirect method/

► Definition:
► Indication:
-Extension of caries is big (2/3 rule)
-Big undercuts in dentin, and cusps
-Rootcanal treated tooth
-Occlusal correction is needed
-Cusps-frakture
 Onlay

► All cusps are reduced.

Counterbevel
(Reverse bevel)

Exeption
 Overlay

► Difference in the preparation in case of the cusps.

► Cusp reduction:
Collar with bevel (skirt)
collar (1 mm withs)
► Not cusp reduction

Difference in supporting, and non supporting cusps

 General rules (onlay)

► Because of the cusp reduction

decreases the retention, (shorter
vertikal walls), therefore the
secondary retentionselement are
required.
► For improving the retention, we
can prepare parallel with the
axio-pulpale wall „Secondary
Retentionselement”
Proximal grooves preparation
Class II cavity preparation for Metal Onlay

Lower 6, MOD caries (Class II)

case:
MOD :
1 occlusal cavity
2 proximal cavity
 Initial (or primer) preparation

► Occlusalreduction:
- Immediately after the decision the cusps should
be reduced.

Why?
- both the access and visibility will be better
- easier to determines the degree of divergence
 Occlusal reduction:
1 2 3
1. Prepare 2 mm deep cavity
(groove)
2. Extende in facially and
lingually
3. Prepare 1,5 mm depth
cuts (in facially and
lingually)
4. Completing cusps
reduction
5. Small portion of marginal 4-5
ridge are left unreduced.
 Occlusal reduction:

► Occlusal Step

After cusps reduction has

to be a 0,5 mm deep
occlusal step between the
reduced cusps inclines
and the pulpal floor.
 Occlusal cavity
► There is 2 not reduced part
of the occlusal cavity.
(mesial and distal marginal
ridge)

► 0,5 mm deep occlusal step

► The facial and lingual walls of

the occlusal step should go
around the cusps in graceful
curves.
 Proximal preparation
is similar, as described in the inlay
preparation
► The extension of proximale carious
lesion gives the extention of proximal
cavity.
► The contakt with the neigbouring
tooth has to be eliminate. (minimum
distance of 0,5mm)
► Between the proximale laterale walls
and the outer elevation of the tooth
has to be 40° degree.
► The divergence depends on the depths
of the cavity.
► The cervico-proximal step stays
supragingival, if it is possible.
 Proximal Preparation

► Widen DE- junction

► Proximale ditch/cut: the
mesio-distal width of the
ditch should be 0,8 mm,
and 2/3 (0,5mm) in Dentin,
und 1/3 (3mm) in enamel.
► We prepare gingivally, and
extend the ditch in
vestibulo-orale direction
until the caries.
► minimum distance of 0,5mm
 Proximale Cavity

► Theprepared Isthmus
has to be only as wide
as necessary, and it
has to be in healthy
dentin.

► Deepcaries is not
removed yet.
 Final (secondary) preparation
► Removal of infected carious dentin and old
restorative material (and pulp protection).

► Preparation of bevels :
- in occlusal cavity !
- in proximal cavity
- on the facial and lingual walls
- on the gingival walls

► Secondary retentions-elements :proximal

grooves, slot, skirt

► Finishing the walls

 Final (secondary) preparation
Removal of any remaining infected dentin and/or old
restoration and Pulp-protection

With round metallbur (hard or steel)

(Calcium-hydroxid )+ Glassionomer
 Preparation of counterbevel in occlusal cavity

► Counterbevel preparation or
► Reverse bevel
on facial and lingual margin of
the reduced cusps.

► The bevel should result in 30°

marginal metal.

► The counterbevel has to be

enough wide, and the
cavosurface margin has to avoid
any contact with the opposing
dentition.
 Counterbevels preparation
Slender, flame-shaped, fine grit diamond
In which cases are not used the counterbevels
preparation, and why?

► On the facial cusp of

maxillary premolars
and the mesiofacial
cusp of maxillary first
molars!
Occlusal blunting: is 0,5 mm

► Esthetic!
 Final (secondary) preparation
Preparation of gingival cavosurface margin in the
proximal cavity. (beveling)

We have to tilt the flame

shaped, fine-grit diamond
mesially, to produce a
gingival bevel. It means a
30° marginal metall.
-In this case the thickness
of cement is thinner than
50 µm, at about 20µm.
-Enamel with dentinsupport
 Final (secondary) preparation
Preparation of proximal cavosurface margins
on the buccale, linguale walls.
(bevel)

► Bevels are directed to

result in 40° marginal
metal, and 140 °
marginal enamel.
Preparation of proximal cavosurface margins
on the buccale, linguale walls.
Oscillating instrument

► Basic principle:
They can transfere the
shape of the working tip
through an abrasive
medium to the tooth
surface.

Abrasive medium: in
generally diamond
 Final (secondary) preparation
Preparation of proximal cavosurface margins
on the buccale, linguale walls.
SONICflex 45˚

gingival cavosurface margin

30°, the proximal
cavosurface margins 45°
The laterale and gingivale
KaVo surfaces are rounded.
 Final (secondary) preparation
Secondary retentionselement „proximal grooves”
In the proximal cavity

► Because of cusp reduction!

► For improving the retention we

can prepare in dentin parallel
with the axio-pulpal wall,
„proximal grooves”. (so called
secondary retentions-element)
 Final (secondary) preparation
The prepared walls, line angle and point angle have
to be finish.
The cavity is ready
 Modifications in Onlay Preparation
► Indikation:
-not healthy (groove) pits and/or fissures
-healthy pits (groove) and/or fissures but
the tooth crown is short, (anatomicaly) or
the tooth crown, because of cusps reduction is
short.
Therefore: additional retention is indicated.
Possibilities:
-Preparation groove extension on buccal or/and
lingual surfaces
-minimal divergence of taper (2%)
-additional proximal/occlusal retentionselements:
skirt, collar, slot preparation.
 „Skirt” prepararion
► Skirt is a thin extension of Skirt
metal onlay on the facial or
lingual proximal margins. The
preparation stays in the most
cases in enamel, if not it
removes very little dentin.

► Retention form und Resistence

form will be improved.

► The skirt extension is a

conservative method for
improving the retetion and
resistence form.
 „Skirt” Prepararion

► The junction of skirt

and counterbevel is
slightly rounded.
 Overlay
„Collar” prepararion

► „Collar” : Where?
Preparation has to be:
above the equator of the tooth,
0,8-1 mm wide, and has to
follow the original contour of
the tooth.
The gingival margin of the collar
has to be lightly bevel, to result
in a 30° metal angle.
Fine-grit diamond
 Overlay
„Collar” preparation
 Slot preparation
► Indikation:
MO Inlay/Onlay in 2.Molar
OD „ in 1.Prämolar
► Place of the slot:
is in Dentin (between the the Pulpa
and Enamel-Dentin junction.
► Bur:
► The extention of the slot:
- M-D Direction: the width of the bur
- F-L Direction: 2 mm
- Depth: 2 mm distance from pulpal
wall
 Facial or lingual surface groove extension

► Preparation groove
extension on buccal
or/and lingual surfaces

► Slot preparation

► „Skirt” preparation
 Mesio-lingual cusps of lower first molar
has to be removed very oft.
(Inlay)
► Cause:extention of caries is big.

► Cusp inclination is very steep.

 Mesio-lingual cusps of lower first molar
has to be removed very ofr.
► Retention grooves improve the retention (a)
► Axio-pulpal line angle has to be rounded (b)
► The encounter of the reverse (contra)bevel and skirt has to
rounded. (c)

a b c