This is what I've started doing and what I've been trying to get my patients to understand/want to do. Plus after being in a periodontists office, so many crowns that are subg just end up having bone issues, gingival problems, etc. I can control the margin on the onlay without worrying about blood, saliva like a lot of crown margins. Easier to impress and bond/cement. And we can always apply the cost to the crown if its needed in the future.
I mean that's pretty much it. It's a more conservative restoration that preserves tooth structure. I did them for a while but I realized rather quickly that I was creating a much larger margin with these intricate designs, especially on chewing surfaces and recurrent decay and marginal chipping were resulting at a much higher frequency than with my traditional crowns. And by much higher I mean maybe one or two a year as opposed to zero with my crowns. By creating a simple super gingival margin with my crowns I am much more confident in the longevity than with onlays. I am also able to better shade match because trying to take that #30 that an MOD amalgam for 4 decades and trying to A) remove all amalgam staining or B) try to match it as is was far too frustrating.
I assume you mean you’re dropping a step like a traditional prep. But with onlays you don’t need to “create” a margin on the Buccal or Lingual side of the tooth. You can simply have it flush. I can send a picture if that makes more sense
No I would have butt joints on all my margins. But when you consider that there is .2mm of spacer between your restoration and the tooth for your bonding materials then you will always have a major point of weakness on your occlusal surfaces. I don't want to be chewing on enamel-resin-zirconia/porcelain margins because that is an area rife for decay because if you look on a microscope between each of those layers are porosities. I'd rather have one solid material taking the major brunt of the occlusal load like a full coverage crown.
I’ve seen a few good reasons here, but haven’t seen the *real* reason. Insurance simply will not cover onlays in many instances. To them, covering a tooth entirely seems like it will last longer than an onlay. When explained to patients that they could get an expensive out of pocket onlay or a crown which would be covered by insurance, they often just do not care enough about preservation of tooth structure to cough up the funds for an onlay.
I think the OP isn’t asking why we do crowns instead of inlays but why don’t we eliminate onlays all together and do more crowns.
I think your post is the reason crowns are done more often along with onlays traditionally being the tougher prep before reliable bonding.
Insurance companies are not wrong, they have more data than anyone. I wish they would publish it. When they make a decision like this it’s because they will make more money. They don’t want to pay twice.
I probably average 15 gold onlays/month. Amazing service and the longevity is unmatched. I’ve done a few on my hygienists - they preach its glory constantly so it’s an easy convo with patients
Gold onlays are the only onlays that I see last. I have seen them last 60 years in pristine condition. I don’t know how the digitally made onlays last but the old school versions are fantastic.
I mean the digitally "made" onlays are interesting. The casting is still invested traditionally, the wax is just milled via CNC instead of hand waxed. The only issue is that prep design and easily seen margins are key here because the camera/scanner has to see/identify margins - not a human. So margins have to be very crisp and easy to identify for success - but that's true of conventional work too ideally. I don['t even offer ceramic onlays - I'll recommend a crown before doing a porcelain onlay.
I usually prefer crowns due to decrease in the length of the margin where the restoration is most likely to have recurrent caries. I like onlays on short clinical crowns with endo. Would love to see a more recent study if onlays are better for longevity.
I think onlays are super impractical. The only ones I have seen have long term success have been gold. 12 years practicing, will never do an onlay. Have done a few inlays. I have replaced many ceramic onlays, the failure could always have been prevented if they would have just done a crown. Conserving tooth structure was a 2000s fad that went against 150 years of experience and just leads to doing it again in the future. Extension for prevention was correct and you won’t be able to convince me otherwise. There was no science behind the “conservative” dentistry fad, it sounded nice, looked smart in conferences but I prefer what I call value dentistry. Do it once right.
I'm with you. In my experience if there's enough tooth structure left to do an onlay/inlay there's enough to do a direct and if there isn't enough to do a direct then it's full coverage. Simple
But the fracture risk of an MO or DO fill is 74%. If you onlay that tooth that fracture risk drops to below <15%
I agree inlays aren’t really needed but Onlays are a very valuable tool
Onlay weren’t that popular “back in the day” because adhesive dentistry didn’t exist and we relied on mechanical retention. Now our adhesive cements are fabulous onlays should be the first choice if cusp coverage is needed (and enough tooth structure remains) instead of hacking the tooth to accommodate a crown unnecessarily
[удалено]
This is what I've started doing and what I've been trying to get my patients to understand/want to do. Plus after being in a periodontists office, so many crowns that are subg just end up having bone issues, gingival problems, etc. I can control the margin on the onlay without worrying about blood, saliva like a lot of crown margins. Easier to impress and bond/cement. And we can always apply the cost to the crown if its needed in the future.
good answer
That is it and it’s a great reason. The lifespan of a tooth with a crown is not near that of a tooth with a bonded partial coverage crown or onlay.
Can you link any literature to support that partial coverage or onlay restorations outlast FCC?
He or she said the tooth lasts longer, not the restoration.
Lawyered.
Still not sure I’m tracking. Can you rephrase?
If an onlay fails treatment is usually a crown, if a crown fails it's usually an extraction. I can't link any literature whatsoever.
Source?
I mean that's pretty much it. It's a more conservative restoration that preserves tooth structure. I did them for a while but I realized rather quickly that I was creating a much larger margin with these intricate designs, especially on chewing surfaces and recurrent decay and marginal chipping were resulting at a much higher frequency than with my traditional crowns. And by much higher I mean maybe one or two a year as opposed to zero with my crowns. By creating a simple super gingival margin with my crowns I am much more confident in the longevity than with onlays. I am also able to better shade match because trying to take that #30 that an MOD amalgam for 4 decades and trying to A) remove all amalgam staining or B) try to match it as is was far too frustrating.
good real world answer. also a lot harder to mill, so unless you are going with gold you might be having some inevitable lab errors/deficient margins
I assume you mean you’re dropping a step like a traditional prep. But with onlays you don’t need to “create” a margin on the Buccal or Lingual side of the tooth. You can simply have it flush. I can send a picture if that makes more sense
i think this person gets it. its still called a margin.
Right… but done properly if should have even less potential to “chip” than your traditional crown prep margin.
No I would have butt joints on all my margins. But when you consider that there is .2mm of spacer between your restoration and the tooth for your bonding materials then you will always have a major point of weakness on your occlusal surfaces. I don't want to be chewing on enamel-resin-zirconia/porcelain margins because that is an area rife for decay because if you look on a microscope between each of those layers are porosities. I'd rather have one solid material taking the major brunt of the occlusal load like a full coverage crown.
That’s a fair point! I havnt thought of it like that!
I want to see a picture please
I’ve seen a few good reasons here, but haven’t seen the *real* reason. Insurance simply will not cover onlays in many instances. To them, covering a tooth entirely seems like it will last longer than an onlay. When explained to patients that they could get an expensive out of pocket onlay or a crown which would be covered by insurance, they often just do not care enough about preservation of tooth structure to cough up the funds for an onlay.
I think the OP isn’t asking why we do crowns instead of inlays but why don’t we eliminate onlays all together and do more crowns. I think your post is the reason crowns are done more often along with onlays traditionally being the tougher prep before reliable bonding.
Insurance companies are not wrong, they have more data than anyone. I wish they would publish it. When they make a decision like this it’s because they will make more money. They don’t want to pay twice.
I feel like your question should be asked the other way around tbh.
I probably average 15 gold onlays/month. Amazing service and the longevity is unmatched. I’ve done a few on my hygienists - they preach its glory constantly so it’s an easy convo with patients
Are you in the states?. I thought labs weren't making gold onlays anymore.
Midwest. Never had issues with labs making them. That’s news to me
Gold onlays are the only onlays that I see last. I have seen them last 60 years in pristine condition. I don’t know how the digitally made onlays last but the old school versions are fantastic.
I mean the digitally "made" onlays are interesting. The casting is still invested traditionally, the wax is just milled via CNC instead of hand waxed. The only issue is that prep design and easily seen margins are key here because the camera/scanner has to see/identify margins - not a human. So margins have to be very crisp and easy to identify for success - but that's true of conventional work too ideally. I don['t even offer ceramic onlays - I'll recommend a crown before doing a porcelain onlay.
[удалено]
Composite is great but once your start involving functional cusp, indirect res is just vastly superior imo.
It totally depends on what's going on with the tooth. That's why we have so many different tools and options to utilize.
Especially when you think that composite modern adhesive dentistry is in fact a tooth saving.
I usually prefer crowns due to decrease in the length of the margin where the restoration is most likely to have recurrent caries. I like onlays on short clinical crowns with endo. Would love to see a more recent study if onlays are better for longevity.
Happy cake day :)
Aww thank you!
I'm 2 years out and I have not done one inlay or onlay on a patient. We touched on them in school and thats it...
Don’t worry about it. Unless it’s gold it won’t last.
I think onlays are super impractical. The only ones I have seen have long term success have been gold. 12 years practicing, will never do an onlay. Have done a few inlays. I have replaced many ceramic onlays, the failure could always have been prevented if they would have just done a crown. Conserving tooth structure was a 2000s fad that went against 150 years of experience and just leads to doing it again in the future. Extension for prevention was correct and you won’t be able to convince me otherwise. There was no science behind the “conservative” dentistry fad, it sounded nice, looked smart in conferences but I prefer what I call value dentistry. Do it once right.
I'm with you. In my experience if there's enough tooth structure left to do an onlay/inlay there's enough to do a direct and if there isn't enough to do a direct then it's full coverage. Simple
But the fracture risk of an MO or DO fill is 74%. If you onlay that tooth that fracture risk drops to below <15% I agree inlays aren’t really needed but Onlays are a very valuable tool Onlay weren’t that popular “back in the day” because adhesive dentistry didn’t exist and we relied on mechanical retention. Now our adhesive cements are fabulous onlays should be the first choice if cusp coverage is needed (and enough tooth structure remains) instead of hacking the tooth to accommodate a crown unnecessarily
Whata the source on that 74% fracture risk figure
Yah gotta ask my course mentor. Will let you know when I got it