Prosthetic restoration – inlays, onlays, overlays

This type of reconstruction is an alternative to traditional filling methods including crowns. It spares healthy tooth tissue from excessive grinding and also reduces the risk of tooth breakage, at the same time improving both the functionality and durability of the restoration and restoring the natural, anatomical appearance of the tooth.

These methods of prosthetic filling are recommended in rebuilding lateral teeth after a root canal and also live teeth with extensive crown damage.

They enable functional, precise, and aesthetic reconstruction of the lost tooth surface, allow perfect reproduction of tangent points, facilitate the maintenance of proper oral hygiene, and allow full use of the tooth while chewing.

• composite or ceramic
• porcelain
• gold

The inlay, onlay, or overlay is then cemented to the tooth using appropriately selected materials and modern adhesion technology to achieve the proper chemical connection of the cement, the prosthetic, and the tooth in a tight, stable, and durable manner.

This type of prosthetic restoration is particularly recommended as the final reconstruction of teeth after endodontic (root canal) treatment. These teeth are usually quite damaged, and thus are more susceptible to cracks or fractures. They are also recommended for extensive damage of crowns of living teeth.

In the case of significant tooth damage, why are inlays / onlays / overlays better than the standard filling?

The standard filling, performed in one step directly in the office, cannot be compared to a laboratory-made prosthesis. The difference is in the durability of the restoration and the tightness of the fit. This type of dental insert is usually made of porcelain or composites, which when subjected to laboratory treatment are stronger than those used in the office. A properly cemented insert also retains its tightness for longer. Traditional fillings reduce their volume (this is the so-called polymerization shrinkage) which can lead to tension between the filling and the tooth wall, and consequently to unsealing of the restoration. This is of no great importance in the case of a small cavity and filling, but in the case of major tooth damage, it may lead to a carious process or even breakage of the tooth.

The method of preparing the tooth for the application of an inlay, onlay, or overlay is more sparing for the tooth as it does not require as much grinding of the tooth’s tissue. However, not every tooth qualifies for this type of reconstruction. Sometimes a traditional crown must be made. With the crown, the whole tooth must be polished. In the case of inlays, onlays, and overlays the grinding range is more limited, which allows a larger part of the tooth to be saved than in the case of traditional, comprehensive prosthetic restorations. In restorative dentistry, the application of these inserts has significantly limited the indications for the use of crowns.

Often, the functional and aesthetic effect is better than with a traditional filling. This type of indirect filling can be produced in various shades and combinations of tooth colors, as well as with various characteristics such as groove discoloration or transparency differences. These effects are obtained by painting or applying composite or porcelain layers of different color or transparency. In some cases, it is not possible to completely mask the transition line between the inlay and the tooth (for ex. when the tooth tissue is heavily discolored). If this is the case, the border between the tooth and the restoration is placed in a less visible area of the mouth or the restoration covers the entire visible surface in the front.

In the case of anterior teeth, usually other prosthetic solutions are used, such as aesthetic composite restorations, veneers, or crowns.

The tooth requires proper preparation. The treatment is usually done in two stages.

At the first visit, part of the tooth is covered with a composite or an insert (in the case of dead teeth). Then, additional preparation is done with a drill with minimal grinding and an impression is taken in order to make a model of the teeth in the laboratory (mapping the situation in the oral cavity), where the technician “builds” the lost tooth fragment. At the next visit, the restoration is checked and if it’s a perfect fit, “glued” into place using adhesion technology.

Restoration in the case of edentulousness depends on the number of implants needed. The most important thing is for the prosthetic work to be properly stabilized. To achieve this, the bridge must be supported by a sufficient number of posts. The physician decides on the number of posts, or implanted implants. In the case of missing teeth and using modern prosthesis, restoration in the jaw may be based on 4 or 6 implants, while in the mandible on 2, 3, or 4 implants.

Mainly, prosthetic implant restorations are divided two groups, removable prosthesis and fixed prosthesis.

Removable prostheses – Their main element is the overdenture prosthesis, which is otherwise referred to as a removable overlay denture or removable prosthesis. They are performed both in the jaw and in the mandible. For this type of work, it is necessary to implant two, three, four, or six implants.

Fixed prostheses are multi-point bridges, screw-retained or cement-retained. They are performed during the reconstruction of the jaw and mandible. Four or six implants are needed for this type of restoration.

Below we present the possible restorations that are made in our Center, depending on the number of implanted implants:

1. when implanting two implants

• milled bar in Cad-Cam technology based on 2 implants with the maximum number of abutments, with an overdenture prosthesis (removable) fastened to the bar, completing the dental arch to 12 or 14 points [possible only in rebuilding the mandible]

2. when implanting three implants

• milled-bar in Cad-Cam technology based on 3 implants with a maximum number of abutments, with an overdenture prosthesis (removable) fastened to the bar completing the tooth arch to 12 or 14-points [possible only in the rebuilding of the mandible]

3. when implanting 4 implants

• reconstruction on 4 Locator-type connections, with an overdenture prosthesis (removable) completing the dental arch to 12 or 14 points [possible during rebuilding of the jaw and mandible]
• SynconeConcept type reconstruction based on 4 telescopic connections, with an overdenture overlay (applied) completing the dental arch to 12 or 14 points [possible in rebuilding the jaw and mandible]
• milled-bar in Cad-Cam technology based on 4 implants with the maximum number of abutments, including an overdenture prosthesis (removable) fastened to the bar, completing the dental arch to 12 or 14 points [possible in rebuilding the jaw and mandible]

4. when implanting six implants

• milled-bar in Cad-Cam technology based on 6 implants with a maximum number of abutments, including an overdenture prosthesis (removable) fastened to the bar completing the dental arch to 12 or 14 points [possible in the reconstruction of the jaw and mandible]

Below we present the restoration possibilities that we do in our Center, depending on the number of implanted implants:

1. with four implants

• all-on-4 reconstruction is the rendering of a 12- or 14-point porcelain bridge milled in Cad-Cam technology based on 4 implants. The work can be both screw-retained and cement-retained [possible when rebuilding the jaw and mandible]
• multi-point milled monoblock bridges, milled entirely in Cad-Cam technology on 4 implants, whole structure of Zirconium oxide (Prettau, Lava, Rainbow) – these bridges can be 12- or 14-point as a rule are screw-retained [possible when rebuilding jaw and mandible]
• Conometric System – 12- or 14-point porcelain bridge, milled in Cad-Cam technology based on 4 implants. The prosthesis is mounted on a tapered coping (telescopic) – fixed prosthesis

2. with six implants

• all-on-6 reconstruction is a 12- or 14-point porcelain bridge milled in Cad-Cam technology based on 6 implants. The prosthesis can be both screw-retained and cement-retained [possible when rebuilding the jaw and mandible]
• multi-point milled monoblock bridges milled entirely in Cad-Cam technology on 6 implants, whole structure of Zirconium oxide (Prettau, Lava, Rainbow) – these bridges can be 12- or 14-point, may be screw-retained, more rarely cement-retained [possible in rebuilding jaws and mandible]
• Conometric System 12- or 14-point porcelain bridge, milled in Cad-Cam technology based on 6 implants. The prosthesis is mounted on a tapered coping (telescopic) – fixed prosthesis

Possibilities of making a multi-point bridge on 6 implants:

We mainly make 12- and 14-point bridges.

1. a multi-point porcelain bridge on metal / chromo-cobalt / titanium, milled in Cad-Cam technology [cemented] consisting of 6 crowns on implants and 6 or 8 pontics (depending on the total number of points in the bridge)
2. multi-point porcelain bridge on metal / chromo-cobalt / titanium, milled in Cad-Cam technology [directly screwed in] consisting of 6 crowns on implants and 6 or 8 pontics (depending on the total number of points in the bridge)
3. multi-point porcelain bridge on metal / chromo-cobalt / titanium, milled in Cad-Cam technology [may be screwed in directly to the implant or indirectly connected through a special connector called “balance base”] consisting of 6 crowns on implants and 6 or 8 pontics (depending on the total number of points in the bridge)
4. multi-point porcelain bridge on metal / chromo-cobalt / titanium, milled in Cad-Cam technology [indirectly screwed in with hole redistribution up to 30 °] consisting of 6 crowns on implants and 6 or 8 pontics (depending on the total number of points in the bridge)

+ if the patient has a significant deficit of soft tissue in each of the above types of bridges, it is necessary to supplement them, i.e. pink ceramics 2D or 3D (in other words rendering of pink gums)

Yes. From the moment of prosthetic reconstruction, follow-up visits are required every 6 months, especially in the first two years after implantation. However, it is recommended that the patient report for regular check-ups, including radiological observation every 6 months or at least once a