2. CONTENTS :
Introduction
Indications
General shape of onlay preparation
Step wise tooth preparation part
Features of onlay tooth preparation
Modifications of onlay preparation
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3. INTRODUCTION :
Full-The cast metal onlay by definition caps all of the cusps of a posterior tooth and
can be designed to help strengthen a tooth that has been weakened by caries or
previous restorative experiences.
Partial onlay
-Studervant-6th
Partly intracoronal partly extracoronal
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5. INDICATIONS
(MARZOUK)
1. considered, if the lesion is one-third to one-half the intercuspal distance.
2. mandatory, if the width of the lesion exceeds one-half the intercuspal distance.
3. if the length:width ratio of the cusp is more than 1:1, but not exceeding 2:1, cuspal
protection is to be considered.
4. if the length:width ratio of a cusp is more than 2:1, cuspal protection is mandated.
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6. 5. need to change the dimension, shape, and interrelationship of the occluding tooth
surfaces
6. for abutment teeth
7. supporting restorations for remaining tooth structure, combined with conservative
tooth involvement.
8. to include wear facets that exceeded the cusp tips and triangular ridge crests
facially and/or lingually.
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7. GENERAL SHAPE OF ONLAYS-
Occlusally, onlays are dovetailed internally and follow cuspal anatomy externally.
Proximally they appear either box- or cone-shaped.
capping of the functional (and sometimes the non-functional) cusps, and the shoeing of the non-
functional cusps.
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dovetail
Box shaped
8. CAPPING V/S SHOEING
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Cap the functional cusp-For
additional retention and
protection.
1.5mm
far enough gingivally to be
away from contact with the
opposing tooth surface
margin should involve 1/4th to
1/3rd facial or lingual surface.
Shoe the non-functional cusp.
1mm
just gingival to the tip & ridge
crests of the involved cusps and
away from occlusal contact
(static and functional).
In cap & shoe, margins should
follow the contour of the cusp
tips & ridge crests.
9. STEPS OF THE PREPARATION OF MOD CAST METAL ONLAY
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10. INITIAL PREPARATION:
Cusp Reduction-
cusps should be reduced-improves both the access and the visibility
the efficiency of both the cutting instrument and the air-water cooling spray is
improved
assess the height of the remaining clinical crown of the tooth, which determines the
degree of occlusal divergence necessary for adequate retention form.
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11. 11
Preparation of pulpal floor
along the central groove
Facial and lingual groove
extension(no more than
2/3rd)
12. PREPARATION OF THE DEPTH GAUGE GROOVES:
The depth cuts are usually placed on the:
i. crest of the triangular ridges
ii. facial and lingual groove regions.
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1.5 mm depth
gauge groove
13. 13
Completion of the cusp
reduction along the side of
the 271 bur.
• Completed reduction,should reflect the general topography of the
original occlusal surface.
• to avoid possibly hitting an adjacent tooth.
• the ridges will be reduced in a later step when the proximal boxes
are prepared
14. single "draw" path, usually the long axis of the tooth crown, so that the completed
preparation will have no undercuts.
gingival-to-occlusal divergence-2 to 5 degrees from the line of draw
Cusp reduction appreciably decreases retention form because of decreasing the
height of the vertical walls, so minimal amount of divergence is often indicated
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15. vertical walls are short, a minimum of 2 degrees occlusal divergence
As the gingivoocclusal height of the vertical walls increases, the occlusal divergence
should increase, allowing as much as 5 degrees in the preparation
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16. OCCLUSAL STEP/TABLE-
The “table” is the transitional area between the intracoronal
and extracoronal parts of the preparation, which is partly in
dentin and partly in enamel.
Relieved from opposing cusps by atleast 1.5mm in both static
and functional contacts.
major resistance forms of the entire structure
flat, following cuspal anatomy in the M-D directions (i.e., three
tables for each cusp, each with different directions).
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17. increase surface area,
provide more locking retention,
conserve tooth structure
physiologically distribute occlusal loads.
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18. 0.5 mm deep occlusal step in the central groove region
between the reduced cuspal inclines and the pulpal floor.
Extend the step along any remaining facial (and lingual)
occlusal fissures as far as they are faulty (fissured).
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20. REVERSE BEVEL OR COUNTER BEVEL-
generous width
prepared on the facial (lingual) margin of a reduced cusp
flame-shaped, fine-grit diamond instrument.
It should be relieved from opposing cuspal elements by atleast 1mm in both static
and functional occlusal contact.
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21. REVERSE BEVEL OR COUNTER BEVEL-
two hollow ground bevels occlusally:
occluso-distally
occluso-mesially
angulation is not as standard.
It is measured by the embracing angle, i.e., the angle between the bevel and the
long axis of the crown. (Marzouk)
On the average, this angulation is from 30-70 degrees, but it varies according to:
a. The amount of indicated involvement for the facial or lingual surface.
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22. 22
b. The amount of needed
retention.
c. The type of cast alloy.
Embracing angle
24. FUNCTIONS OF COUNTERBEVEL/ HOLLOWGROUND BEVEL
i. bulk
ii. distribute forces physiologically on underlying tooth structures.
iii. increase the immobilization of the restoration.
iv. retention and/or support.
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25. Proximal box-
Continuing with the No. 271 carbide bur held parallel to the long axis of the tooth
crown, prepare the proximal boxes.
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27. Preparation of Bevels and Flares-
flame-shaped, fine-grit diamond instrument
counterbevels on the reduced cusps,
to apply the gingival bevels
to create secondary flares on the facial and lingual walls of
the proximal boxes.
The fine-grit diamond instrument also is used to bevel the
axiopulpal line angles lightly.
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28. 28
metal angle at the margins of onlays is 40 degrees
except at the gingivally directed margins, where the metal angle should be 30
degrees.
After beveling and flaring, any sharp junctions between the counterbevels and the
secondary flares are rounded slightly to produce an uninterrupted blending of all
junctions.
32. MODIFICATIONS IN ONLAY TOOTH PREPARATIONS
i. Facial or Lingual Surface Groove Extension.
ii. Inclusion of Portions of the Facial and Lingual Smooth Surfaces affected by
Caries, Fractured Cusps, or Other Injury.
iii. Enhancement of Resistance and Retention Forms.
iv. Modifications for Esthetics on Maxillary Premolars and First Molars.
v. Endodontically Treated Teeth.
vi. Restoring the Occlusal Plane of a Tilted Molar.
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33. i. FACIAL OR LINGUAL SURFACE GROOVE EXTENSION
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facial surface fissure
(mandibular molar) or a
lingual surface fissure
(maxillary molar) is included
additional retention form
34. ii. INCLUSION OF PORTIONS OF THE FACIAL AND LINGUAL SMOOTH
SURFACES AFFECTED BY CARIES, FRACTURED CUSPS, OR OTHER
INJURY.
cut a shoulder perpendicular to occlusal force by extending
the proximal gingival floor (adjacent to the fracture) to include
the affected surface.
desired resistance form by being perpendicular to gingivally
directed occlusal force.
vertical wall in the remaining lingual enamel.
The linguogingival bevel is continuous with the gingival bevel
on the mesial surface.
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36. These preparation features:
a) improve retention form,
b) resist forces normally opposed by the missing mesiolingual wall, and
c) help protect the restored tooth from further fracture injury.
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37. iii. ENHANCEMENT OF RESISTANCE AND RETENTION FORMS
When the tooth crown is short (which is often the case when all cusps are reduced),
the operator must strive to maximize retention and resistance form in the
preparation.
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38. PROXIMAL RETENTION GROOVES
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Shallow(0.3mm deep) retention grooves may
be cut in the facioaxial and the linguoaxial
line angles with the No. 169L carbide bur.
The long axis of the bur must be held parallel
to the line of draw and the tip of the bur must
be positioned in the gingival box internal
point angles.
39. SKIRT PREPARATION
Definition- Skirts are thin extensions of the facial or lingual
proximal margins of the cast metal onlay that extend from the
primary flare to a termination just past the transitional line
angle of the tooth.
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40. Concept-
1. conservative method
2. retention and the resistance form.
3. eliminates the chance of postrestorative fracture of the tooth
4. an extracoronal restoration that encompasses and braces the tooth against forces
that might otherwise split the tooth.
5. atraumatic –only on enamel-removing very little (if any) dentin.
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42. When lingual wall of proximal boxing is inadequate or missing,
retention form can be improved by facial skirt extension.
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43. Technique-
the slender, flame-shaped, fine-grit diamond instrument.
Usually prepared entirely in enamel.
Step 1: long axis of the instrument parallel to the line of draw,
translate the rotating instrument into the tooth to create a definite vertical margin,
just beyond the line angle of the tooth, providing at the same time a 140-degree
cavosurface enamel angle (40-degree metal angle).
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45. Step 2: Extending into the gingival third of the anatomic crown is usually necessary
for effective resistance form.
Step 3: Translate the instrument from the entrance cut toward the proximal box to
blend the skirt into the primary flare and the proximal gingival margin.
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46. Step 4: round the junction between the skirt and the counterbevel.
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47. ADVANTAGES OF SKIRTING-
successfully for many teeth that exhibit the split-tooth syndrome.
when the proximal surface contour and contact are to be extended more than the
normal dimension to develop a proximal contact.
when splinting posterior teeth together with onlays.
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48. DISADVANTAGE
increases the display of metal on the facial and lingual surfaces of the tooth.
For this reason, skirts are not placed on the mesiofacial margin of maxillary
premolars and first molars.
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49. COLLAR PREPARATION
To increase the retention and resistance forms when preparing a weakened tooth
for a MOD onlay capping all cusps,
To reduce the display of metal, however, facial surfaces of maxillary premolars and
first molars are not usually prepared for a collar.
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50. TECHNIQUE-
Step 1: Use a No. 271 carbide bur at high speed
0.8-mm deep shoulder around the lingual (or facial) surface to provide
2 to 3 mm high occlusogingivally.
Step 2: To provide for a uniform thickness of metal, the occlusal 1 mm of reduction
should be prepared to follow the original contour of the tooth.
Step 3: Round any undesirable sharp line angle.
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52. Point to remember-
The lingual skirt extension, the lingual collar or the lingual surface groove
extension on a maxillary molar protects the facial cusps from fracture.
The facial skirt extension, the facial collar or the facial surface groove extension on
a mandibular molar protects the lingual cusp from fracture.
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53. SLOT PREPARATION
retention form.
Such a slot is preferred over preparing a box in the distal surface because:
1. more conserving of tooth structure and of strength of the tooth crown,
2. the linear extent of marginal outline is less.
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54. TECHNIQUE-
use a No. 169L carbide bur whose long axis should parallel the line of draw.
The slot is cut in dentin so that if it were to be extended gingivally, it would pass
midway between the pulp and the DEJ.
ADVANTAGES
Such a position and direction of the slot prevents:
1. exposure of the pulp,
2. removal of the dentin supporting the distal enamel,
3. perforation of the distal surface of the tooth at the gingival termination of the slot.
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56. The slot should have the following approximate dimensions:
1. mesiodistally, the width (diameter) of the bur-0.5mm
2. Faciolingually- 2 mm
3. depth,-2 mm gingival of the normally positioned pulpal wall.
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58. iv. MODIFICATIONS FOR ESTHETICS ON MAXILLARY
PREMOLARS AND FIRST MOLARS.
i. Occlusal reduction should only be 0.75 to 1 mm
ii. cusps do not receive a counterbevel but are "stubbed" or blunted by the
application of a sandpaper disc or the fine-grit diamond instrument
iii. blunting -0.5 mm in width.
iv. Secondary flare omitted
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60. v. ENDODONTICALLY TREATED TEETH
more conservative for the health of the facial and lingual gingival tissues not to
prepare the tooth for a full crown but for a MOD onlay
skirt extensions and collar preparations.
better able to resist lateral forces that might otherwise fracture the tooth.
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61. vi. RESTORING THE OCCLUSAL PLANE OF A TILTED MOLAR
When the unprepared occlusal surface is less than the desired occlusal plane, a
corresponding decrease in occlusal surface reduction is indicated.
The mesiofacial and mesiolingual margins should be well extended onto respective
facial and lingual surfaces.
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In the cast restorations, cuspal protection is to be
In the tooth preparation,
Onlays are ideal restorations
With the cusps reduced,
Also, once the cusps are reduced, it is
271 bur held parallel to long axis of crown 2 mm deep along central groove prepared. B, Extending central groove cut facially and lingually to verify need for cusp capping the groove should not be extended more than two thirds the distance from the central groove to the cusp tips
With the side of the No. 271 carbide bur, prepare uniform 1.5 mm deep depth cuts on the remaining occlusal surface.
Completing cusp reduction. Note that small portions of mesial and distal marginal ridges are left unreduced to avoid scarring adjacent teeth.
After cusp reduction there should be a
Maintaining the
, Occlusal step i s extended facially and lingually past any carious areas and is extended to expose proximal DEJs (j) in anticipation of proximal boxing.
For each cusp, there should be
The more the desirable involvement there is, the less will be the embracing angle to preserve tooth structure.
-The shorter the preparation walls (axial surfaces) are, the less will be the embracing angle with the long axis of the tooth.
-the less the castability of the alloy is, the greater will be the embracing angle, to allow for bulk of material marginally.
Caries has been removed, and cement base has been inserted. B, Counterbeveling facial and lingual margins of reduced cusps. C, Section of B. D, Fissure that extends slightly gingival to normal position of counterbevel may be included by slightly deepening counterbevel in fissured area.
for the restoration at its inclined planes, areas of imminent stresses
Increase surface area of contact between the tooth surface and cast, helping to
Help to guide the cast to one specific relation with the preparation surface, and substantially
G, Preparation with proximal boxes prepared. Note clearances with adjacent teeth.
If the occlusal step and the proximal boxes have been extended properly, any caries or previous restorative materials remaining on the pulpal and axial walls should be visible.
They should be removed.
D, Fissure that extends slightly gingival to normal position of counterbevel may be included by slightly deepening counterbevel in fissured area.
E, Slightly round the junctions between counterbevels and secondary flares.
F, Lightly bevel axiopulpal line angle.
G, Improving retention form by cutting proximal grooves.
H, Completed MOD onlay preparation.
I, Completed MODE onlay preparation showing extension to include facial surface groove/fissure.
is helpful for checking the interocclusal clearances.
lightly press a portion of softened, low-fusing inlay wax over the prepared tooth (teeth); then immediately request the patient to close into the soft wax and slide the teeth in all directions.
Now cool and carefully remove the wax. Hold it up to a light, and note the degree of light transmitted.
Use a No. 271 carbide bur to
A, Mandibular first molar with large MOD amalgam and fractured mesiolingual cusp.
B, Preparation (minus bevels and flares) for MODFL onlay to restore fractured molar shown in A. No. 271 carbide bur is used to prepare gingival shoulder and vertical lingual wall. Reducing cusps for capping and extending out facial groove improve retention and resistance forms.
C and D, Beveling margins.
E and F, Completed preparation. Gingival and lingual bevels blend at x and y is cement base.
G and H, Completed onlay.
Large cement base x indicates severely weakened tooth crown. Occlusal force (heavy arrow) may fracture facial cusp (A) or lingual cusp (B), which may expose pulp (p).
C and D, Skirt extensions (s) on mesiolingual, distolingual, and distofacial transitional line angles prevent fractures shown in A and B. Esthetic consideration contraindicates skirting mesiofacial line angle. E, Distal view of preparation shown in D. Skirt extensions are prepared with fine-grit diamond instrument. F, Collar preparation around lingual cusp prevents fracture shown in A.
(x). B, Facioocclusal view of A. Maximal resistance form is developed by skirting distofacial (y) and mesiofacial (x) transitional line angles. C, Occlusal view of B
Initial cut for skirt is placed just past transitional line angle of tooth. G and H, Blending skirt into primary flare.
the flame shaped diamond instrument to avoid creating a ledge at the gingival margin of the skirt extension.
. Be sure not to overreduce the line angle of the tooth when preparing skirt extensions
G and H, Blending skirt into primary flare. I, Occlusal view showing mesiolingual and distolingual skirts. Caution is exercised to prevent overreduction of transitional line angles (x). Facial surface groove extension also improves both retention and resistance forms. J, Slightly round the junction of skirt and counterbevel. K, Skirting all four transitional line angles of tooth further enhances retention and resistance forms.
An example is the mandibular second molar that has no molar posterior to it and requires a MO onlay restoration capping all of the cusps. The necessary retention can be achieved by cutting a distal slot.
A and B, Cutting distal slot for retention for MO onlay to treat terminal molar having large cement base (x) resulting from extensive occlusal and mesial caries. C, Preparing mesial slot for retention for DO onlay to treat maxillary first premolar that has large cement base (x). F, Section of D.
on the facial cusp ridge to decrease the display of metal. This thickness should increase progressively to 1.5 mm toward the center of the tooth to help provide rigidity to the capping metal.
A and B, Capping one of two facial cusps on maxillary molar. C, Blunting margin of reduced cusp when esthetics is major consideration. D to F, Margin shown crossing distal cusp in D indicates treatment illustrated in either E or F.
A. Mandibular second and third molars tilted mesially. Note poor contact relationship between molars and between molar and second premolar.
B, Second premolar is prepared for inlay, and molars are prepared for onlays. Margins of preparations are well extended on facial and lingual surfaces to aid in recontouring teeth to improve occlusal relationship and to improve proximal contours and contacts.
C, Completed restorations. Note improvement both in occlusal plane and in proximal contacts.