Inlays
Sometimes, a tooth is treatment planned to be restored with an intracoronal restoration,
but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite,
would compromise the structural integrity of the restored tooth by possibly undermining the remaining
tooth structure or providing substandard opposition to occlusal (i.e. biting) forces. In such situations,
an indirect restoration may be indicated, such as the porcelain or gold inlay . When gold is used,
the tooth-to-restoration margin may be finished and polished to such a super-fine line of contact that
recurrent decay will be all but impossible. It is for this reason that some dentists recommend gold as
the restorative material of choice for pretty much any and all restorations. While these restorations
might be ten times the price of direct restorations, the superiority of gold as a restoration in terms
of resistance to occlusal forces, protection against recurrent decay, precision of fabrication, marginal
integrity, proper contouring for gingival (tissue) health, ease of cleansing and many other aspects of
restorative quality offers an excellent alternative to the direct restoration.
Onlays
Additionally, when decay or fracture incorporate areas of a tooth that make amalgam
or composite restorations essentially inadequate, such as cuspal fracture or remaining tooth structure
that undermines perimeter walls of a tooth, onlay might be indicated. Similar to an inlay, a onlay is
an indirect restoration which incorporates a cusp or cusps by covering or onlaying the missing cusps.
All of the benefits of a inlay are present in the onlay restoration. The onlay allows for conservation
of tooth structure when the alternative is to totally eliminate cusps and perimeter walls for restoration with a crown.
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