In today’s modern dental landscape, advancements in diagnostic technologies have given dentists the tools to spot dental cavities in their early stages, within these innovations, the dental onlay has emerged as a crucial intervention, offering a conservative and visually pleasing solution to restore damaged teeth.

This early identification sets the stage for a variety of treatment options personalized to meet the needs of each patient. Dentists now have access to sophisticated treatment approaches that not only effectively tackle dental cavities but also take into account the unique requirements of every individual, allowing for the preservation of natural teeth..  The adoption of dental onlays underscores a commitment to maintaining tooth structure while addressing dental issues, representing a noteworthy advancement in contemporary dental care.

Traditional vs Modern Dentistry

Dentistry started thousands of years ago, but it was in the early 1800s that we segregated dentistry as a separate field. In these times, dentistry started evolving and catered to the treatment of dental cavities and the restoration of lost tooth structure.

Silver amalgam, commonly known as a silver filling, was first introduced in dentistry in the 1820s and gained immediate traction owing to its strength and durability. However, as we progressed through the years, concrete drawbacks of amalgam fillings came to be known.

Traditionally, dentistry used silver amalgam to restore a tooth after dental cavity removal. Dental amalgam has no adhesive properties and adheres to the tooth mechanically. This meant that apart from removing the infected tooth structure, a lot of healthy tooth structures had to be removed to ensure the retention of a dental cavity filling. Specific forms are given while preparing a cavity for amalgam. This depends on the type and extent of the cavity. Removal of healthy tooth structure, in turn, weakens the tooth structure and makes it susceptible to breakage.

Moreover, dental amalgam, over time, imbibes water and tends to swell in size, which leads to sharp shooting pain. Pain results from the filling, pushing and compressing of the pulp tissue of the teeth. The pressure on the pulp is a painful stimulus, and the only way to eliminate the pain is to remove the filling, which in itself tends to be painful.

As mentioned earlier, dental amalgam does not have any adhesive properties as Dental Filling or Dental Onlay and leaves microscopic gaps at the margin where it meets the tooth. This means the tooth is still exposed to the external environment, and bacteria can enter inside. These bacteria, with the help of sugars, will release acidic substances and reinfect the tooth with dental decay. Now, dental decay affects the inside of the tooth, and eventually, the removal of the tooth remains the only solution. Amalgam also tends to produce galvanic shock if it comes in contact with other metals in the mouth. Silver fillings tend to look inaesthetic and even discolour the tooth. Some patients also report developing teeth sensitivity post-amalgam restoration.

Owing to the drawbacks of silver fillings, a need was felt to develop aesthetic adhesive fillings , Dental  Inlay & Dental Onlay. I will shed light on adhesive dentistry in the upcoming sections of this article.

Another aspect of traditional dentistry is that it takes the help of metal crowns to restore severely misshapen or broken teeth. Dental crowns are an excellent way to save severely damaged teeth that straightforward dental fillings or dental onlay cannot save. Dental crowns are indicated where the tooth defect is large, but still, the teeth can be saved. However, the procedure for a dental crown involves extensive tooth preparation as we need to make space for the crown to sit over the tooth and adhere to it.

Therefore, adhesive dentistry was introduced to counter the drawbacks of traditional dentistry while ensuring proper restoration of decayed, damaged and broken teeth.

A fundamental question that would come to your mind at this point would probably be – What is adhesive dentistry?

Adhesive dentistry

To put it plainly, adhesive dentistry, as the name suggests, deals with chemically bonding the restorative materials to the dental hard tissues, enamel and dentin of the tooth.

Adhesive dentistry encompasses the use of composite resins that can be used for direct filling and indirect fillings, such as dental onlay and inlay and dental veneers.

The speciality of adhesive dentistry materials is that they chemically bond to the tooth structure rather than physically. That means it requires minimal preparation, and healthy tooth structure is not sacrificed for the sake of retention. A dental bonding agent enables the composite resin material to attach itself to the tooth structure.

     By using an adhesive method, the dentist might make sure that only the affected part is removed and the maximum of the tooth structure is preserved. This, in turn, ensures the structural integrity of the treated tooth.

Adhesive dentistry makes use of tooth coloured material which offers highly aesthetic results. These materials do not stain the tooth and look lifelike. Since the maximum tooth structure is preserved, you won’t face the problem of sensitivity.

These materials do not expand, which ensures there is no discomfort or pain. Chemical bonding will seal the margin, and it is highly unlikely for bacteria to penetrate the filling minimising the risk of secondary dental cavities.

So, now that you know how adhesive dentistry helps you save more enamel and dentin let us take a look at its different forms, namely, onlays, inlays, and veneers.

Dental Inlays, Dental Onlays, and Veneers

       Onlays and Inlays are known as indirect dental restorations. Unlike traditional dental fillings, these are made outside the mouth.

The procedure starts with a complete oral examination which also includes taking relevant x-rays. Next, the dentist will identify the decayed teeth. If the tooth decay is significant and cannot be restored with a straightforward filling, he will recommend you to go for an onlays or inlays.

Onlays and inlays are reserved for larger cavities that cannot be restored by usual fillings but are not big enough to consider a crown.

Onlays and inlays offer you a more conservative approach and save the maximum of your tooth structure.

The dentist will first clean the decayed part and then take a dental impression of your upper and lower teeth. This impression will serve as a guide for your onlays and inlays.

Next, adhesive materials such as ceramic, zirconia or composite resin will be used to make your indirect restoration to exacting measures digitally.

     In the next appointment, the dentist will place the Inlay / Onlay in the cavity and check for fit. Once approved, the Inlay / Onlay is fixed with the help of bonding agents and finished to ensure a natural sheen.

Inlays are reserved for smaller cavities that have not yet involved the cusp or mounds of the tooth. Whereas onlays are recommended when a tooth’s cusp has been involved, and it needs added reinforcement.

       Dental Veneers, on the other hand, are tooth coloured shells that fit on the tooth’s front surface. Veneers have excellent aesthetic value and can be used for multiple dental issues. They can conceal discoloured and misshapen teeth and can be used to close small gaps between teeth. They can also be used to cover extensive feelings on the front teeth. Veneers also offer a conservative approach, as minimal tooth preparation is required. Veneers can be made from porcelain or composite.

The best material for Dental Onlays

One question that always resurfaces in the dental clinic is – What is the best material for onlays?

This section will shed light on different materials that are used to make onlays.

In earlier times, gold was considered the best material for inlays. Even now, many dentists provide gold restoration; however, they are not as popular due to aesthetic drawbacks. Some of the most common materials for making inlays/onlays are ceramic, zirconia and composite.

Ceramic or Porcelain for your dental onlay? 

Porcelain or ceramic is one of the most popular dental materials for inlay/onlay due to its strength and ability to be manipulated into tooth coloured restorations. Porcelain blends in easily with natural tooth structures and yields appropriate aesthetic results. In addition, they have optimum strength to restore a tooth’s function, such as chewing.

Zirconia

Zirconia is also a type of ceramic; however, it is reinforced and developed from a single block ensuring higher strength. Zirconia is one of the most sought after dental materials as it has exceptional aesthetic value and provides natural translucency to the tooth. It is robust and can last for many years with proper care.

However, a significant problem that arises with porcelain and zirconia is that they are difficult to repair. In case to break your restoration or it wears off, the removal becomes difficult, and you will have to undergo the entire procedure all over again.

Composite

Composite resins have gained immense popularity for inlays/onlays in recent times. They are built layer by layer and offer beautiful and natural aesthetics. They blend in with the tooth, and it is almost impossible to tell that you have a filling.

ODORO system of composite resins also provides you with the best in class material for inlays/onlays. It is also highly preferred by dentists as composite allows for proper repair. They also are more conservative in nature and preserve maximum tooth structure. They bond well to the tooth and last a long time with appropriate care.

Summary

Fortunately, advances in dentistry have led to the development of adhesive dentistry, which allows for the preservation of healthy tooth structure and aesthetic restorations. This technique ensures minimal preparation and a strong bond to the tooth structure, providing highly aesthetic results with minimal discomfort and the prevention of secondary dental cavities. Dental Inlays, onlays, and veneers are popular forms of indirect dental restorations used in adhesive dentistry.

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