Inlays and Onlays in Koramangala, Bengaluru

The treatment that sits between a filling and a crown

Most dental websites in Bengaluru list fillings and they list crowns, and then there is nothing in between. In practice a very large number of back teeth land exactly in between, and what happens to them depends entirely on which clinic they walk into.

The tooth in question has usually had a big amalgam or composite filling for ten or fifteen years. The filling is now wider than the tooth structure holding it. There may be a crack running off one corner, or a cusp may have already snapped off while eating something unremarkable. It does not necessarily hurt.

There are three honest options at this point, and only one of them is right for any given tooth:

• Another direct filling. Quickest and cheapest today. In a tooth this broken it is also the one most likely to be back in this chair in three years, because composite placed directly into a very large cavity shrinks slightly as it cures and pulls at the walls it is supposed to be supporting.
• A crown. Reliable, and it will last. It also requires the entire tooth to be cut down on every side by the thickness of the crown, including the walls that are still perfectly good.
• An inlay or onlay. Made at a lab to fit the hole that is actually there, then bonded in. It replaces what is missing and leaves what is not.

What the difference actually is

An inlay sits inside the walls of the tooth, filling the hollow between the cusps. Think of it as a filling that was made on a bench instead of in your mouth.

An onlay does the same and then covers over one or more cusps, the pointed biting surfaces that take the chewing load. The moment a cusp is cracked, missing, or thin enough to be at risk, the onlay is the restoration you want, because covering a cusp is what stops it flexing, and a flexing cusp is what eventually splits a tooth in half.

Because both are made outside the mouth, they can be made accurately to a shape a dentist cannot achieve by hand in a wet cavity with a tongue in the way: proper contact with the tooth next door, proper anatomy on the biting surface, proper margins.

Why this is our own speciality’s work

Conservative dentistry and endodontics is one postgraduate subject, and root canal treatment is only the half of it that patients have heard of. The other half is this: rebuilding a natural tooth so it stays in your mouth, instead of cutting it down or taking it out.

Dr. Chaitanya K holds an MDS in that subject, and was her university’s gold medalist in it during her BDS. Indirect restorations sit squarely inside what she trained for, and the judgement about whether your tooth needs a filling, an onlay or a crown is the part of it that matters most. It is a judgement made with the X-ray in front of you and explained before anything is prepared.

The material

We use ceramic for almost every case. It bonds chemically to the tooth, which is what gives the restored tooth back much of its original strength, and it does not show at the margin the way a metal-based restoration does.

Composite inlays are available and cost less, and they are a reasonable choice in specific situations. They are not as hard-wearing, and on a molar taking full chewing load they will not last as long.

Gold is the historically longest-lasting material for an onlay and we will happily discuss it, but almost nobody in Bengaluru chooses it now, for obvious reasons.

Two appointments, a week apart

The first appointment does the work: the old filling and any decay come out, the cavity is shaped so a solid piece can seat into it properly, and a scan or an impression goes to the lab with the shade. You leave with a temporary restoration and a tooth you can eat on carefully.

The second appointment, about a week later, is the short one. The fit is checked, the contact with the neighbouring tooth is checked, and then it is bonded in under isolation, because the bond is what makes the restoration strong and the bond fails if the tooth is wet while it is being made. Then the bite is adjusted until it feels like nothing.

When we will tell you not to bother

If the tooth is decayed below the gum line, or so little wall is left that there is nothing to bond to, an onlay is the wrong answer and a crown is the right one. If the pulp is already involved, it needs a root canal first, and pretending otherwise just means doing the restoration twice.

And if the cavity is genuinely small, you need a filling, not this. We will say so. Several of our Google reviews are from people who were told they needed less than they came in expecting, and that is deliberate.

Where we are

Tooth District is in S.T Bed Layout, Koramangala 4th Block, on Koramangala 1st Main Road just off 80 Feet Road. We see patients from across Koramangala, Ejipura, Jakkasandra, Adugodi, HSR Layout and BTM Layout, and regularly from Indiranagar, Domlur and HAL.

If you have been told a back tooth needs a crown and you would like a second opinion on whether it really does, bring the X-ray if you have one, or we will take a fresh one.