Unbiased oral health information

Procedures

Inlays

Procedure overview

Learn about the dental procedure, when it is generally prescribed, and other information which can increase your knowledge of the topic.

Inlays are "indirectly fabricated" dental restorations for the repair of chipped or decayed teeth. Indirect fabrication means that the tooth is prepared for the inlay, an impression (mold) of the tooth is made and poured in dental stone, and the restoration for the tooth is made in a laboratory on the stone replica rather than the tooth itself. The inlay is then "luted" (i.e. glued) into the tooth, generally at a separate appointment. Inlays can be made from composite resin, gold and other metals, or various ceramic materials.

Inlays are typically prescribed when it will be difficult to restore a tooth to its proper shape and re-establish proper contacts with the adjacent teeth. Less tooth structure is removed than would be necessary for crowns or onlays. Inlays are very similar to fillings, except that they're generally made in a lab, which adds cost and complexity to the procedure.

Concept™ inlay in lower molar tooth; Compliments of Ivoclar North America

Figure 1: A ceramic inlay being positioned in a model of the tooth. Note that the tooth has been shaped with divergent interior walls to allow the inlay to be inserted in the tooth. It will be bonded into the tooth using any of a variety of dental adhesives or luting agents.

Metal (gold) inlay/onlay dental restoration of a lower molar tooth

Figure 2: A more traditional gold inlay shown in a lower molar, with one cusp of the tooth being replaced. It can be difficult in some circumstances to restore a tooth's proper shape and especially the contact it makes with the adjacent tooth by placing a filling. In such cases, making an inlay in a laboratory may be an option. Also note how the use of an inlay preserved a large part of the tooth's natural structure in this case.

Post-operative discomfort

A common misconception about teeth is that working on them, like trimming fingernails, should not lead to any complications. In reality, though, working on teeth is a surgical procedure. Teeth are very well-supplied with two different types of nerve tissue. And unlike other tissues of the body that are living, teeth can't swell, and are poorly equipped to deal with inflammation. Working on teeth very commonly produces inflammation—just as making an incision in an arm or leg would. Inflammation is a process by which your body sends immune cells and healing cells to the affected area so that they can repair the "wound". It does so by increasing blood flow to the affected region.

When the surgery is performed on soft tissue (i.e. skin, muscle), increased blood flow to the area produces swelling—enlargement of the soft tissues—which are somewhat elastic (i.e. "stretchy"). Since teeth cannot swell, inflammation causes the blood pressure inside the tooth to increase. The increased pressure on the nerves inside may produce significant discomfort. Well-maintained dental instrumentation, skilled technique, and use of desensitizing medications can minimize post-operative discomfort, but may not eliminate it.
Learn more: Diagnoses › Irreversible pulpitis
Learn more: Diagnoses › Reversible pulpitis

Anything that causes a pressure change inside an inflamed tooth can provoke more discomfort. The most common culprits are cold temperatures and chewing. Cold causes the fluid inside the tooth to contract (shrink), changing the pressure. Chewing sends small hydraulic compression waves through the extra fluid in the tooth, and these pulses are perceived as pain. Sensitivity to heat is a symptom in some cases, but generally heat sensitivity is less common. Severe sensitivity to heat is a sign that there may be gas in the tooth. This is an unfavorable situation, because the gas is usually produced by bacteria (i.e. the tooth is infected). Sometimes the only way to reduce the pressure in the tooth is to make a hole into the pulp space (i.e. perform a root canal).
Learn more: Diagnoses › Acute apical abscess

Some people are inclined to think something must have been done wrong if they experience discomfort after a dental procedure. Although this can be the case, if proper procedure is followed, it is more likely the tooth's reaction to what was done that causes the problem. Does this mean you should wait until your tooth hurts to fix a problem that has been diagnosed? Definitely not! Very often problems with teeth (i.e. cavities, etc.) don't hurt unless they are advanced. Waiting until the problem is advanced to fix it is a big mistake. The bigger the problem is, the harder it is to fix and the more likely it is to produce complications; and it will frequently have a poorer prognosis (likelihood of long-term success) if you wait too long to have a problem fixed.

If your dentist can show you the problem (e.g. on the X-ray, with a photo, etc.) in such a way that you have a clear understanding of what it is, how it can be fixed, with how much urgency it should be addressed, any options you may have for fixing it, the risks, and intended benefits of each, the likelihood of success ("prognosis") of each, and the cost of each, you will experience better treatment outcomes.