Stump inlay - manufacturing for a tooth under a crown from zirconium and other materials

What is a stump tab

A stump inlay in dentistry is a pin structure used for prosthetic purposes when it is impossible to restore the natural tissues of the coronal part of the tooth. The inlay is attached to the root part, protruding onto the visible surface of the tooth, forming a support for the artificial crown. The main condition for its use is the ideal health of the tissues and roots surrounding the unit. The stump tab, in contrast to the anchor pin, intended only to strengthen the tooth, consists of two parts: the lower one, installed in the canal, and the upper one, which gives the tooth its shape. The system rests on the surface of the tooth being restored and is able to evenly distribute the load on the root.

NeoStom – Dentistry website

This is an operation of excision in a certain sequence of hard tissues of the tooth crown to give the cavity the desired shape. Like any surgical intervention, preparation of a cavity in vital teeth under an inlay may be associated with the development of early or delayed complications: • postoperative tooth sensitivity; • opening of the tooth cavity; • acute and chronic pulpitis; • secondary caries. The development of complications may be due to the action of local damaging factors: mechanical trauma, drying, hyperthermia, vibration, microbial invasion. Therefore, to prevent the development of complications, the formation of cavities for inlays in teeth with preserved pulp is performed with adequate pain relief, in compliance with the general rules, principles and preparation regimes.

• Preparation of vital teeth for inlays, more than for other types of orthopedic structures, is associated with the risk of damage to the pulp (traumatic pulpitis). Therefore, when preparing a cavity for an inlay, it is necessary to take into account the anatomical and topographical features of the tooth being prepared: the structure and thickness of hard tissues in different areas, the topography of the tooth cavity. Excision of hard tissues should be carried out under X-ray control and taking into account safety zones (Abolmasov N.G., Gavrilov E.I., Klyuev B.S., 1968, 1984), with control of the depth of preparation. • Dissection should be carried out intermittently, with well-centered, sharp instruments, under full air-water cooling (50 ml/min). The water temperature should not exceed 35 °C. • When preparing, it is necessary to observe the speed modes of preparation for enamel and dentin. • To prevent the development of secondary caries, it is necessary to control the quality of removal of infected dentin. • After preparation, the prepared dentin must be protected. • Preparation of a carious cavity consists of the following stages: — excision of all hard tissues affected by the carious process and complete removal of infected dentin (necrotomy); — preventive expansion of the cavity; — formation (special preparation) of a cavity of the desired shape. When forming cavities for inlays, carbide and diamond burs of the following shapes are used: spherical, cylindrical, cone-shaped, flame-shaped. By sequentially using diamond and carbide burs of the same shape and size, the most optimal conditions for preparation are created. Removal of infected dentin and preliminary formation of a cavity in dentin is recommended to be carried out using carbide burs with a small number of blades. At the main stage of cavity formation, it is advisable to use diamond burs, at the final stage - carbide burs with a large number of blades (finers) or diamond burs with red markings. General principles of forming cavities for inlays The main features of preparing teeth for inlays, as opposed to fillings, are the creation of relative parallelism of the side walls for the possibility of introducing the finished structure, as well as the need for preparation to a depth that ensures sufficient strength of the inlay. To ensure reliable fixation of the inlay while maintaining cavity edges that are resistant to chewing pressure and to prevent relapse of caries during cavity formation, certain principles must be observed. • The cavity is given the most appropriate shape, such that the insert can be easily removed from it in only one direction. In this case, the vertical walls of the cavity should be parallel or slightly diverge (diverge). The slope of the walls is not a constant value and can vary depending on the depth of the cavity: for superficial cavities the slope should be less, for deep ones it should be greater. • The bottom and walls of the cavity should be able to withstand chewing pressure well, and their relationship should contribute to the stability of the inlay. The design of the angle formed by the outer walls and the bottom of the cavity has a certain significance for stability. The angle of transition of these walls into the bottom should be clearly defined and approach a straight line. • The bottom of the cavity should be parallel to the roof of the tooth cavity and be of sufficient thickness to protect the pulp from external influences. Depending on age, the safe thickness of dentin above the pulp cavity can range from 0.6 mm for teeth whose root formation process has already been completed, and 1.4 mm for teenage and young adult teeth with wide and open dentinal tubules.

• To prevent relapse of caries, it is necessary to carry out preventive expansion of the cavity. • When forming a complex cavity that involves several surfaces of the tooth, retention elements should be created to prevent the inlay from moving in different directions. Additional retention points should be created if at least one outer wall is missing or its height is insignificant. Fixation elements can have different shapes: cross-shaped, T-shaped, dovetail. • The cavity for the inlay must have sufficient depth with mandatory immersion into the dentin. • The formed cavity should be asymmetrical or have additional recesses that serve as guides when inserting it into the cavity. There should be no undercuts that would interfere with the removal and insertion of the inlay. In each specific clinical case, the method of preparing hard dental tissues for an inlay will differ depending on the class of hard tissue defect and the material used to make the inlay. Thus, the peculiarities of cavity formation in the manufacture of metal inlays include the creation of a bevel (rebate) in the enamel with a width of at least 0.5 mm at an angle of 45° relative to the internal walls of the cavity, which ensures an accurate marginal fit of the inlay to the enamel, increasing its retention area ( Fig. 1-2).

Rice. 1-2. A finally formed cavity with the creation of a bevel (rebate) during the manufacture of a metal inlay. In the manufacture of metal-free inlays, the creation of bevels in the enamel is contraindicated due to the properties of the materials - their fragility in the presence of a thin layer in the area of the transition to the tooth enamel. In addition, when making metal-free inlays, the internal corners of the cavity should be slightly rounded, the outer boundary of the cavity should be within the enamel (Fig. 1-3). When forming a cavity for composite, ceramic inlays, the edges of the cavity are not finished to ensure a high degree of fixation.

Rice. 1-3. The final formed cavity for the manufacture of a non-metallic (ceramic, composite) inlay

Preparation of class 1 cavities according to Black Class 1 cavities (Fig. 1-4) are characterized by the preservation of all outer walls, which, if the cavity is formed correctly, prevent displacement of the inlay. The stability of the inlay is ensured by the depth of the cavity and the angle between the bottom of the cavity and its walls.

Rice. 1-4. View of a mandibular molar after completion of the formation of a 1st class cavity under the tab. 1st class cavities located on the chewing surfaces of molars and premolars are formed at the locations of fissures and intercuspal fossae. The cavities are given a typical shape: they should follow the fissure pattern without the formation of sharp corners (see Fig. 1-4). When forming a cavity, elements are created (bottom, walls of the cavity, bevels, etc.) that have a certain functional significance. The main wall of the cavity, which takes on most of the chewing pressure, is the bottom. It is formed parallel to the chewing surface and perpendicular to the long axis of the tooth. The tilt of this cavity wall is permissible only towards the strong outer wall. The tilt of the cavity bottom towards the weakened wall can cause a fracture of the tooth crown. When forming deep cavities to prevent perforation, one should not strive to form a flat bottom by grinding off the hard tissues of the tooth. If the bottom of the cavity is concave, it is subsequently leveled with lining material. To prevent recurrence of caries during the formation of class 1 cavities, enamel prisms that have lost contact with dentin must be ground off. For this purpose, the enamel wall must be given the most favorable slope, taking into account the radial direction of the enamel prisms along the edge of the tooth defect.

When forming cavities of the 1st class, you should not make them with symmetrical contours (round, oval) - this will complicate the fit and may cause incorrect fixation of the inlay in the tooth crown. To add asymmetry, the cavity is slightly lengthened or expanded towards one of the fissures. If there are two or more cavities on the occlusal surface, they are combined into one. Preparation of class 2 cavities Class 2 cavities are characterized by destruction of the contact surfaces of the chewing group of teeth. The preparation of a 2nd class cavity begins with separation, which is carried out with a thin diamond head to the level of the tooth neck. The separation plane must be strictly vertical or slightly inclined towards the center of the tooth crown. Then, using a fissure bur, a cavity is formed on the contact surface to create a ledge and an additional area on the chewing surface (Fig. 1-5). The gingival wall of the cavity should be located at the level of the gingival margin. An additional area on the occlusal surface is intended both for preventive expansion of the cavity and to prevent displacement of the inlay towards the missing wall. On the chewing surface, hard tissues are excised, bypassing the intact slopes of the tubercles, and the cavity acquires a complex shape, which ensures good fixation of the inlay. If both contact surfaces of the tooth crown are affected, it is necessary to form a three-sided cavity (both contact and chewing surfaces are prepared) even if there is a filling on one of the contact surfaces. In this case, separation is carried out and, according to general rules, cavities are formed on both contact surfaces, which are then connected to each other by the cavity formed during excision of the chewing groove. To prevent chipping of the vestibular or oral walls of the cavity, which are under load during chewing, it is often necessary to grind off the tubercles, then restoring them with the inlay material.

Preparation of class 3 cavities There are three degrees of destruction of the tooth crown with caries of the contact surface: • without disruption of the labial or oral surface; • with damage to one of them; • with simultaneous destruction of the labial, contact and oral surfaces. Depending on the degree of destruction of the crown, the method of forming cavities changes. When only the contact surface is affected, the cavity is formed in the form of a triangle with the apex facing the cutting edge and the base parallel to the gingival edge. The bottom of the cavity should be convex, repeating the contours of the contact surface of the crown. The formation of such a cavity is possible in the absence of adjacent teeth.

Rice. 1-5. View of a mandibular molar after preparation of a class 2 cavity for making an inlay

Rice. 1-6. View of the maxillary canine after completion of the formation of a class 3 cavity for the inlay. In case of combined lesions of the contact and oral (or labial) surfaces, the cavity is formed taking into account the path of insertion of the inlay and the creation of an additional fixation platform (usually in the form of a “dovetail”). An additional cavity is created in proportion to the main one, immersing it in dentin. The transition from one cavity to another is designed in the form of a step. When forming a cavity under the inlay, cavity elements are formed, each of which carries a certain functional load (Fig. 1-6). With the simultaneous destruction of the contact, oral and vestibular surfaces, additional depressions are created in the dentin from the labial and oral surfaces to hold the inlay. At the same time, the axial wall of the cavity is preserved in the form of a roller, which will protect the pulp chamber. If there are cavities on both contact surfaces, they are connected by a fairly wide groove passing through the blind fossa.

Preparation of class 4 cavities The nature of the formation of class 4 cavities depends on the structural features of the cutting edge. Teeth with destruction of the cutting edge are divided into two groups depending on its width. As a rule, teeth with a wide cutting edge are found in older people, in patients with increased wear of hard dental tissues. In such teeth, between the layers of enamel there is a fairly thick layer of dentin, which makes it possible to create a cavity or an additional fixing platform in it. In this regard, the need to prepare the palatal surface of the tooth crown is eliminated, and the inlay located on the cutting edge protects the tooth from further abrasion. The shape of the prepared main cavity located on the contact surface must be such that the path of insertion and removal of the inlay coincides with the long axis of the tooth, and the gingival wall is perpendicular to the long axis of the tooth. In addition to the main cavity, an additional platform is created in the cutting edge in the form of a groove, commensurate with the main cavity and the width of the cutting edge. This groove may end with a recess in the form of a channel, into which a pin fixed in the inlay will subsequently enter, improving its fixation, or it may move into a cavity on the other contact surface (in case of damage to both contact walls of the tooth). In teeth with a thin cutting edge, the formation of the main cavity is carried out in the middle third of the tooth crown, perpendicular to the palatal surface. This direction determines the insertion path of the tab. The bottom of the main cavity becomes the labial wall of the tooth crown. To ensure fixation of the inlay, an additional platform is formed in the area of the blind fossa at the base of the dental tubercle with immersion in the dentin. If both contact surfaces are affected with a violation of the angles of the cutting edge, the latter is used to form a step and create a saddle-shaped connection of the proximal cavities. When the cutting edge is chipped, it is ground off, creating a bevel from the oral surface. Then a cavity is formed taking into account the topography of the tooth cavity with the creation of vertical channels for the pins. The canals should run midway from the pulp to the enamel edge.

Preparation of class 5 cavities When forming cavities in the cervical region, it is necessary to take into account the proximity of the cavity to the equator and the danger of opening the pulp chamber located close to the surface of the tooth. The expansion of the cavity is carried out to the greatest curvature of the tooth crown in the area of the equator and contact surfaces. The bottom of the cavity is formed convex, especially on the front group of teeth. The gingival wall is formed at the level of the gingival margin, except for those cases when there remains a section of intact hard tissue at least 2 mm wide between the edge of the cavity and the gum. The mesial and distal walls of the cavity must be at a certain angle to each other, and the wall facing the cutting edge (or occlusal surface) and the gingival wall must be parallel. This ensures retention of the tab. Protection of prepared dentin After preparation, to protect dentin from irritating factors, its dentinal tubules are sealed using desensitizers - materials whose operating principle is based on sealing dentinal tubules in various ways. The main effect of using desensitizers is to reduce the sensitivity of prepared dentin. During the production of the inlay, the cavity formed in the tooth must be closed with a temporary filling, which protects the tooth from thermal, chemical, mechanical and microbial influences in the postoperative period.

We recommend reading:

Preparation of teeth for veneers. Fixation of veneers
Theoretical foundations of tooth preparation

Manufacturing technology of the stump tab

The method of layering ceramics. After receiving the impressions, a refractory model is made, a ceramic pin is tightly installed in the channel, ceramic is applied to it, and firing is performed. In the process of applying ceramic layers, it is possible to choose different colors and shades of the material, dyes and modifiers.
Production of ceramics from tablet molds by pressing. An inlay is modeled from wax, and sprues are installed in the direction of the ceramic flow. Using a silicone ring, investment material is introduced and a limiter is placed. Pressing is carried out in an oven equipped with a microprocessor control system. The resulting product after pressing and casting is a solid single crystal, the abrasion of which is comparable to the natural abrasion of hard dental tissues.
Manufacturing using CAD/CAM method. Allows you to form prostheses and parts that match the implant, abutment, and the shape of the tooth stump. The unit is scanned in the mouth or on a model, 3D modeling is carried out using a special program, the information received is transferred to a milling machine, which mills the product under computer control. The method is precise and complex, requiring high costs for professional training of personnel to operate the equipment.
Injection molding method for manufacturing a stump insert. Casting a working model from plaster/polyurethane, selecting an ashless pin similar to the root canal, applying silicone varnish to the root. The pin is inserted into the canal and modeling is carried out with ashless plastic/wax. After a control check, the cast stump insert is removed and transferred to a metal casting. The method is technologically easy, low-cost, requires a minimum of material costs, but is very sensitive to the quality of casting. With strict adherence to all norms and rules, reliable and high-quality microprostheses are obtained.

Preparation methods: ultrasonic, laser, tunnel, chemical

There are several methods that allow you to prepare teeth; let’s look at each of them in more detail.

Ultrasonic preparation

The principle of operation of devices of this type is that the grinding of teeth occurs due to high-frequency vibration of the instruments under the influence of ultrasound.

Advantages:

working tips exert minimal pressure on tooth tissue;
during operation, a small amount of heat is released and no significant heating of enamel and dentin occurs;
the procedure is painless;
Ultrasound does not cause microcracks and chips on the walls of the pin;
there is no negative effect on pulp tissue.

Laser preparation

Pulsed lasers are used for grinding teeth, the effect of which is that under the laser beam, water in the dental tissues is greatly heated. This leads to microscopic damage to the integrity of the enamel or dentin, pieces of which are immediately cooled and removed using a special water-air mixture.

Advantages:

Laser equipment operates silently.
High safety of the procedure, since there are no elements rotating at high speed.
Low heating of dental tissues.
Turning speed.
Complete absence of pain.
The edges of the pin have no chips or cracks.
Since the procedure is non-contact, the possibility of infection is minimized.

Tunnel preparation

Today, turbine dental units are used for grinding teeth, with the ability to adjust the operating speed, and diamond or metal tips. The result of the work directly depends on the quality of the equipment, since worn-out tools cause significant overheating of the tissue, which significantly increases the risk of destruction.

When grinding teeth using the tunnel method, they try to leave as much of their own dental tissue as possible. The main advantage of the technique is the ability to clearly control the size of the removed tissue layer and clearly predict the result.

Flaws:

possible heating of the enamel and resulting pain with insufficient anesthesia;
If the technique is violated, soft tissue injury may occur;
When using low-quality instruments, there is a high risk of microchips and cracks in hard dental tissues.

Air abrasive preparation

When using this method, instead of a rotating drill and drill, an air mixture with abrasive powder is used, which is supplied under fairly high pressure. When contacted with enamel or dentin, this combination causes minor destruction and removal of tooth dust.

Advantages of the technique:

simplicity and high speed of all manipulations;
no heating of tissues and no pain;
the absence of vibration has a positive effect on pulp tissue during the preparation of vital teeth;
maintaining the maximum amount of dental volume.

Chemical preparation

The chemical treatment method involves the use of active substances (most often acids) that soften enamel and dentin, followed by removal of damaged tissue. The disadvantage of the procedure is the need for prolonged exposure to reagents (sometimes up to half an hour).

Advantages of the chemical method:

no thermal damage to teeth;
there is no need for pain relief;
there are no small chips or microcracks in the enamel;
psychological comfort for the patient due to the lack of sound of a working drill.

Manufacturing methods

Straight. It is characterized by its low cost, ease of implementation, and does not require the presence of fire-resistant models or impression materials. With the direct protocol, the future core inlay is modeled in the oral cavity, and then dental laboratory specialists replace the wax with the working restoration material. Disadvantages: insufficient visibility of the surgical field, risks of thermal injuries to the mucous membrane, large time expenditure for the dentist.
Indirect (indirect). It is used for all types of defects; production takes place in two stages: obtaining an impression plus obtaining a model.

Indications for installation

destruction of the crown part of the tooth;
periodontal diseases (splinting);
defects in the shape, position of the unit, supragingival area;
There is no way to put a pin with a filling. For example, if the chewing teeth are destroyed.

Contraindications for installing a post-core restoration on a pin

: caries, cysts, damage or absence of roots, gum disease, periodontal disease, pathological mobility of the dentition, allergies to the alloys from which the structure is made.

We offer

single crowns;
veneers, lumineers;
bridge-like devices;
implant-supported restoration;
systems with stump pin system.

Advantages of stump inlays

Compared to other post systems, the stump post is much stronger. The inlay distributes the load more evenly and fits tightly to the remaining teeth, which prevents the formation of cracks and the development of caries.

Other advantages include the possibility

regenerate destroyed/lost units;
support natural teeth with bulk fillings;
remove increased abrasion of tooth enamel;
restore anatomical form/functionality;
align curvature, maintain aesthetics;
make prosthetics on implants.

Comparison with classic pins

Standard pins - pros:

gentle tissue preparation;
the ability to conduct therapy in one session;
low price.

Minuses:

the coronal and intraradicular segments of the restoration may become separated because there is no chemical bond between them;
in the case of active rods, there is a risk of a wedging effect during the screwing process;
the absence of a base in the structure leads to a sharp increase in the propping load on the root during operation;

Pros:

the stump and the pin are cast from identical material and connected, which 100% eliminates the possibility of their separation;
slight wedging effect during cementation of the stump inlay;
minimizing disjoining pressure, since the chewing load is transferred to the walls of the root, along its axis, to the rod.

Stump pin inlays can be used when the destruction index of the occlusal surface of a unit is more than 60-100% (standard pins - 50-60%). Such inlays are durable and guarantee the reliability of the structure.

Our dentistry offers installation of several types of core microprostheses

serve within 5-25 years;
reliability of crown fixation;
excellent strength;
simplification of subsequent fastening of bridges;
the ability to work with any degree of destruction, restoration of bite;
lack of access for pathogens. No inflammatory processes;
simple replacement of the prosthesis if necessary.

Stump tab, what it is, how and when it is placed

08.02.2019

Stump tab, what it is, how and when it is placed

A stump inlay is a cast metal or metal-free ceramic structure that is installed in the dental canal. It serves as a reliable support for a bridge or single crown. A stump inlay is used in cases of severe tooth decay that cannot be restored. The main condition for dental prosthetics with inlays is healthy roots and surrounding dental tissues.

The price of stump inlays depends on the material for its manufacture, the complexity of the design and the qualifications of the dentist. An inlay made of an alloy of precious metals is more expensive, but its properties are different.

The exact cost of dental prosthetics with core inlays is determined at the dentist’s first consultation, because only in such a situation can you assess the amount of work to be done and select the appropriate materials.

Advantages and disadvantages

The absence of one tooth negatively affects all other teeth. There is a reliable and quite affordable option for tooth restoration.

Why should you choose inlay prosthetics?

Resistant to food coloring.
Protecting the enamel of sensitive teeth from abrasion.
Possibility of use without the danger of destruction from the load on the chewing teeth.
The insert can also be used for problematic roots: curvature, complete or partial obstruction, curvature, pathology of periodontal tissues.
Preparing a tooth for prosthetic restoration with a dental crown.
Restoring the shape of a tooth after injury or destroyed by caries.
Increased strength of the dental inlay compared to a standard filling due to the uniform distribution of pressure on the tooth.
Use as a support for bridges or crowns.
Allows you to reliably close a decent cavity in the tooth.
Compatible with other types of prostheses, it allows you to increase the effectiveness of prosthetics.
Reliable fixation in the canals without access of pathogenic microbes to the living tooth for the occurrence of caries.
If the crown is destroyed, the stump tab does not need to be replaced.
The stump and pin are cast, as a rule, in a monolithic manner ─ this eliminates the possibility of fracture.

A stump inlay cannot be installed if there is an inflammatory or purulent process at the root of the tooth, for example, the formation of a cyst.

In case of severe deformation and obstruction of the root, this procedure is prohibited, as well as in case of pathological mobility of teeth of II-III degree or in the presence of significant changes in periodontal tissue.

It is important to remember that some types of metals can cause allergies or darkening of teeth. Gold is considered the ideal material for making core inlays.

Stages of installing tabs

Dental treatment using core inlays consists of several stages:

Determining the condition of the tooth by examining the root system of the tooth (if periodontitis or a cyst is detected, surgery is required).
Filling tooth roots. The use of a stump is possible on reliable roots without a hint of inflammation, since it can only be removed later with the tooth.
The length of the root should be the height of the crown, and the walls should be at least 1 mm thick to withstand the pressure. The excess is removed 2 mm from the gum level.
Preparing a tooth for a stump inlay.
Making a core inlay from metal or ceramic to match the tooth.
Trying on a tab. If all parameters match, the tab is fixed inside the dental canal to the filling material. Before installation, the dentist will file additional pins at the top of the insert so that it can be easily installed. After fixing, they are broken off and the surface of the inlay is polished. To fix the inlay, different types of composite cements are used, which are inserted into the canals on pins. Then the tab is inserted into the prepared holes and securely fixed.
Making a bridge or crown that will cover the inlay. Preparation for crown installation is planned for the next visit.

Types of stump inlays

A collapsible or monolithic pin inlay is used when restoring a tooth with two or more roots, a non-separable inlay is used for single-rooted teeth. It consists of a pin and a stump, which allows you to create an imitation of the crown part of the tooth, on which the crown will then be placed. Another advantage that a core inlay has is its ability to support an entire bridge or a single crown.

But it must be remembered that the use of this method is possible only taking into account two conditions: healthy periodontal tissues and good root condition.

A cast stump inlay is made of two parts: a supragingival stump and a pin, which are cast separately or joined together monolithically. The tab is fixed in the root canal. A structure in the form of a crown made of plastic, glass or metal ceramics, or metal is installed on it. Cast stump inlays are also used as supporting elements for bridge and clasp prostheses. And the main advantage of cast inlays is that there is no need to grind down adjacent teeth.

Nowadays, more and more doctors are using a cast stump insert for treatment. The cost increases, but the durability and reliability are worth the cost, especially when the inlay is the support of a bridge.

A tooth with a core tab will not break, as sometimes happens when restoring a tooth with a pin, when filling material is poured from above. The only thing that can happen in this case is a defect in the dental crown itself, which can easily be replaced by a dentist.

The main task of dentistry is to preserve the diseased tooth. But it happens that only the root remains of the tooth, and only the island or the top of the tooth is completely destroyed from the crown part. In this case, the dentist will try to restore what was lost using a stump tab, which will also save adjacent teeth without grinding them down. Installation of a prosthesis requires serious medical intervention: opening the dental canal and depulping the nerve.

There is no need to rush to remove a damaged tooth: if the condition of the root, according to the diagnostic results, is satisfactory, then the clinic’s specialists will carry out high-quality, quick and painless prosthetics using a stump insert.

Selecting material for the stump tab

The material for making the inlay must meet certain requirements: it must be hard and elastic, bioinert, almost without shrinkage during casting, with low thermal conductivity, materials similar in physical and aesthetic properties to living teeth - ceramics, porcelain, composite materials.

Modern dentistry can offer the following options:

The ceramic core inlay is suitable for patients who prefer non-metallic crowns. Such stump inlays (kosmopost) are used on the front teeth. The color is perfectly adjusted to natural. The material for manufacturing is zirconium or carbon pins, onto which the crown is built up. There is also a mixed version - a stump inlay with metal ceramics. This option is more durable and can be used on chewing teeth.
A cobalt-chrome core inlay will be ideal for restoring chewing teeth with heavy loads. Such inlays are very hard and difficult to process and are not suitable for collapsible structures. Such alloys can cause allergies.
Stump inlays made of gold are the safest, hypoallergenic and aesthetic. Gold is a universal material, does not corrode, melts easily and is processed after installation.
Metal stump inlays can be made of noble and base metals. Silver has bactericidal properties, but after installation, an oxide film appears on the teeth, causing darkening of the enamel and gum pigmentation. Titanium has high bioinert properties, but is difficult to process due to its fragility. Chrome and nickel may shrink.
A stump inlay made of zirconium dioxide is a sensation in dentistry. In terms of strength, it is not inferior to metal ones, and in terms of quality (hypoallergenic, durable, identical to natural teeth) ─ it is significantly superior to them.

In any case, if you decide to restore a damaged tooth using an inlay, rather than using standard factory pins, discuss your decision with your doctor in advance and get detailed advice on this issue.

Classification of stump inlays

View	Description
By installation method
Cast	Manufactured under high pressure and temperature. The non-separable model consists of a main part and pins for fixation. Can be replaced over time
Collapsible	Designed for two to four channels. Similar in design to cast ones, only some pins are made removable. This is due to the fact that channels do not always have a symmetrical structure. Comes with a lifetime warranty
Based on base material
Metal	These can be cobalt-chrome, precious metals and their alloys. They are characterized by increased reliability. Disadvantages include an unaesthetic appearance, which is why they are most often placed behind the smile line
All-ceramic	Made from zirconium dioxide or pressed ceramics. Zirconium is as durable as its metal counterparts. Ceramic inlays are aesthetically pleasing and natural-looking, which is why they are used for front teeth. All-ceramic ones are produced automatically. This ensures maximum compliance with the bite
Metal-ceramic	Products made from metal ceramics are of average quality and affordable price. Due to the difference in thermal expansion of metal and ceramics, there is a high risk of falling out
Composites	Composite inlays are rarely used due to their low durability

Important

: It is desirable that the materials of the pin and crown parts of the core structure coincide. For example, if the core inlay is metal and the crown is ceramic, then the metal will be translucent.

Comparison of ceramics with other materials

Ceramics is far from the only material from which inlays are made.
They can be made from various metal alloys (including precious ones) or from a combination of metal and ceramics, but only ceramic or zirconium inlays are considered the best in terms of aesthetics and reliability. For example, a metal-ceramic tooth inlay is inferior to solid ceramics in reliability, and most metal alloys are not bioinert. The exception is gold tabs. Gold does not cause allergies, and thanks to the plasticity of the material, it is possible to “fit” the insert well and eliminate the occurrence of micro-gaps. There are nuances regarding the ceramics itself. Just 30-40 years ago, the dental industry did not have the production technology to produce reliable all-ceramic inlays. Despite the fact that ceramics is a safe and aesthetic material, it is quite fragile and poorly suited for chewing teeth, and it is the lateral teeth that are most often restored with the help of inlays. That is why special high-strength ceramics made by injection molding under high pressure are used to produce inlays. Another method is the CAD/CAM technique. This is a fully automated process. The doctor uses equipment and software that allows the patient’s individual data to be loaded into a special milling module, which cuts products from zirconium dioxide blocks. The most well-known technologies at the moment are CEREC and e.max: such inlays are considered the most reliable and aesthetic and are used in the best clinics around the world.

Multi-channel and single-channel tabs

When treating a multi-rooted tooth, the doctor must make a decision: to make a collapsible or solid-cast core microprosthesis. If the root canals run parallel, solid blanks are used. Before choosing one of the various options for inlays, the patient is diagnosed - they take pictures and CT scans. Computed tomography helps to visualize the condition of the root segment, the configuration of the canals, and the presence of bone and periodontal diseases that require treatment. A multi-root microprosthesis is a good option because it creates uniform pressure on the entire tooth while being held in several canals at the same time. A crown with such a base can be used to mount a bridge restoration without the risk of destroying or damaging the tooth.

Requirements of orthopedic dentistry for the use of core inlays:

the root canal must have good patency over a length identical to the length of the pin;
absence of purulent-inflammatory processes in the root zone;
the walls must be of sufficient thickness (2 mm or more) to resist the chewing load transmitted through the stump structure, the protruding area must not be affected by caries;
the stump should not be covered by the gum, otherwise gingivectomy is indicated;
apical tissues should not have manifestations of chronic/acute inflammation.

Indications and contraindications for installing a ceramic inlay

Indications	Contraindications
The tooth is destroyed as a result of injury or disease by 20-30 percent High abrasion of enamel An inlay or crown has already been installed on the antagonist teeth The inlay is used as an attachment for an adhesive prosthesis	If the tooth is more than half destroyed or less than two walls remain An inlay is rarely placed in case of serious damage to the incisors and canines It is not recommended to install on baby teeth and wisdom teeth

Stages of manufacturing and installation of dental prostheses

We work in several stages

Preparation. We remove the carious area, perform a filling, take an x-ray for verification, and form a cavity.
We unseal the roots by half or one third, giving them a taper and width. It is also important to choose the optimal tab option.
We take an impression of both jaws and cast it from plaster in a dental laboratory. It is important that the microprosthesis corresponds to the antagonist organ.
We scan the cavity and carry out modeling on a computer.
We send the task to an automated milling machine, which produces the product.
We burn the workpiece in a special oven.
We treat the area with an antiseptic and fix the fat-free microprosthesis with cement.
Trying on and selecting a crown, installing a finished core inlay.

Complications and errors

Errors in the manufacture of core inlays are divided into two groups: those associated with the work of the orthopedic dentist and the actions of the dental technician.

Clinical:

unsealing of the canal to an unsatisfactory amount;
root perforation during teeth grinding;
giving an inadequate shape to the channel, which can lead to de-cementing of the structure;
errors when taking impressions.

Laboratory:

poor-quality casting when using the casting method;
non-compliance with processing standards during the pressing method;
violation of the firing regime when applying ceramic layers.

Quality criteria for core restoration: high aesthetic level, reliable fixation, long service life, uniform distribution of pressure when pressed.

Preparation (turning) for various types of crowns

A dental crown is a kind of “cap” that is placed on a healthy or damaged tooth. The main task of such a design is to restore the functions of the entire dentition.

The following types of crowns exist:

Metal - made only of metal: sewn;
stamped;
metal-ceramic - consist of a metal frame lined with ceramic mass.

Made of metal-free ceramics - they do not have an internal frame and consist entirely of ceramics:

porcelain;

from zirconium dioxide;

metal-composite - combined crowns, cast from metal and having a plastic lining only on the front part.

plastic - made entirely of plastic.

Features of crown preparation:

Grinding for solid metal crowns begins from the side surfaces, which eliminates damage to adjacent teeth, after which up to 0.3 mm of hard tissue is evenly removed.
Preparation for metal-ceramics involves preliminary depulpation of the tooth, followed by the removal of 2 mm of tissue on each side. It is mandatory to create a ledge, the width of which depends on the model of the prosthesis. The walls of the stump must have a pronounced roughness for reliable fixation of the elements.
The correct preparation technique for a porcelain crown involves giving the stump a conical or cylindrical shape. A rounded ledge is formed, which is immersed into the gum up to 1 mm (on the palatal surface it can be left at the border with the gum).
Preparation for a zirconia crown should be carried out with a clearly visible margin, forming a rounded or shoulder shoulder. When treating anterior teeth, the thickness of the tissue removed should not exceed 0.3 mm, and for the chewing group - 0.6 mm.

Hygienic oral care

After installing the microprosthesis, 10-14 days pass before fixing the bridge or crown. During this period, the prosthesis requires special careful care:

chewing food with the opposite side of the jaw;
exclude solid foods;
teeth are brushed as standard;
The oral cavity is rinsed with an antiseptic solution after each meal;
the gums are treated with an anti-inflammatory agent.

Stump inlays do not require specific care. It is enough to regularly brush your teeth, undergo an examination by a doctor, and undergo a professional sanitation procedure. To clean crowns, it is recommended to use soft brushes, dental floss, and special brushes. With proper care and following the recommendations of dentists, the stump insert will serve you for many years.

Why us

it doesn’t hurt: during installation we use different types of anesthesia, depending on the patient’s individual parameters;
it’s fast: treatment will require 2-3 visits;
it’s reliable: we provide a 3-year warranty;
it’s convenient: we work with any materials – gold, zirconium dioxide, porcelain;
it's safe: we have our own dental laboratory. We use equipment from European brands, which guarantees high accuracy and safety of products.

Restore a tooth that seemed hopeless - install a core tab at an attractive price at Dr. Razumenko’s dentistry in Moscow!

Preparation for veneers

Veneers are partial microprostheses, the main function of which is to improve the aesthetic appearance of the vestibular part of the front teeth. The main material used for their manufacture is ceramics. Enamel preparation plays a significant role when installing such prostheses, since the density and reliability of fixation of the elements directly depends on its quality.

The preparation of teeth for ceramic veneers occurs in a certain sequence:

processing of the vestibular surface;
turning the side surfaces;
preparation of the cutting edge and palatal surface (if necessary).

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When processing the vestibular surface, the thickness of the layer that needs to be removed is initially determined. Then grooves are created on the prepared part, serving as a guide for the doctor, along which the entire volume of hard tissue is ground. A ledge is formed at the gum level (the grooved one is most often used). In the process of processing the lateral surfaces, 2 options are possible: with the preservation of interdental contact points and with the extension of the preparation boundaries to the lingual side. In the first case, the overall integrity and stability of the dentition is maintained. With the second option, aesthetic indicators are significantly improved.

Depending on the veneer model and the required conditions for its installation, the cutting edge can be ground off or left unchanged. If there is a need to remove tissue from the lingual surface, then the preparation boundary should in no case coincide with the line of contact with the antagonist teeth.

Prices for installing a stump tab

To find out the cost of a stump tab, sign up for a consultation at Dr. Razumenko’s dental clinic. To do this, fill out an application on the website or call: 8 (495) 380-01-38.

Code no.	NAME OF PROCEDURES	Unit of measurement	Cost, rub.
712	Fixation of restoration with glass ionomer cement	1 500,00
735	Single-root post-core inlay CAD/CAM	7 000,00
736	Multi-root post stump inlay	8 000,00
737	Single-root/multi-root post stump tab, collapsible	9 000,00
738	Zirconium pin insert	11 000,00
739	Cast pin insert with attachment	12 000,00

* The prices indicated on the website are not a public offer. The exact cost of treatment can only be determined at an appointment with a doctor.

Prices for treatment in Moscow full price list

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Article Expert:

Razumenko Evgeniy Gennadievich

Chief physician and founder of the dental clinic. He has been working in aesthetic dentistry for many years, restoring teeth of any complexity with ceramic and composite restorations. Winner of competitions in aesthetic dentistry. Applies CAD/CAM technologies in prosthetics.

Work experience 22 years

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