Dental tissue is one of the most durable types of tissue in the human body. In theory, teeth should last a lifetime, but this is not always the case. Many people already have teeth that need treatment from a young age. One of the innovative ways to correct damaged teeth is a stump inlay. This method of prosthetics allows you to save even “worn-out” teeth and make them outwardly indistinguishable from natural ones.
Design Features
A stump inlay is a structure made from a patient’s dental impression for attaching a crown. This type of denture is a combination of cast material of different alloys. The prosthesis is installed into the dental canal from the inside to strengthen the damaged dental crown.
A stump tab is the only way to restore a maximally damaged tooth (more than 70%).
The upper part of such a prosthesis looks like the stump of a ground tooth, which is where the name “stump” comes from. For special strength, the prosthesis is made by casting from various metal alloys.
This prosthetic model is not a crown. This is a completely different structure. It is difficult to do without this extremely reliable type of prosthetics in modern dentistry.
Stump tab, pin and crown: which is better
It is impossible to compare core inlays and crowns. These are prostheses of fundamentally different purposes, properties and configurations. And only the dentist can decide which type of prosthetics is preferable for a particular patient.
However, a core inlay is not used for teeth with very thin walls. In this case, a crown can more effectively cope with the task of strengthening the crown of the tooth. The crown will be especially strong if it is attached to the stump tab. At the same time, it is possible to maximally strengthen even the most worn teeth and completely restore their natural chewing function.
Both the post and core support strengthen damaged teeth. However, this type of prosthesis guarantees super-strength dental fasteners, uniform chewing load and protection from further destruction.
A very important advantage of the inlay is its fastening using a cement composition. This guarantees a tight fit to the tooth of any degree of wear and prevents the formation of cracks.
General overview
Dental inlays are orthopedic micro-prosthetic structures that replace cavities in the crowns of damaged teeth.
As a result of the restoration, the organs acquire an anatomical shape and relief that is as close as possible to nature. In fact, this is another type of filling, but the only difference is that the production is carried out outside the patient’s mouth , and in the laboratory using a plaster cast.
This process allows you to get rid of shrinkage of the composite material , which inevitably occurs during classical filling.
Also, using the tab, it is possible to recreate an exact copy of the missing fragment of a destroyed tooth. All the tubercles on the surface of the product perfectly follow the contours of natural elements.
Microprostheses are characterized by a fairly strong macro and microstructure, which is resistant to abrasion. The products are installed already formed, while the filling material has a plastic consistency.
Inlays are a more progressive method of restoring the integrity of teeth. They provide longer and more stable operation compared to standard treatment.
Types of tabs
Typically, the dentist recommends a particular type of inlay to the patient. Let's look at the main features of such structures.
Stump prosthetic models are used in the form of two types of dentures:
- collapsible;
- cast.
Cast stump inlay
Cast ones are used most often; they are also called pin ones. They are manufactured at high temperature and pressure. Such models include a main platform (for holding the tooth) and fixation pins (for strengthening in the dental canal). This type of prosthesis is used for single-rooted or double-rooted teeth (including those with non-parallel canals). These dentures are not suitable for multi-channel teeth.
A pin stump insert (or cast) is used in cases of severe destruction of the tooth base. It can also secure crowns when restoring extremely damaged teeth.
For the pin insert, especially reliable materials are used that clearly retain the required shape during casting. For this purpose, they usually take gold and other metal alloys (including cobalt + chromium), and cermets.
Collapsible tabs
Collapsible structures are used for multi-channel dental roots (3-4 channels). In this case, the pin is partially made removable in order to freely enter the root canal. This type of denture perfectly matches the shape of the tooth.
Thanks to the dismountable technique, individual pins are inserted into the tooth and secured there. They cannot be removed after installation, so collapsible structures have a lifetime warranty.
Types of materials
The type of stump inlays is related to the material used to make them. Dentists use types of prosthetic models made from:
- metal;
- metal ceramics;
- solid ceramics;
- composite materials.
Metal
They come in chrome-plated cobalt and precious metals. Such models are very durable, but not always aesthetically pleasing. Therefore, they are usually made for the chewing teeth, and not for the “smile zone”.
All-ceramic
They are made from a pressed type of ceramic with the addition of zirconium dioxide. In terms of strength, this type of inlay is no worse than metal ones, but the aesthetic component is similar to porcelain structures. Their disadvantage is their fragility, which is why they are used mainly for front teeth.
Modern automated technologies are used in the manufacture of all-ceramic dental structures. Thanks to this, such prostheses are absolutely protected from factors affecting antiseptics or manufacturing technology.
When installing all-ceramic inlays, you don’t have to worry about the addition of secondary caries.
Metal-ceramic
Metal-ceramic models often fall out, as their quality is somewhat “lame”. These troubles are associated with a discrepancy between the degree of expansion of ceramics and metal.
Composite inlay
Composite products are rarely used in modern dentistry. Such designs have few advantages over ordinary fillings, but they are expensive.
There is also a special type of core prosthesis for the restoration of anterior teeth (frontally located teeth).
Inlays made of either zirconium or titanium oxide are highly durable and do not cause such a serious complication after installation as an allergy to the metal.
The gold design is ideal for the body due to the fact that it does not react with other elements and is as hypoallergenic as possible. Dentists have long loved to work with gold: it does not break down and does not corrode, but is perfectly processed (and can also be melted or forged).
Most often, gold structures are used as a reliable option for restoring chewing teeth.
On the one hand, the silver model is good for use: who doesn’t know about the bactericidal properties of this metal? However, a serious disadvantage makes it rarely used for prosthetics: a characteristic oxide film around the reconstructed tooth, followed by darkening of the enamel and pigment spots in the gum area.
Chrome-plated nickel alloy is also used for this type of prosthesis. However, experts are aware of the disadvantage of this material in the form of severe shrinkage.
When to choose stump inlays
It happens that the top of the tooth is severely destroyed, but a significant part of its hard tissue is preserved. In such a situation, the dentist can use filling material to restore the missing tooth part. However, to securely install a crown in such a tooth, special fastening structures are required to prevent it from further deteriorating. In this case, the doctor forms a stump prosthesis in the crown area.
In situations of destruction of the coronal part of the tooth or thinning of its walls, the use of a stump inlay is undesirable. Otherwise, the root after such prosthetics will not cope with the chewing load and will crack. Then the tooth cannot be restored.
However, with a skillful doctor and adequate indications, the stump tab is a guarantee that the root will be well strengthened and “withstand” the chewing load. At the same time, the tooth itself will be completely preserved, since the extremely strong cement connection will ensure a perfectly tight fit of the core structure to the dental residue, saving it from splitting.
Advantages of stump inlays
- maximum reliability of the “root - stump - crown” system;
- proportional load on the tooth when chewing;
- service life of the structure.
A number of indications have been developed for the stump inlay. Its use is possible:
- in case of abnormal location or formation of a tooth;
- with seriously damaged teeth (more than 70%) in the coronal part;
- if it is necessary to strengthen the tooth before installing a crown;
- in cases where it is impossible to restore the crown using other methods (filling, etc.);
- for supragingival dental defects of any origin;
- for supporting a bridge (for strengthening);
- in a situation of preserving a sanitized dental canal;
- for splinting in case of periodontal pathologies.
How it is made
What stages must be completed in order for a patient to have a high-quality stump prosthesis installed?
The specificity of the installation of stump inlays is the individuality of their production for each clinical case.
Before installing these structures, thorough sanitation of the mouth, filling of the canals and removal of the destroyed pulp in them is required.
Main stages of the process
- The orthopedist prepares the dental cavity for installation of the inlay.
- Then the specialist selects the optimal type of material, taking into account the basic parameters of the desired material (shrinkage, hardness, bioinertness, residual elasticity, thermal conductivity).
- The orthodontist makes impressions of the patient’s jaws to ideally “fit” the prosthesis into the dentition (with the obligatory consideration of antagonist teeth). The blank model is sent to the dental office.
- The variability in the manufacture of the prosthesis must be taken into account: single-root or multi-root (depending on the anatomy of the tooth being restored).
- The dentist makes a prosthetic model from the material selected by the orthodontist. Then a wax model is made from the plaster sample. Only after this do they proceed to the manufacture of a finished stump prosthesis from the selected material (metal, ceramics, composite).
- The structure is covered with a special corrective shell and sent to the doctor.
- In the dental office, the doctor processes the dental cavity and the finished inlay. After this, the prosthetic model is installed on the patient.
- Hiding the stump model of the prosthesis under a crown or bridge.
Description of manufacturing stages and techniques
Creating tabs is a critical stage of work. The patient's comfort depends on the correct manufacturing. Our specialists carefully adhere to the following stages of technology:
- Cleaning dental tissues
- Forming a cavity by removing areas affected by caries
- Taking an impression
- Sending data to a dental laboratory
- Casting a plaster model
- Digital processing, contraction formation
- Transferring the improved computer model to milling equipment
- Formation of the workpiece followed by heat treatment
- Applying a porcelain mask
At the last stage, the production of the tab is completed. The attending physician takes the results of the dental technicians’ work. The mini-prosthesis is ready for use. Our manager invites the patient to the dental center.
Now about the techniques for creating microprostheses:
- Direct . The procedure does not take much time. An impression is made exclusively from the affected area. Efficiency “covers” one drawback - the inability to take into account the patient’s bite.
- Indirect . A labor-intensive, multi-stage, detailed technique. The doctor takes a picture of both jaws, not cavities. This approach allows us to take into account all the individual structural features of the masticatory apparatus without exception. How much does a tooth inlay made by the indirect method cost? The price depends on the materials used. The cost of an inlay made using the indirect technique will be higher than that of one made using the previous method. The patient’s investment and the dentist’s time and effort pay off in results. There is no need for the patient's direct presence - the dental technician makes the adjustment based on the impression. Our clients do not feel any discomfort or pain after installing the inlays. There is practically no adaptation period.
- Computer . 3D modeling appeared later than the two previous methods. It is superior to the indirect method of making inlays in terms of time and accuracy. The microprosthesis model turns out to be ideal. The creation of a computer “cast” is not carried out by a specialist, but by innovative software equipment. The inlay itself is made by dental technicians according to the resulting model.
Each manufacturing method has a number of advantages. The final result and the cost of the insert depend on the technique used.
Advantages of a stump inlay
Most people know about the use of pins for damaged teeth to strengthen them. However, it is the shape of the core inlays that is more similar to the natural shape of the tooth. This type of denture has undeniable advantages for use:
- Protects sensitive enamel from abrasion.
- Preservation of chewing teeth from destruction.
- Large selection of crowns.
- It can be combined with other types of dentures to strengthen the dental crown or bridges.
- Rational distribution of food load (especially important for sick or damaged teeth).
- Long service life.
- Giving the tooth an ideal shape.
- Possibility of correcting the position of teeth (in some cases).
- Possibility of use for front teeth.
- Resistant to food staining.
- Possibility of replacing the crown with another one.
- Use for problem roots (periodontal pathology, curvatures, various degrees of obstruction, etc.)
- Use when restoring teeth after injury or caries.
- Reliability of prosthetics in the presence of significant dental cavities.
- Particular strength due to the technology of simultaneous casting of the inlay and pin.
- There is no need to replace the inlay in case of crown destruction.
- Guaranteed against fracture of the prosthesis thanks to the monolithic method of manufacturing the stump and pin.
- No access of microflora to the tooth and the occurrence of caries due to the maximum tightness of the fastening.
Contraindications for installation
Contraindications include childhood, pregnancy, and the presence of cracks in the roots and inflammation underneath them. As for contraindications specifically for the varieties, it is not recommended to fix a composite restorative inlay on the front teeth and in case of large damage to the chewing crowns - the exception is dense composites for milling. Composite stumps are not installed on chewing teeth, because the latter experience the highest loads during grinding of food.
“The dentist did not advise me to make a composite inlay at all. He said she wouldn't last long. And in a few years you will have to get prosthetics again. Therefore, I decided to immediately make a good ceramic one, they say that they can last a very long time. Unless, of course, you chew nut shells with them.” Svetlana Alekseevna, review from forum.stom.ru
Minuses
Like any other type of prosthesis, the stump tab has some disadvantages in technology and manufacturing time:
- High cost and longer production time (requires several visits to the orthodontist).
- Duration of treatment (preparatory stage for installing the “inlay + crown” complex after the second visit to a specialist).
- Cutting down a significant amount of bone and tissue for maximum docking during installation.
Flaws
The primary disadvantage of microprostheses is the impossibility of repairing them. If the material is partially destroyed or chipped, the tab must be replaced with a new one.
This is interesting: Aligners for straightening teeth are the best alternative to braces for correcting a bite
In addition, the design disadvantages include the following characteristics:
- high cost of installation (compared to conventional filling);
- other specialists are additionally involved in the process, for example, a technician;
- It takes more time to complete the entire complex of recovery manipulations.
It is also necessary to consider the professional factor - incorrect work of the doctor increases the likelihood of complications such as inflammation, tissue infection, poor adhesion of the inlay to the tissues.
Care after prosthetics
Caring for your teeth after installing a core prosthesis differs little from normal oral hygiene. This should include brushing your teeth twice daily. In this case, it is better to use a brush with soft bristles.
After each eating session, it is advisable to rinse your mouth with warm water, herbal infusions (chamomile, sage) or special ready-made mouth rinses.
To clean the interdental spaces, use floss or a brush.
It is advisable to visit a dentist every six months.
Price
The stump model of the prosthesis is not a cheap dental structure. Its cost may vary from one dental office to another. The most inexpensive is the metal model (on average from 2,000 to 3,000 rubles). A prosthesis made of pressed ceramics costs about 12,000 rubles. And most of all you have to pay for the zirconium dioxide inlay (about 15,000 rubles).
If your tooth is damaged, but its root is not damaged, do not worry! Modern designs in the form of a stump tab will help you preserve and strengthen a hopeless tooth.
Sources used:
- I. Yu. Lebedenko, Orthopedic dentistry, 2012
- Seifollahi M. Preparation of lateral teeth for all-ceramic inlays
- https://medicine.wustl.edu/
Reviews
Restoration of damaged teeth with inlays is classified by dentists as the most gentle treatment method. Despite the high cost, its effectiveness is high if there are indications for it.
If you have experience with such treatment and would like to express your opinion on its effectiveness and feasibility, please share your feedback in the comments to this article.
Sources:
- https://zubovv.ru/protezirovanie/nesemnyie-p/vkladki/inlay-onlay-overlay.html
- https://smile-at-once.ru/uslugi/vkladki.html
- https://www.vash-dentist.ru/protezirovanie/nesemnyie-p/vkladki/inlay-onlay-overlay.html
- https://doctorhollywood.ru/keramicheskie-vkladk
- https://galadent.ru/protezirovanie/vkladkikeramicheskieonlayinlayoverlay
