Onlays Vs Full Crowns – Decision Making 2024 – PDP189

Have we fully shifted towards lithium disilicate overlays and onlays? Are full crowns considered a sin in 2024? (Maybe just on Instagram then!) Spoiler: Crowns TOTALLY have a place, and so do large direct composite restorations! Dr Alan Burgin and I share our decision making trees for indirect restorations as part of ‘Crowns and Onlays Month’ on Protrusive Dental Podcast. Find out which clinical factors sway us more towards a Overlay vs a Vertiprep - and the rationale for each type of restoration. https://youtu.be/Gntb083yUOQ Watch PDP189 on Youtube Protrusive Dental Pearl: Use Vaseline on the gingivae when carrying out a ‘smile trial’ or bis-acryl mock-up - will result in an easier clean up! Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode:01:54 Protrusive Dental Pearl02:44 Introduction - Dr Alan Burgin18:20 Types of Indirect Restorations31:16 From Onlay to Crown44:40 Crowns - Traditional vs Verti-Preps54:00 Reflection57:48 Alan’s Prep Course For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. This includes Vertipreps for Plonkers and clinical videos demonstrating Onlay Preps. Join us on Protrusive Guidance, our own platform for dental professionals. No need for Facebook anymore! 😉 If you liked this episode, you will also like PDP089 - Vertiprep Revision Click below for full episode transcript: Jaz's Introduction: Overlays and onlays have become very popular. So is there still a place for full crowns? I still place full crowns because I use vertical crowns, i.e. vertipreps. Even then, if a tooth has enough enamel, my indirect restoration of choice will very likely be an overlay restoration. Something like lithium disilicate. [Jaz]The other modern consideration that we have is composite. We can actually go really far with composites and I know the bigger the composite the less predictable it can be but sometimes with modern techniques and looking after the occlusion you can get a long time out of a large composite and often due to budgetary reasons or otherwise the large composite is what we may be opting for in many scenarios. So where do we draw the line? What's the limit of a large posterior composite? These are all the real world questions we'll be discussing today with my guest Dr. Alan Burgin as part of crowns and onlays month in June 2024. So remember in February we did Adhesive Dentistry, then in March we did Documentation, April we did Mental Health, in May we did may the Force Be With You Orthodontics, and now we're doing Crowns and Onlays. And I hope you agree that this is big enough to deserve its own month. It's our daily decision making. It's our bread and butter daily restorative dentistry. Hello Protruserati, I'm Jaz Gulati and welcome back to your favorite dental podcast. Every PDP episode, I give you a Protrusive Dental Pearl, except this time I've actually just run out. There's no more pearls out there. There's no more tips. In all the episodes we've done in the last six years, we've covered every single tip in Dentistry. And so, there we are. There's no more tips, guys. Dental PearlI'm just kidding. Listen, the tip for this one, the Protrusive Dental Pearl, by the way, if you want access to every single protrusive dental pearl, we've created a new PDF, by the way, which all the previous pearls are there in one PDF. This is freely available in Protrusive Guidance, our community, and the home of the nicest and geekiest dentists in the world. The website for that is protrusive. app or download the iOS, Android app is called Protrusive Guidance. The pearl for today is when you're doing a mock up with a bisacryl. What's bisacryl? It's like, you know, ProTemp, LuxaTemp, Integrity, all these instant crown bridge temporary materials. When you're doing a mock up like a smile preview, perhaps before veneers or something. The issue we have is how ugly they can look because of how much coverage they get on the gums. Now you could try and scallop the putty so that it's less messy and less on the gums. But a really important tip I'm going to share with you is to put some Vaseline on the gums. I literally just get Vaseline all over the gums and it'll be so much easier to take off that bisacryl. So you get that really crisp, beautiful look of that mock up. So next time you dive straight in to put that putty on, just remember a little bit of Vaseline goes a long way on the gums. Now, I hope you enjoy the conversation with Alan, which is eligible for CPD via Protrusive Guidance. And I hope you enjoy our little geeky discussion. I'll catch you in the outro. Main Episode:Dr. Alan Burgin, the Bergmeister. This is like, I don't know, your third or fourth appearance on Protrusive, but let me tell you, man, you're always such a welcome guest. How are you today? [Alan]Yeah, I'm good. Thanks, mate. Thanks for having me back on. [Jaz]You're just such a great guy to speak to. And I know one of the fears I had, Alan, about having you on the podcast again, let me tell you a fear I had, right? The fear I have is that we're just going to be like two guys just totally in agreement with each other. And it's going to be very vanilla, right? Now, it'll be still very educational, and it'll be totally worth everyone's time to listen about it and gain something and our philosophies and what we consider when we look at an individual tooth in a mouth and figure out, okay, what type of restoration will I choose? And I think there's a lot to be said about that. And everyone's different, but I'm scared that it'll be too similar. So I'm going to be really trying to play devil's advocate and try and find some differences, which I'm sure hopefully we'll find one. [Alan]Yeah, that's fine. Maybe I'll try and chuck some curve balla in there for you so I can catch you out. [Jaz]Maybe, maybe I'll start challenging you. But for the listeners, those who haven't heard any of the previous episodes with Alan and also for those that are premium members, he's got a really great full mouth rehab sort of walkthrough, which was just truly brilliant. That's on the app, but the previous episodes are done. Do check it out. We talked a lot about initially we talked about the career journey and then what did we pivot to thereafter? [Alan]We did a Gothic arch one, didn't we? I think we're on YouTube. That got really, really nerdy. [Jaz]Yeah, that was really geeky. Centric relations records and everything that was with Chris as well, wasn't it? [Alan]Yes. Yeah, yeah. [Jaz]I'll put the show link in the show notes. I'll put the link for that as well. Today we're talking about when do you crown something like a full crown? And nowadays, when can you consider doing more like an overlay onlay? And we'll discuss all these terms. But before we get into that, for those who haven't listened to us previous episodes, Alan, just remind us, you know, where do you practice? What is your niche? What are your passions? [Alan]Yeah, sure. So, I'm based down in Cornwall. I work in the city of Truro, which is just about classified as a city, as big as it gets in Cornwall really. I work in a fully private practice and I've been placing implants for probably last five, six years. But my main area of focus, similar to yourself, is more tooth wear related. So I'm very much a general dentist. And do everything pretty much apart from endo and that's what I like to do. Yeah. Bring it all together. And I like having that background with the implants that fits quite nicely with the tooth wear. And yeah, mostly focusing now on rehabs, indirect, direct as well. And those bigger cases where you can, like they would say, play that quarterback role on. [Jaz]Well, I see your Instagram, I follow you, I love the stuff that you do. And the thing that you're great at, which so much of the Protruserati guests that we have on are so great at, are really reflective posts and step by step stories and considering and rationalizing the daily decisions. We have to make those bread and butter decisions, but you truly are a great generalist. I love how you are. I don't even say you're jack of all trade. I truly think you're in that category where you're getting the master of all trades or aspiring to be. And it's so great to see all the things you put out there. So please continue to do that. Today's topic is such a real world topic, right? We deemed a tooth to need an indirect restoration. Which way will we go? Will we prep 360 degrees around the tooth or are we going to be a little bit more contemporary? I'm going to do like an onlay or an overlay. Now, before we even get to that, I think the first place to start, Alan, I'd like to hear your views and reflections on the following question. Nowadays with composite, we can really push the boundaries a lot more like the opportunity to do a M O D B L like all surfaces composite, kind of like a direct onlay is looking a lot more predictable than it was perhaps in the past. And a lot of times we are, we are doing this as our, definitive restoration. So I want to ask you, how do you feel about composites getting bigger and bigger and bigger? And at what point have you drawn the line in the sand that now in 2024, this is the point where you'd be happy with that composite. This is the point where you think, actually, no, I'm not going to even get the compules out here because this tooth needs an indirect. I'm just going to put a core in there or tell the patient it's a core, but really this patient needs an indirect. So essentially what is the boundaries? Where are the boundaries of large composites. [Alan]Good question. It's really relevant, isn't it? Because that's the kind of stuff we see in practice day to day. I always try to be not overly negative, but I will often give patients worst case scenario.