CDEN0109

24 I I opinion _ inlays & onlays difficult to achieve quality contacts in large restora- tionswithpoortoothalignmentorspacing. Nomatterhowgoodthedirectresinmaterialsget, theabovesituationswillusuallybebetterservedbyin- direct restorations in the same way that gold inlays/onlays are considered superior to large amal- gams,especiallythosethatreplacecusps. Reason No. 6: Many third-party payment plans don’tpaybenefitsforaestheticinlaysandonlays,but most pay a benefit toward porcelain-fused-to-metal crowns. In a health care profession, it shouldn’t be neces- sary to even respond to such a statement, but I will. If a properly informed patient would rather sacrifice healthy tooth structure to save a few dollars or for a perceived greater longevity, well, that’s his or her choice.Itmaybewhatthatpatientfeelsisbestforhim- self or herself at that time. The operative words, how- ever, are ‘properly informed’ (pros vs. cons) and ‘his or herchoice.’Weshouldn’tmakethechoiceforapatient based on an assumption that all patients want the cheapest option or what their insurance will partially payfor. In conclusion, for many dental practices, offering only low-cost (at least initially), large fillings or expe- dientcrownswheretheymaynotbethebestourpro- fessionhastooffer,isquestionableandshort-sighted. The bottom line in dentistry today, as it always has been,istorecommendtreatment,whichaccordingto theclinician’sprofessionaljudgment,isinthepatients’ best interest. This is usually what the clinician would select if he or she were the patient. The patients may notalwayswantthatparticularserviceanddeclineto haveitdone,buttheyalwaysdeservethechoice. The trend in dentistry is clearly toward more aes- thetic and less invasive. Indirect resin and ceramic in- laysandonlaysarenotonlycompatiblewiththistrend, but fulfil very nicely the restorative void between fill- ingsandcrowns._ Editorialnote: Acompletelistofreferencesisavail- ablefromthepublisher. Fig. 7_Molars with failing restora- tions and recurrent decay. Fig. 8_Both distal cusps of the first molar were onlayed due to a horizon- tal crack in the middle of the pulpal floor that stopped halfway across. The distal buccal cusp of the second molar was onlayed due to a crack on the pulpal floor at the base of the cusp. Fig. 9_This 44-year-old patient was pleased that crowns could be avoided and no sound healthy tooth structure was unnecessarily removed. Fig. 10_Indirect resin composite onlays at four years. Note contacts and marginal integrity at gingival margins as seen on the radiograph. cosmeticdentistry 1_2009 Dr Ron Jackson has published many articles on aesthetic and adhesive dentistry and has lectured extensively across the United States and abroad.He has presented at all the major US scientific conferences. Dr Jackson is a fellow in the American Academy of Cosmetic Dentistry, a fellow in the Academy of General Dentistry and is director of the AdvancedAdhesiveAesthetic Dentistry andAnterior Direct Resin programmes at the Las Vegas Institute for Advanced Dental Studies. He maintains a private practice in Middle- burg,VA,USA,emphasising on comprehensive restorative and cosmetic dentistry. cosmeticdentistry _author info Fig. 7 Fig. 8 Fig. 9 Fig. 10