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

If a tooth is destroyed by caries or as a result of injury, it must be restored, otherwise the tooth can be lost, and the absence of even one dental unit in a row is fraught with the most unpleasant consequences for health. For example, due to the absence of a tooth, an incorrect bite may develop, which leads to disruption of the correct process of chewing food and the development of various diseases of the digestive system.

If the tooth is slightly damaged, then most likely the doctor will use a regular, light-curing filling to restore it. But if the damage is significant, it would be more correct to use a stump tab.

Many people do not even know what kind of structure this is - a stump tab and for what purpose it is used by dentists. Meanwhile, the use of stump inlays makes it possible to successfully restore teeth that at first glance seem completely hopeless and must be removed.

In the article we will tell you in detail about what stump inlays are, what types of them exist, and why severely damaged teeth are best restored with inlays, and not with fillings and pins.

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.

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.

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.

What are the quality parameters of dental prosthetics with inlays?

If the technology was violated during the process of fixing the inlay, or the patient has not undergone preventive examinations for years, then secondary caries may occur at the border of the contact of the microprosthesis with the dental tissues. Then it will be necessary to carry out treatment and remove the dental inlay. At the same time, the design itself does not in any way stimulate the occurrence of caries. To avoid it, the main thing is to prevent technological inaccuracies during the installation process, so that the tightness of the dental inlay with filling the cavity with composite cement is equal to 0.004 microns. It is also important to ensure that there are no overhanging edges for a complete aesthetic and functional restoration of the tooth.

If the tab is installed correctly, then it does not provoke an increase in tooth sensitivity, and if not, then the antagonist tooth may begin to react to irritants due to malocclusion.

If pain occurs as a result of complications such as caries, pulpitis or periodontitis, the dental inlay must be opened and appropriate treatment carried out. After which this microprosthesis will need to be replaced with a new one.

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.

Types of restoration dental inlays: description, characteristics

In this section of the article, we will tell you about what restoration dental inlays can be, used in tooth restoration as an alternative to conventional fillings. Prostheses will be classified mainly according to the material of manufacture and according to this criterion, the inlays can be ceramic, composite, or metal. The material of the tooth inlay will affect both the performance characteristics of microprostheses and their cost.

Ceramic tooth inlay and its features

Most often, ceramic dental inlays are used to restore chips on living teeth and act as a high-quality and more reliable alternative to conventional fillings.
Ceramic inlays can only be placed on teeth that are alive, not loose, and have been treated for caries. Ceramic dental inlays have many advantages: they are aesthetically pleasing, durable, do not change their beautiful color even with prolonged use, and do not wear off. The high density of the marginal contact of the ceramic inlay with the natural tissues of the tooth eliminates the risk of developing secondary caries.

But ceramic dental inlays have some disadvantages. Some consider the disadvantages of ceramic inlays for teeth to be the high price of this type of microprosthesis in Moscow (from 8 thousand rubles), however, it should be noted that the high cost is fully justified by the long service life of ceramic inlays and their impeccable aesthetics. Please note that with ceramic inlays installed on your teeth, you will need to give up the habit of chewing nuts, crackers, and other types of too hard foods with your teeth. The ceramic inlay may not withstand such heavy loads!

Metal tooth tab: characteristics, pros, cons

Metal restoration inlays are used quite rarely these days, and all because microprostheses made from this material have a number of disadvantages:

When installing metal inlays in the mouth, a very unpleasant galvanic side effect for the patient may occur, expressed in constant and profuse salivation, a pronounced metallic taste in the mouth;
Installing metal inlays does not allow for high-quality and tight contact between the microprosthesis and the natural tissues of the tooth, and this increases the risk of developing secondary caries. Gold inlays on teeth can provide a good fit, but their price will be high, because gold is a noble and expensive metal;

Metal inserts can cause allergic reactions;
The aesthetics of metal inlays also leaves much to be desired.

The only significant advantage of metal inlays for teeth is the fairly low price for this type of microprosthesis in Moscow. The cost of a metal tab in the capital’s clinics starts at 4,000 rubles for one orthopedic product.

Composite inlays for teeth

Composite inlays are used to restore single-rooted teeth, which include incisors and canines, that is, the front teeth included in the smile area.
Installation of a composite inlay can only be carried out if the tissue in the tooth being restored is preserved in a volume of at least 50%. Composite inlays are also called pin inlays because when they are placed in the tooth canal, a pin is first placed on which the dentist will apply the composite material in layers. If the tooth is severely damaged, installing an inlay on a pin is not recommended, since over time the pin may begin to wobble in the tooth canal and its mobility can lead to a fracture of the tooth root. If your tooth is more than half destroyed, you do not need a restoration, but a stump inlay followed by installation of a crown!

How much will a composite tooth inlay cost? The answer to this question will depend on what type of post and composite material the dentist uses during the restoration process.

The price of a restoration insert will also depend on the method of its manufacture. All inlays, except composite ones, are created in the laboratory using dental impressions. The tooth for the inlay must be ground down, although the volume of tissue removed will be less than the amount of dental tissue that is removed for the crown. The most complex manufacturing technology is for ceramic crowns, which are made from pressed ceramics: they are created using CAD/CAM computer technology. The complexity of the technology increases the price of ceramic inlays, but such microprostheses will have high anatomical accuracy, which means they will last longer.

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.

Crown inlays: contraindications

We have already said that the indications for using inlays for crowns are the complete destruction of the tooth crown, or if only thin walls remain of the crown. However, there are also contraindications to their use -

the root of the tooth should not be destroyed below the gum level,
root canals must be properly sealed,
there must be no inflammatory processes at the roots of the teeth,
allergy to the materials of the tab (allergy to metal is rare),
cannot be installed on mobile teeth.

Important: if your root is destroyed just below the level of the gum (by 1-2 mm), then in some cases it will still be possible to make a stump inlay on it. To do this, the gums around the root of the tooth are peeled off and the bone tissue is cut down with a bur (an osteotomy is performed). Such a height of bone tissue is removed so that the gum mucosa is just below the level of root destruction. Osteotomy is performed by a dental surgeon and is quite inexpensive.

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.

Cost of prosthetics in Moscow and other cities

How much does a zirconium inlay cost? Its price is 18-20 thousand rubles. Moreover, prices in the capital and other cities are approximately equivalent, because the basis is the cost of the material (which is purchased from the same manufacturers or suppliers).

1Zinovenko O.G., Shinkevich M.V., Sadovskaya I.V. Aesthetic prosthetics using zirconium dioxide, 2014.

Author: Sambuev B. S. (Thank you for your help in writing the article and the information provided)

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.

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.

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.

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.

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!

What is known about the shortcomings

According to reviews from some patients, a zirconium inlay (restorative or stump) has only one drawback - its high cost. Another disadvantage is the time spent on prosthetics - it takes about 2 weeks to complete the treatment. Although, for example, CEREC technology allows you to make a restorative microprosthesis in 15-20 minutes - and it will be installed on the day you go to the clinic. However, such equipment is not available everywhere.

Read on the topic: what is CEREC technology - when does the dentist and patient need it, its pros and cons.

Another disadvantage is the pure white color of zirconium dioxide (several shades lighter than natural enamel) and its opacity. But dental technicians solve this problem by applying liquid ceramic, colored in the shade of enamel, to the upper part of the zirconium restorative microprosthesis. Or you can use alternative prosthetic options (more on them below).

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

Tab lifespan

The service life of restoration inlays will depend on the material and production technology of microprostheses, as well as on how accurately the patient follows the dentist’s recommendations. Composite inlays last about 5-7 years, ceramic inlays - up to 20 years. This is subject to high-quality dental and oral hygiene and regular visits to the clinic for preventive examinations.

Stump inlays can last you a lifetime, and crowns on them last up to 15-20 years.

Do you still have questions about restorative and core dental inlays? Ask them to the orthopedists of our dentistry in Moscow - Vanstom! You can make an appointment with the clinic’s doctors at any time convenient for you - through the chat on our website, the call back form, or simply by dialing the contact phone number!

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