Dental inlays and onlays offer an excellent alternative to “direct” amalgam or composite fillings to restore teeth that have sustained some damage, but not enough to require a full coverage crown. While “direct” fillings such as dental amalgam and composite fillings are placed immediately after the decay or damage is removed and the tooth is prepared, inlays and onlays are known as “indirect” fillings. This means that they are fabricated outside of the mouth prior to final bonding or cementation.
While in the past, many inlays and onlays were caste from gold; today’s dental inlays and onlays are typically custom made of either the highest grade of dental porcelain or composite resins. In addition to providing an exact match to the color of tooth for a cosmetically pleasing result, inlays and onlays have the distinct advantages of being more durable than other fillings, preserving more underlying tooth structure and actually strengthening the tooth so that it can bear up to 50 to 75 percent more chewing forces.
Inlays and onlays only differ from each other in the amount of tooth structure they cover. An inlay is fabricated when the replacement of tooth structure does not require coverage of any cusp tips. If the damage from decay or injury is more extensive and involves more of the tooth’s chewing surface, including one or more cusp tips, an onlay is required.
Both inlays and onlays are fabricated outside of the mouth based upon the exact specifications provided by an impression of the prepared tooth. The final inlay or onlay is then custom made by either a dental laboratory or in-office with a same day system.
Inlays and onlays are precision-made restorations used to repair back teeth that have decay or structural damage but do not require a full crown. An inlay fits within the cusps and grooves of a posterior tooth, while an onlay extends over one or more cusps to rebuild and protect weakened areas. Both are fabricated to match the tooth’s contours and are bonded in place to restore function and form.
Because they are crafted outside the mouth, these restorations can achieve very smooth margins and accurate contacts with neighboring teeth. The conservative nature of inlays and onlays preserves healthy enamel and dentin, which supports long-term tooth vitality. Patients often choose them when they want a durable, tooth-colored alternative to large direct fillings or more invasive full-coverage restorations.
Direct fillings are placed and shaped inside the mouth and are best for small cavities, while inlays and onlays are lab- or mill-fabricated and offer superior anatomical detail and wear resistance. Compared with crowns, inlays and onlays require less removal of healthy tooth structure because they only replace the damaged portion of the tooth. This conservative approach helps maintain tooth strength and can reduce the long-term risk of needing root canal therapy.
In practice, the choice among a filling, an inlay/onlay, or a crown depends on the extent of damage, occlusal forces, and esthetic needs. Inlays and onlays often provide better margins and contacts than large direct restorations and can be a durable compromise when a crown would be unnecessarily aggressive. Your dentist will weigh functional and esthetic outcomes when recommending the optimal option.
Common materials for inlays and onlays include high-strength ceramics or porcelain, composite resin, and metal alloys such as gold. Ceramic and porcelain are favored for posterior teeth when tooth-colored esthetics and stain resistance are important, while gold remains an excellent choice when maximum strength and longevity are priorities. Composite resin can be used in select situations for a more conservative or cost-effective tooth-colored option.
The ideal material depends on the restoration’s location, the patient’s bite, and esthetic goals; ceramics excel at matching natural translucency, whereas metals perform well under heavy occlusal load. Your clinician will recommend a material that balances durability, appearance, and functional demands for each specific tooth. Advances in ceramic technology have improved fracture resistance and wear compatibility with opposing teeth.
Good candidates are patients with moderate decay or fractures that affect a significant portion of a posterior tooth but do not justify full-crown coverage because sufficient tooth structure remains. Inlays and onlays are also appropriate for replacing large failing fillings that have begun to leak or fracture, or when a tooth requires cusp protection without removing healthy enamel. Patients with good oral hygiene and controlled gum disease generally experience the best long-term outcomes.
Patient-specific factors such as bite patterns, bruxism, cavity size, and overall restorative plans influence candidacy for these restorations. Heavy grinders may need occlusal adjustments or a nightguard to protect any indirect restoration, and compromised teeth with extensive structural loss may be better served with crowns. A clinical exam and diagnostic imaging will determine whether an inlay or onlay is the most conservative, durable choice.
Treatment usually begins with removing decay and old restorative material, followed by shaping the tooth to receive the custom restoration and taking an impression or digital scan. If a lab is used, a temporary restoration may be placed while the inlay or onlay is fabricated; if an in-office CAD/CAM system is available, the restoration can sometimes be milled and placed the same day. At the placement visit the dentist will check fit, contacts, and shade, then bond the restoration using a strong resin cement and make final occlusal adjustments.
Local anesthesia is typically used so the procedure is comfortable, and most patients experience only minimal postoperative sensitivity after bonding is complete. Proper bonding reinforces the remaining tooth structure and helps distribute biting forces evenly across the restoration. At Briter Dental we prioritize precise fit and gentle placement to minimize sensitivity and maximize long-term performance.
Yes, many practices offer single-visit solutions using CAD/CAM technology that allows digital scanning, in-office milling, and same-day placement of ceramic restorations. This approach eliminates the need for a temporary restoration and reduces the number of appointments while still delivering a well-fitting, esthetic result. Not all offices use in-office milling, however, and some clinicians prefer laboratory fabrication for complex cases or specific material choices.
Laboratory-made inlays and onlays remain a highly reliable option and may provide additional customization such as layered ceramics or specialized occlusal adjustments. Whether single-visit or lab-fabricated, the goal is the same: a precise, durable restoration tailored to the tooth’s anatomy and the patient’s bite. Your dentist will discuss the best workflow based on clinical needs and available technology.
With proper care and regular dental monitoring, inlays and onlays commonly last a decade or more, and many function successfully for several decades depending on the material and oral environment. Ceramic and gold restorations are known for long-term durability, while composite options may wear faster but can be more easily repaired. The restoration’s location, the patient’s bite forces, and parafunctional habits such as grinding all influence longevity.
Routine dental examinations allow your clinician to check margins, contacts, and occlusion so any issues can be addressed early before failure occurs. Prompt attention to minor defects can often extend the life of a restoration, and maintaining excellent oral hygiene reduces the risk of recurrent decay at the margins. Discuss expected longevity for your specific case with your dentist to set realistic expectations and plan appropriate follow-up care.
Maintaining the restoration begins with excellent daily oral hygiene: brush twice with fluoride toothpaste and floss daily to minimize plaque buildup at the margins. Avoid repeatedly chewing excessively hard or sticky items that can stress the restoration, and do not use your teeth as tools to open packages. If you have a history of clenching or grinding, wearing a custom nightguard can protect indirect restorations from premature wear or fracture.
Keep up with regular dental checkups and professional cleanings so your dentist can monitor the restoration and the supporting tooth structure. Early detection of wear, marginal breakdown, or recurring decay enables conservative repairs rather than full replacement in many cases. By combining good home care with routine professional oversight, you help ensure the restoration performs well for years.
Be alert for changes such as new or persistent sensitivity, a rough or catching feeling at the restoration’s edge, visible gaps or discoloration at the margins, or a change in how your bite feels. These symptoms can indicate microleakage, marginal breakdown, fracture, or wear that requires evaluation. If you notice any of these signs, schedule an examination so the restoration can be assessed clinically and radiographically.
Your dentist may be able to repair minor defects, rebond a dislodged piece, or recommend full replacement depending on the extent of damage and the condition of the underlying tooth. Timely intervention often prevents more extensive treatment and helps preserve natural tooth structure. Regular monitoring during recall visits also helps catch issues before they become symptomatic.
Decision-making begins with a comprehensive clinical exam and diagnostic imaging to evaluate the extent of decay or fracture, the amount of remaining tooth structure, and occlusal forces. The dentist will consider functional needs, esthetic goals, and the overall restorative plan for adjacent teeth to determine whether a conservative indirect restoration is appropriate. When multiple options exist, the clinician will explain the benefits and limitations of each approach and how they relate to the tooth’s long-term prognosis.
Patient preferences and oral health factors—such as bruxism, periodontal status, and hygiene—also influence the recommendation, and the chosen treatment aims to balance durability with tooth conservation. We take a conservative, evidence-based approach to restorative care and tailor recommendations to each patient’s circumstances. If an inlay or onlay is recommended, the plan will include details about the material choice, expected steps, and follow-up to ensure predictable results.