The Inlay / Onlay Notes Template UK Dentists Use
An inlay/onlay notes template captures the indirect intracoronal/cuspal restoration — clinical rationale for indirect over direct restoration, vitality, crack/fracture assessment, Montgomery consent, preparation with cusp coverage rationale, impression/scan, temporary, lab prescription, and cementation — meeting CGDent, NHSBSA inlay/onlay guidance, and MDR 2017 standards.
NHSBSA audits flag inlays and onlays without a documented clinical rationale for choosing indirect over direct — and so do indemnity reviews. Below is the template UK dentists paste into their PMS to make the rationale defensible from the start.
Download the free Inlay / Onlay template — plain text, GDC/FGDP(UK)-aligned.
Why this inlay / onlay template wins
- Indirect vs direct rationale on its own line — NHSBSA-defensible for NHS cases, audit-defensible for private.
- Crack assessment with transillumination/wedge test — captures cracked tooth syndrome risk that drives the cusp-coverage decision.
- Cusp coverage map — which cusps and why — defends against later disputes about whether coverage was needed.
- Non-eugenol temporary cement when resin definitive planned — prevents bond failure at cementation.
- Pre-op photographs — cracked tooth syndrome cases need baseline visual evidence.
Compliance: the medico-legal angle
- CGDent Clinical Examination & Record-Keeping (3rd ed) — operative records and rationale for treatment choice.
- NHSBSA Inlay and Onlay Guidance (July 2019) — for NHS cases, the clinical indication for an indirect restoration must be documented.
- MDR 2017 — custom ceramic restorations are custom-made medical devices; statement of conformity required.
- Montgomery — cracked tooth syndrome carries a real risk of failure; this must be discussed and documented in consent.
Common mistakes UK dentists make
- No rationale for indirect over direct — flags NHSBSA audit for NHS cases.
- No crack assessment documented — leaves the cracked-tooth-syndrome risk undefendable.
- Cusp coverage decision not justified per cusp — disputes about overtreatment.
- Eugenol-containing temp cement when resin definitive planned — debonding failure at fit.
- No pre-op photographs of cracked tooth — baseline evidence missing for any later complication.
Frequently asked questions
When should I choose an onlay over a crown?
When tooth structure can be conserved. Onlay covers only the cusps that need protection (cracked, weakened) while preserving sound axial walls. Crown sacrifices sound tooth structure circumferentially. For a tooth with one or two compromised cusps and otherwise sound axial walls, onlay is the more conservative choice — better long-term tooth survival.
How do I assess if a cusp needs coverage?
Three tests: (1) Transillumination — visible crack lines; (2) Wedge / Tooth Slooth test — positive on release indicates cracked tooth syndrome; (3) Cusp thickness assessment — if remaining cusp <2mm at base after caries removal, cover it. Document which test(s) and result.
Ceramic, gold, or composite for an inlay/onlay?
Ceramic (e.max, leucite): aesthetic, ~10-15yr survival, requires resin cementation. Gold: 20+yr survival, less aesthetic, lower cost, easier to adjust. Composite: cheaper, ~5-7yr survival, less wear-resistant. Patient preference, occlusal load, aesthetic demand all factor. Document the choice and rationale.
What's the difference between an inlay and an onlay?
Inlay — intracoronal restoration, no cusp coverage. Used for moderately wide cavities with sound cusps. Onlay — extends over one or more cusps for protection. Used for cracked or weakened cusps. The distinction matters for NHSBSA classification and for the prep design.
Why do NHS audits flag inlays?
NHSBSA Inlay/Onlay Guidance (2019) — under NHS contracts, indirect restorations should not be used where a direct composite would be equally effective. The audit looks for documented clinical rationale showing why indirect was clinically necessary. "Wide cavity, cracked cusp, cusp coverage required" is defensible; absent rationale flags the case for review.
How do I temporarily restore an onlay prep?
Same as crown — bis-acryl (Protemp, Luxatemp) or preformed shell. Use non-eugenol cement if resin cement is planned for the definitive. Check occlusion — temporary should NOT contact in heavy excursions or it'll fracture.