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when the area of decay includes the cusps of the tooth and it is too large for a filling but not large enough for a crown then an onlay is used firstly the tooth decay is removed and then a dental tray is used to create a mold and impression of the new tooth structure which is then sent to the dental laboratory where a cast is made and the onlay is fabricated to match it using dental amalgam when the onlay returns from the laboratory the dentist cements it into place