Fillings vs. inlays and onlays vs. crowns: which repair does my tooth need?
It mostly depends on how much tooth is left. A small cavity can be fixed with a filling. A larger one may call for an inlay or an onlay made by a lab. When a big piece of the tooth is gone, a crown is usually suggested. Pearl Dental Care does all of these.
When is a filling enough?
If the cavity is small, a filling is usually the answer. Our most common restoration is composite bonding, a tooth-colored material that is shaped in the mouth and hardened with a special light. It looks and feels much like your natural tooth.
Because the composite is bonded to the tooth, it helps strengthen the tooth. A packed material like amalgam expands over time and can create fractures that let bacteria leak in, which is one reason we have moved away from it.
What is a porcelain inlay or onlay?
When a tooth needs a larger repair, or a larger piece of a cusp is missing, we may suggest an inlay or, more commonly, a porcelain onlay. You can think of these as conservative crowns. There is less drilling than for a crown, and more of the original tooth is preserved.
An onlay is made indirectly. That means it is a custom designed piece of porcelain, crafted to fit into your tooth and replace the missing natural tooth structure, then cemented or bonded in place. A filling, by contrast, is packed directly into the cavity and molded there.
The porcelain is strong and tooth-colored, so it blends with the natural tooth. Because of how it is designed and bonded, it restores much of your natural tooth strength. In the past these were made from gold and then composite. Today the more attractive and durable choice tends to be porcelain.
Why does saving tooth structure matter?
Every time a restoration is done, it takes a little more of the tooth with it. By doing onlays, we can keep the cusps and the internal strength of the tooth, so it stands up to chewing forces better. The fee for an onlay is closer to that of a crown, while the tooth reduction is much more conservative.
When is a crown the better choice?
When a larger portion of the tooth is missing, a crown is usually the suggestion. A crown covers the whole tooth. It is also a common option after a tooth fractures, chips, or has root canal treatment and needs its strength rebuilt.
Crowns can be made in gold, porcelain, or porcelain fused to gold. Many patients choose the newer all zirconium crowns, which can have the strength of metal with the look of porcelain.
How long will an onlay last?
Assuming normal wear and tear similar to natural teeth, onlays can last many years. Good home care, regular maintenance and a low sugar diet help them last longer still. Stronger materials and better bonding cements are part of why the potential life span is longer than it used to be.
How is the restoration made?
For an onlay or a crown, we scan the tooth with our Dandy scanner and send the scan straight to the lab. No putty, no waiting for it to set in your mouth. The scan gives the lab a more accurate model, which means a better fitting restoration. Crown work is done in two visits, with an acrylic temporary in place for one to two weeks.
To ask a question or book a visit, call Pearl Dental Care at (630) 810-9940 or visit us at 331 W 63rd St, Westmont, IL 60559.
This guide is educational only. Your dentist will tailor any plan at your visit.
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