Last week, we got Dr. Kivel to sit down and give us his thoughts on a common dental question, "Should I get a crown or an onlay?". Here, he explains the differences and what factors may influence your decision. Take it away, Dr. Kivel!

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So you've got a tooth with a fracture or decay that requires something larger and stronger than a filling.  Maybe the term “crown” sounds familiar or is something you’ve had performed in the past.  But now you are being given the choice of doing a partial crown or what is often called an onlay.  How do you decide?

In the past, when a patient had a big structural problem with a tooth it meant that the dentist was likely going to shape the tooth to resemble an upside down paper cup to then glue on a strong restoration that would replace the shaved down “crown” of the tooth.  This unfortunate sacrifice of healthy tooth structure was required to give the “crown” something to hold onto.  The crown also tended to go all the way to the gumline, often causing irritation and sometimes resulting in recession.  Lastly, by shaving the tooth down, there was always the risk of aggravating the nerve inside of the tooth, maybe even causing a root canal.  A crown is still an excellent choice, and maybe the only choice in circumstances where most or all of the tooth needs to be replaced.

Modern materials and adhesives have given us dentists the ability to focus on replacing just the part of the tooth that is experiencing a problem with a partial crown, often termed an onlay.  In other words, we don’t have to shape a tooth into a little nub to put a large crown over it.  Instead, a replacement piece is fabricated out of an ultra strong material and is then “bonded” to the tooth.  It is a fairly technical procedure, but with experience, great isolation technique (no saliva!) and preferably with same-day CAD/CAM capabilities (using a computer to make crowns in the dentist's own office), it is a common approach and good alternative to a conventional crown.  The uncommon, but possible, drawback is that a partial crown may be more vulnerable to fracture or breaking off.  But with all the healthy tooth structure of the tooth saved, it merely needs to be replaced.

Crowns and partial crowns cost the same in most offices.  They are also usually made of the same material, the most popular being the tooth colored and incredibly strong “emax”.

Choosing between a crown and onlay can come down to answering the following question.  

What is more important to you:

1.  having a restoration that has a stronger likelihood of lasting longer (crown), or

2.  having a restoration that is as minimally invasive, tooth-conserving as possible (partial crown/onlay)?

When asked what I would do if I were faced with the choice of a partial crown/onlay or full coverage crown, I would choose a partial crown/onlay every time.

I hope this blog helped you decide between a crown and an partial crown/onlay.  If you have any questions, please reach out to us or stop in!  

Thanks for your interest,
Aron
 

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