This is one of the most asked questions I get at the chair. So here’s a summary answer.
Crowns. People usually call crowns “caps”. Think of a crown as a kind of perfectly formed tooth-shaped thimble that fits over the whole tooth and covers it completely. It’s the strongest restoration we have, and it can repair teeth when nothing else will work. It can be gold, porcelain, plastic, or any combination. It can be made to look, feel, and function naturally. It can be attached to other restorations to form bridges and stabilizing splints. We need to shape your tooth to fit under the crown.
Inlays (and onlays). Think of inlays as very strong fillings for teeth that are too badly damaged for an ordinary filling but not so badly damaged so they need a crown. Inlays are made outside the mouth on an exact replica of your tooth and then placed into your tooth and bonded there. Inlays come in two basic forms: inlays and onlays. Inlays fit completely into a prepared tooth, while onlays fit into the tooth but roll over the top and cover one or more cusps to protect them from fracture. A big advantage of inlays and onlays is that they can be fashioned with near perfect form, because they are made outside the mouth. And because of the way they are made, they are very resistant to breakage. They are the best way to restore form and function to any tooth while preserving as much natural tooth structure as possible.
Inlays and onlays can be gold, porcelain, or composite resin.
Since they are made in the laboratory on a model of your teeth made from impressions, like crowns they need two visits to complete.
Composite resin onlays can sometimes be made right in the natural tooth instead of on a model. This restoration, which we call an “direct resin onlay”, is a one visit procedure, and is becoming more and more popular as the resin manufacturers give us increasingly great resin materials. I am liking doing these more and more. They save you some time and they save you some money.
Fillings. This is what dentists usually are talking about when they mean a restoration fashioned right in your tooth using soft materials that harden in the tooth, while you sit with your mouth open. In our office they are made of composite resin (hardened by the high-intensity blue light you’ve seen us use so often). We do not use silver amalgam for fillings. We gave amalgam up in 1982 (yup, 1982).
Fillings are one-visit procedures, and are an excellent choice for small to moderate repairs to teeth that are still strong. Modern composite resins are amazingly good materials, and getting better and better all the time. If the damage to your tooth is too extensive for a good resin filling, the tooth should be restored with an inlay, onlay, or crown.
The choice of restorative technique depends on many factors, and is made with you at the time. As one patient said while we were making this choice with him, “You got to fit the punishment to the crime.”
Not the way I would have said it, but it does express the idea pretty well.
Send me e-mail at DrSteveRoss@aol.com if you have a question and you want a personal answer.
