Dental Crowns Versus Restorative Care, Which is Best?

A tooth damaged by decay, injury or age should be addressed quickly in order to save it, and the question often comes down to crowns versus fillings (or restorative care). Your dentist will seek a long-term solution that preserves as much of the tooth as possible to maintain its stability and function.

A filling is an inexpensive solution if there is still enough tooth left, but if it takes over ¾ of the tooth structure it may not be the best choice for the long term. While a crown is more expensive than a filling, it is far more effective at keeping the remaining tooth intact, often preventing root canal or eventual extraction. If the dentist believes the patient’s tooth could be completely lost following yet another filling, then he/she will likely recommend a crown.

When a filling is appropriate

Restorative care like a filling is a more conservative approach to tooth repair than a crown, and your dentist will typically consider a filling before a more invasive procedure. Because fillings are the conservative option, they are usually recommended for minor cavities. The National Center for Health Statistics estimates that 91% of adults between the ages of 20 and 64 have had at least one cavity, and more than 25% have untreated tooth decay. Most of those cavities are so small that the patient won’t even notice them in the mirror, but even tiny cavities can produce symptoms like pain and sensitivity to sweets or cold. If left untreated, small cavities will continue to decay, which will require more extensive treatment to address.

A filling is quick to place and inexpensive, but it cannot do the work of a crown. A filling can delay the need for one, but a crown will be required if the tooth is further compromised. A filling also has a limited lifespan. On average, a composite filling will last around eight years, depending on the individual’s predisposition to decay and oral hygiene habits. When the filling reaches the end of its usefulness, replacing it may solve the problem if there is enough healthy tooth left to accommodate the restoration.

When a crown is the better option

A crown is the right choice when a tooth is extensively damaged or decayed as in the following examples:

  • If a tooth is cracked;
  • If large tooth portions are fractured off;
  • After a root canal to preserve remaining tooth structure, which now over time becomes more fragile;
  • When a particularly large filling results in additional instability and damage to the tooth over time.

A crown, like a filling, has a finite lifespan, though it can last decades if installed properly and well-maintained. Fortunately, a crown is easy to keep clean, and it offers excellent protection to the underlying natural tooth. Patients often find that a crown performs better than large fillings over the long term.

Fillings

A dental filling restores the integrity and function of the tooth in a minimally invasive fashion, making it a popular and viable option for teeth with minimal damage. This form of restorative care can be delivered directly or indirectly.

A direct restoration uses a malleable material that is applied directly to the tooth and hardened to immediately provide stability and function. A filling can be placed during a single visit to the dentist with little risk of adverse reaction. Direct restoration is typically done with amalgam (a silver and tin alloy) or composite materials. Amalgam fillings are silver in color while composite fillings can be color matched to the tooth and polished following placement, ensuring the best possible look. In recent years not many dentists use amalgam as preparation for this restoration requires more tooth removal.

Indirect restorations are fabricated outside of the tooth prior to placement and may include veneers, inlays and onlays. Indirect restorations are made by either taking an impression of the patient’s mouth or employing computer-aided design to generate a detailed picture of the patient’s teeth. Indirect restorations are usually made from porcelain, gold or a combination of the two, but may also be made of composite or special plastic materials.

Crowns

A crown or “cap” is a more comprehensive approach to tooth repair. The crown encases the entire top surface of the tooth, looking and functioning like a natural tooth. If a gap exists between the crowned tooth and neighboring teeth due to tooth loss, a bridge may be fabricated to fill it.

Before a crown can be positioned, any compromised portions of the existing tooth structure are removed, and sometimes a core or build up is added for support. The remaining portion of the tooth is shaped down to accommodate the cap. The dentist will take an impression or scan of the prepped tooth, and the lab will fabricate the crown from porcelain, metal, zirconia or a combination of materials. The crown is then secured over the tooth with dental cement.

A reputable dentist will always recommend the best long-term option for optimal oral health. Spending the money for a crown now may save more money and discomfort in the future. Talk with your dentist about the right option for you.

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Dorothy Paul, DDS
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