Crown vs filling – when do we do crown and when do we do a filling?
Crown vs filling is a very tough thing to decide. Nearly every dentist has their own criteria and that criteria is highly subjective. The same dentist may not even have the same recommendations from year to year and forget about dentist to dentist. The variability between professionals is enormous. No one really knows who is “right”.
Factors dentists consider when deciding crown vs filling.
There are many factors a dentist must think about when deciding whether or not a tooth needs a crown or a filling. Most evolve around how much tooth structure is left and what the patient habits are.
- How much tooth structure is left.
- Did the tooth have a root canal?
- How much functional abuse the patient is applying to the tooth/teeth.
- Dental history of the patient.
- The decay risk of the patient.
- The condition of the rest of the teeth.
- The financials of the patient.
- Variable patient specific issues.
- Variable dentist specific issues.
Crown v filling – How much tooth structure is left?
Definitely the most important factor in deciding whether or not a tooth needs a crown or a filling will suffice. There is no hard and set rule for this or else crown vs filling would not be a debatable topic.
Did the tooth have a root canal?
Basically back teeth with a root canal should have a crown and front teeth should not. I have another post on this topic as there are some exceptions as to where you need a crown after a root canal.
Functional abuse, decay risk, and patient history factors when deciding crown or filling.
All three of these are patient specific so they vary from person to person. The more functional abuse, grinding and clenching, the more one would lean toward a crown. Cracks and wear facets are good indicators of functional abuse. The more decay, well the more tricky. Do you just do a cheaper filling knowing they will need a crown later or do a crown and hope you limit the area of the tooth that can decay? Are they so bad that you are just buying time so what the cheaper filling? Patient history is basically how well are crowns and fillings holding up in that person.
The above photo shows a tooth with cracks and wear facets. The wear facets are circled in black and the black arrows are pointing to the cracks.
The same tooth as above right before we bond it and take an impression for the dental crown. The arrows point to the crack that was under the metal filling.
The condition of the rest of the teeth and the financials of the patient factors help decide crown or filling.
When thinking about crown v filling, the rest of the mouth may come into play. If only dealing with one tooth then this is not an issue, however, if you have a mouth full of decay the long term plan must be thought about. The long term plan will need to include a discussion about finances. It costs a lot to fix a mouth full of decay and if the person doesn’t change their diet and oral hygiene habits then it can be a waste of money.
Crown or filling on these teeth? To me these teeth require knowledge of the the rest of the mouth. I am more conservative and none are crowns for sure in my eye, but I will use transillumination and patient history to decide when to pull the trigger. I also consider insurance issues, so teeth like this will get done in the end of the insurance year if nothing else was done.
The variable factors of crown v filling include the odd things.
Patients may not like crowns or fillings for some personal reasons. Dentists may not like doing a dental filling in certain areas of the mouth or in certain people as they are too difficult to do well. A large filling on a back upper molar of an obese individual with a gag reflex can be very challenging to do well and the dentist may be better able to provide a crown.
Crown vs filling the website
A website the helps determine crown v filling from the literature is crownorfill.com.
Still in it’s infancy as of 2018, this site really can be the evidence based site to help us decide crown or filling.