Can't you just fill it instead of doing a crown?
Sometimes, and it comes down to how much healthy tooth is left around the hole. You should be shown that on your own photographs before you decide.
A filling patches a hole. Once too much structure is gone, that filling behaves like a wedge every time you bite, and it can split what remains, which usually ends in an extraction.
Fills the gap
Fine while strong walls of natural tooth surround it.
Wraps the tooth
Force travels around the tooth instead of through it.
The physics, briefly
A back tooth has walls, called cusps. Chewing pushes them apart slightly and the surrounding tooth holds them together. Cut a wide hole through the middle and those walls lose their support, so each bite flexes them.
Filling material does not hold them. It sits between them, and under load it pushes outward. That is the wedge.
Fair questions to ask
- How much natural tooth is left around the filling? Ask to see it magnified.
- Has this tooth already been filled more than once, and how large is the old filling?
- Is there a crack line visible, and where does it run?
- What happens if I fill it and it splits later? The honest answer to that last one is often extraction, which is the whole argument.
When a filling really is enough
Small cavity, thick walls of healthy tooth around it, no cracks. Fill it. A crown on that tooth would remove sound structure for nothing, and every crown is a permanent commitment on that tooth.
The recommendation should change with the evidence. If it does not change no matter what the tooth looks like, that is worth noticing.
Written by Dr. Peter Bonifatto, DMD, a general dentist in Las Vegas whose practice focuses on cosmetic and restorative work. General information, not a diagnosis. What your own teeth need is decided at an exam, with x-rays.
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