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Director of Clinical Content
@DoctorBase

Teeth #4, and 5

I am recieving several opinions on what do with these teeth.

1. composite

2. inlay

3. onlay

4. crown.

Money is no issue and I want the strongest restoration.

I'm hearing that composites can be converted into crowns later.

Inlays are a good option as well but are only good as the supporting remaining tooth structure around it.

My dentist stated Note about #4/5: You wi

my dentist found a cavity on the side of tooth #4, would this change the treatment to include a crown rather than a composite?
Poster
  • Male | 36 years old

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Featured Answer

1 UpVoted this answer
At some point you need to trust the dentist you plan on seeing for treatment. All the above treatment options may work just fine for you, however, there really is no substitute for a chairside examination. There are several considerations for each, not even considering cost, that your dentist will review with you. Bottom line, the best person to ask for a recommendation is your dentist.
The strongest restoration would be one of the new generation all ceramic crowns, however for your teeth I think that would be overkill. In my opinion, get those amalgams out, as it appears that they are leaking and get a good base in there to seal the dentin, then I would recommend ceramic onlays for those teeth. A good choice of materials would be e.Max. Make sure that they are bonded with a resin cement such as Unicem, Variolink, or Panavia. Hope that helps!
Louis B. Sachs
Looking at the x-rays, I see two teeth with very large amalgam fillings in them. Typically I would recommend full coverage porcelain crowns as the ideal restoration of choice. To often an inlay or a filling of that size in a bicuspid tooth can cause a tooth fracture which will result in extraction of the tooth. Therefore, a full coverage crown on both of those teeth is what I would recommend.
James P. Tasto
I believe that ceramic onlays or crowns will be the best option to restore these teeth from a strength and aesthetic standpoint, depending what on the physical examination of these teeth reveals, including x-rays. E-Max ceramic would be the material of choice due to aesthetic concerns, if crowns or onlays are needed. Type II or IV gold restorations would be the absolute strongest but it would not look good in your smile.
Without an xray to see how much decay I would do either a inlay or onlay do not do a full crown
Norman Graulich
Dear Sir: Good Day. I evaluating your clinical photo; is the decay on tooth #4 recurrent under your amalgam or silver filling? The determination can not be accurately treatment planned with this photo and other documentation. Your doctor in recommending a treatment for you is based upon your overall health, periodontal tissue(gum) health, your occlusion(bite) and your oral hygiene. In general; a more conservative restorative treatment is the best; that is saving as much natural tooth structure. The comments below by my collegues are all terrific answers. Research has shown that an amalgam or silver filling will last longer than a composite filling. A gold crown which is not very esthetic will last longer than a porcelain crown.
Donovan Young
If you are concerned about aesthetics as well as strength, I would have porcelain crowns placed over these teeth.
Be conservative,, save tooth structure and do porcelain inlays, emax ceramic.
Composites are a great solution to restoring conservative and small sized cavties. If the cavity is wider than two-thirds the width of the tooth, the recommendation would be a crown or inlay, based on the depth of the cavity and proximity to the nerve of that tooth. For example, if tooth #4 in the above picture has a very deep cavity close to the nerve (pulp) of the tooth it would be a better idea to go with a crown in case the tooth ends up needing a root canal down the road. If you were to go with an inlay right now and the tooth ends up needing a root canal down the road in a few months or years, the inlay will have to be replaced with a crown for better support of the tooth and the patient will end up incurring the cost of paying for both inlay and a crown.
Prathima Chawla
All good responses. That's the reality of dentistry. There is often more than one good solution. If mesial of 4 has decay, a crown or at least on onlay which covers the palatal cusp, might be best option. It is not unusual to find decay forming next to an amalgam so I would not be surprised if there was a cavity there. 5 might be OK with a "direct" composite, but hard to say w/o x-ray . Even with x-ray, sometimes you have to see what you have after filling and decay are removed and then make the call. If 4 does not have mesial decay and not a great deal of decay, direct composite, done correctly, should be fine. The second premolar (4), also handles more chewing function and forces than first premolar, so I tend to lean more towards indirect (crown, onlay) for second premolars. Also, first premolar is very much in the esthetic zone, so try to stay away from restoration that will cover buccal cusp as it may not match in the present or over time.