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composit filling with crown vs Inlay

I did my posterior tooth coomposite filling three years back and it is fractured because of angular tooth shape. I have two options

1) new composite filling with crown 2) INlay
Poster
  • Complaint duration: 10 days
  • Medications: no
  • Conditions: no
November 30, 07:05 PM

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Featured Answer

2 UpVoted this answer Scott Bobbitt, DMD Dentist, Nashua Cvetan Mechev, DDS Dentist, La Mesa
As as a endodontist, I tend to see all of the restorations that don't work. This is a broad generalization: In posterior teeth, there is a greater opportunity for tooth fracture with an inlay restoration as opposed to getting an only or a full crown that covers the cusps of the tooth. This is especially true for lower second molars and upper first bucuspids. These teeth have grooves that are susceptible to fracture.

Teeth should for tested cracks of significance before anesthetic is used. Biting on a plastic stick may suggest a crack that requires cuspal coverage, if it hurts on release of biting. Transillumination with a fiberoptic light reveals the presence of larger cracks in teeth.
Peter Cancellier
Peter Cancellier, DDS
Endodontist in Irvine, CA
Level: Contributor (5)
Website: http://www.endodonticsofoc.com
December 01, 09:21 AM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
i do not see a photo or xray so I cannot comment
Abraham M. Speiser
Abraham M. Speiser, DDS
Dentist in Newark, NJ
Level: Master Contributor (54)
Website: 60 Park Place Dental Group
December 01, 05:20 PM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
These are two options to restore your tooth, a buildup (composite filling) and crown or an onlay (not an inlay). It would be hard for me to recommend anything without a visual exam and x-rays of this tooth. I do not recommend an inlay as your tooth can fracture again. An onlay covers the cusps to help prevent fracture, and a crown covers the whole tooth.
James W. Kearney
James W. Kearney, DDS
Dentist in Colorado Springs, CO
Level: Master Contributor (63)
Website: http://www.austinbluffsdental.com
December 01, 05:13 PM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
On your verbal description alone, it is impossible to make a recommendation. Broad generalization: if the composite filling failed to support the tooth, an inlay won't either as it is simply a solid material (porcelain or composite) that is bonded ("glued") with composite cement. Best options: (1) replace the composite filling if the size is <50% of the volume of the crown of the tooth; (2) place a crown if the filling size is >50% of the volume.

Definitely need an x-ray and photograph to make the decision viable for you. You also need to know the reason(s) for the fracture. Cause for fracture (Is the filling fractured? The tooth fractured? Both?) is indeterminable--but could be from excessive bite forces on the filling--from day one of the filling, especially if it is on the side (in-between) the teeth, or from subsequent changes to the bite relationship. I often will simply replace a filling if that is the case.

Could be from clenching/grinding--do you wear a night guard to protect your teeth while sleeping? Need to consider night time AND day time habits (ice-chewing/popcorn/etc.).

Good luck.
Scott Bobbitt
Scott Bobbitt, DMD
Dentist in Nashua, NH
Level: Candidate (1)
December 01, 04:59 PM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
This kind of situation will have to be treated depending on whether there is enough tooth structure left, occlusal factors, etc. This has to be evaluated by a dentist and the options should be presented to you. crown will cover the whole coronal portion of the tooth and will protect it but more tooth reduction is necessary for that, Inlay is like a filling only its lab made and cemented , onlay is another alternative and may be a great solution as well.
Alexander S. Litvinov
Alexander S. Litvinov, DDS
Dentist in Cherry Hill, NJ
Level: Top Contributor (39)
Website: Restorative Dental Arts
December 01, 04:58 PM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
I would lean towards a crown based on the information given. Without an xray, it's hard to tell for sure.
Jay B. Wettstein
Jay B. Wettstein, DMD
Dentist in Ontario, OR
Level: Contributor (21)
Website: Jay B. Wettstein Dentistry
December 01, 04:02 PM
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1 UpVoted this answer Cvetan Mechev, DDS Dentist, La Mesa
Your dentist can explain which option will work best for you given the amount of good sound tooth structure that remains. Sometimes the doctor doesn't know whether the crown or onlay will be the restoration of choice until all of the decay and undermined tooth structure is removed; so it becomes a "game time" decision. But do discuss the pros and cons of each restoration with your dentist.
Barbara R. Webster
Barbara R. Webster, DDS
Dentist in Downers Grove, IL
Level: Top Contributor (26)
Website: Barbara R. Webster, DDS
December 01, 03:41 PM
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1 UpVoted this answer Robert G. Csillag, DMD Dentist, Newton Centre
The treatment you should receive now will depend on the remaining tooth structure. Since composite had previously failed, I would be inclined to try a different material and procedure.
J Abe Smith
J Abe Smith, DDS, MPH, FICOI
Oral Medicine Specialist in San Juan, Trinidad, ON
Level: Contributor (13)
December 01, 10:14 AM
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Crown

Will give best support from future fracture.

50% of tooth should be intact for restoration with hybrid microfil.
Daniel G. Sena
Daniel G. Sena, DDS
Dentist in Dallas, TX
Level: Top Contributor (34)
March 15, 01:39 PM
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A properly placed biomimetic filling is the most conservative way to restore a tooth. When a tooth has had a fracture or has a thin wall the biomimetic design prevents further fracture and avoid root canal.

To find a biomimetic dentist go to http://www.findabiomimeticdentist.com/

For more information check out - http://www.academyofbiomimeticdent.org/
Jacques Doueck
Jacques Doueck, DDS
Dentist in Brooklyn, NY
Level: Contributor (8)
Website: Doueck Dental
February 10, 11:19 PM