When a tooth becomes damaged, a dentist will sometimes recommend restoring it with a cap, also called a dental crown. Caps are oftentimes expensive, and for a dentist to place one, they have to remove much of the tooth’s material. Fortunately, other treatment options are sometimes available that either cost less or require less drilling.
Onlays and ¾ Crowns
Dentists can sometimes use onlays and ¾ crowns to reinforce teeth instead of a cap. Onlays and ¾ crowns are similar to caps in that they cover the tooth, but they do so to a lesser extent than a cap. Think of them as hats. If a cap were a winter facemask, a ¾ crown would be an ushanka (a hat with ear flaps), a complete onlay would be a knit-stocking hat, and a partial onlay would be a kippah (a small, traditional Jewish hat).
A ¾ crown covers the top of a tooth and three of the tooth’s sides, with the side of the tooth that isn’t covered usually being the side that’s visible. Onlays only cover the top of a tooth and one or more of a tooth's cusps (as opposed to an inlay, which does not cover any of a tooth’s cusps). If it covers the entire surface of the tooth, it’s called a complete onlay. If it only covers only some of the cusps, it’s called a partial onlay.
The advantage of onlays and ¾ crowns is that the dentist has to remove less of the tooth’s structure when placing them. This reduces the chances that complications occur while the tooth is trimmed. And, for onlays, it’s easier for patients to maintain the health of their gums, as caps sometimes make it difficult to remove plaque at the tooth’s base.
The primary disadvantage to these options is that it’s generally easier for a dentist to make sure the prosthetic (the cap, ¾ crown, or only) remains in place if it covers the whole tooth. Generally, the greater the degree to which a restoration covers the tooth, the easier it is for a dentist to make sure it doesn’t come loose. However, because dental cements are have been getting better year-over-year, it’s continually less of a concern that this will happen.
Depending on a number of factors, your dentist might be able to place a veneer instead of a cap. Veneers cover only the front of teeth, and they’re usually used for cosmetic purposes. The advantage to placing a veneer instead of a cap is that less tooth material needs trimmed, especially if a minimal-prep veneer is placed instead of a traditional porcelain veneer.
Your dentist will have to decide whether a veneer is right for your tooth or not, however. Depending on the extent of the damage, a veneer may not provide the right kind of support or protection your tooth needs. If you’re considering caps for cosmetic purposes, however, veneers provide a less invasive way to boost the appearance of your smile.
If your tooth has received enough damage that your dentist suggests a cap, opting for a filling isn’t the way to go, though it is an alternative.
Caps are better than fillings for large cavities and other damage because fillings don’t offer the same level of protection as caps. Fillings are more prone to fracture, break, and fall out than caps. They also do not function as well as caps, which replace a tooth’s function completely.
Sometimes if a tooth has been severely compromised due to a fracture or decay, a dentist might place a “dental core” — a filling — to build up the tooth before placing a crown. Such a solution is only temporary, however, and not meant for long-term use.
The advantage to getting a filling instead of a cap is that it costs less, and it takes less time to receive. But, while some people never have trouble with their fillings, the cost and time advantages quickly disappear if the filling breaks, cracks the tooth, or falls out.
A tooth extraction is the cheapest and simplest alternative to getting a cap. But they can cause problems, which eventually you’ll have to pay to fix. When a tooth is extracted, the surrounding teeth shift. Shifted teeth can impact a person’s ability to chew, and they can hit each other, which puts them at risk of fracturing. They might become difficult to clean, as well.
If you must get a tooth extracted, we highly recommend opting for a dental implant. Implants not only keep teeth aligned, but they maintain the function of the tooth, and they help preserve the health of the jaw bone.