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Crowns, Bridges, and Onlays

Crowns are sometimes referred to as “caps.” They are an artificial replacement for the part of the tooth that is above the gum line. A crown typically covers the entire tooth, replacing most of the enamel. They can be made from metal, gold alloys, porcelain, or other white material. Crowns may be fabricated in a laboratory or on a Computer Assisted Design machine. Once made, they are then cemented or bonded into place.

Teeth that have cracked enamel, broken cusps, extensive decay, or defective fillings need to be crowned most of the time. These situations are more involved than a simple area of decay and can also be more serious, making a replacement filling insufficient or impossible. Cracked enamel can allow mouth fluids and bacteria into a tooth.  Left unrepaired, this can result in a contaminated nerve. Broken cusps or other broken sections can continue to fracture, causing extreme pain and possible nerve damage. Extensive decay usually means that a large part of the tooth structure has been damaged or destroyed making the area to be repaired too large for a simple filling. A defective filling that is broken/fractured or has sections that have shrunk/expanded away from the rest of the tooth leaves it at risk for nerve exposure. A crown replaces the damaged parts of a tooth making it viable again! Doing so adds years to its lifespan. Crowns can also be fitted to make cosmetic improvements in the appearance of teeth.

An onlay is a restoration that replaces the central portion of a tooth along with a partial crown covering damaged cusps. When positioned properly, it is then cemented or bonded into place. An onlay is recommended when a tooth has been extensively damaged, yet still has a bit more natural tooth structure remaining. Onlays provide a more conservative restoration solution in comparison to a full crown.

Crowns and onlays are often required where there has been too much tooth destruction for a “filling” to work. Fillings are not sufficient for repairing cracks, broken cusps, extensive decay, or severely damaged old fillings. To support a filling, there has to be enough of the natural tooth remaining. If not, a crown or onlay is typically the only solution.

Many patients are concerned about possible insurance coverage for crowns and onlays. While insurance may help, most will not cover all the costs for crowns and may stipulate an “alternate benefit” of payment toward a silver filling instead of an onlay. Most plans also have a maximum limit as to the amount of money they will pay for any treatment during a year’s time. It is our responsibility to prescribe what is best for you. The insurance carrier’s responsibility is to control payments. While the suggested cheaper alternative might sound financially enticing, the cost of repairing improper solutions later down the road might potentially end up costing more.

Even if your insurance only covers a portion of the fee, a crown or an onlay may be the best way to restore your damaged tooth.

Call us if you want to know more.  We are always happy to help!