See what the National Experts have to say…
A Dental Crown is a (nearly) 200 year old technology that carries with it benefits, of course. However, the problems associated with Crowns are numerous and worthy of discussion, especially since a much newer, better and less invasive technology (called a BONDED ONLAY) is available today.
Briefly … A Dental Crown involves the removal with a drill of ALL of a tooth’s enamel — all the way down to the gumline. Then, an impression of the cut tooth is made. Later … a Crown (or “Cap”) is glued/cemented to the tooth.
Problems with Dental Crowns are…
- Crowns involve more tooth removal — causing more internal tooth trauma which can lead to a future root canal problem.
- Crowns involve cutting into the tooth aggressively near the “neck” of the tooth which is closer to the interior Root Canal System … thus, more trauma is imparted to the NERVE of the tooth. Again, the result is a higher likelihood of necessitating a Root Canal in the future.
- A Crown’s Margin (perimeter) is right at the gum-line. This is a natural food collection zone (almost like a gutter). When food sits right next to the margin of a Crown it is much more likely that the Crown will DECAY at this margin — likely, then, the Crown will need to be re-made. This, of course, leads to more tooth reduction, more trauma, etc. which promotes even more dentistry and costs (root canals).
- Because a Crown’s margin is at the “neck” of the tooth it actually can WEAKEN the tooth. This is especially disconcerting considering that a Crown is ostensibly being placed to strengthen the tooth.
- A Crown typically (not always) will have a metal understructure to it to give it strength. This metal will usually show up as a “black line” right at the gum line where it results in very unpleasing cosmetics. Many patients become frustrated with this “black line” showing at the gum-line because they do all they can do to keep the area clean and it still looks “dirty”.
Briefly … A Dental Onlay involves only the removal of weak or affected tooth structure, leaving the healthy and strong part of the tooth un-touched. An impression of the prepared tooth is then made. Later (maybe even same-day?) a Protective Onlay is Bonded to the Tooth. This “Bonded” Onlay very closely re-creates and resembles a healthy, natural tooth.
Why Onlays are better…
- Less Trauma to the Nerve inside the tooth (less chance of a Root Canal being needed on this tooth)
- Less chance of recurrent decay at the edge of the restoration (called the margin) … since the margin of an Onlay is in a higher, more cleansable area and the margin of a crown is at the gum line. This leads to longer lasting and healthier restoration. Crown margins at or below the gum line may often incite gum inflammation, or worse, more severe forms of Gum Disease.
- Due to the above 2 considerations… a Crown is more likely to have to be re-made than a properly performed Onlay
- YET…. If another restoration is ever needed, there is more tooth structure to still work with under an Onlay as opposed to under a Crown.
- Onlay is a better looking restoration than a Porcelain fused to Metal Crown — No Black line showing at the gum line. Many times with an Onlay we don’t have to cut down the visible side of the tooth and, thus, the Onlay blends in with a nearly “chameleon” type effect. A typical Crown often looks too opaque and fake.
It’s not over for Crowns quite yet, however, the fat lady is clearing her throat. Crowns are still the restoration of choice in these instances..
- When a Full Crown already exists and it must be replaced
- When a tooth is so badly broken down or bothersome that an Onlay will not work. This is really quite a rare occurrence.
National Experts have, for many years, been guiding/teaching Dentists to place more conservative, minimally-invasive Onlays instead of Crowns!
So then … Why are dentists still doing crowns?
Habits…Older dentists prefer crowns since they know them best. They are very comfortable practicing their usual ‘drill-em and fill-em’ or (better yet), ‘crown-em’ dentistry.
Less experienced types have learned a similar conventional, yet older, mind-set from well-aged dental school instructors who, likely, are light-years away from state-of –the-art dentistry circa 2010.
Degree of Difficulty… Onlays are technically more demanding and difficult to perform than Crowns. They are harder for the operator to prepare and much more difficult to bond in to place. Therefore, there is a steep learning curve required.
Onlay treatment performed with lesser skills leads to colossal frustration for all involved.
Further, the lab work is much more challenging. Only higher-quality labs will even offer Onlays since they are so much more difficult to make.
Expense… Due to their technical demands, Onlays are more expensive (for the DDS) to perform, especially when they are just starting to learn how to place them. However, for an experienced provider of Onlays the difference is insignificant.
Further, the Lab Fees, as described above, are higher for Onlays. Therefore, it makes sense for an operator to provide the better treatment of Onlays for patients only if skills and experience warrant it.
What Have the National Experts Been Saying?
Dr. Gordon Christensen of Provo, Utah is, almost without question for the past 20 years, the most recognizable and trusted worldwide dental authority on restorative dentistry techniques and materials. He travels and lectures virtually everywhere to share his vision and he continues to “practice what he preaches” as he still sees patients for exceptional treatment. His research (Clinical Research Associates) is virtually unchallenged as guiding DDS types into doing the right thing for their patients. He travels across the globe sharing and teaching wet-fingered dentists the best procedures that we should be provding for our patients.
Dr. Christensen’s view on the subject of Crowns vs Onlays is very clear. He is not a fan of cutting a tooth down for a Crown, just because it is the easier treatment, one that practicing dentists have been providing for patients for scores of years. He has even gone so far as referring to Crowns as “Tooth Coffins” (meaning Crowns can lead to the death of the inside, root canal- nerve part of the tooth) in a clinical essay trying to prod dentists to do the right thing and cut-back on all that cutting!
Instead, Dr. Chrisensen and almost every other reputable national “guru” or expert on the subject preaches (and has been preaching for quite awhile) that general restorative dentists should be preparing weak or fractured teeth more minimally and then bonding an ONLAY on top of the tooth. Yes, it takes more time… but it is most definitely worth it for optimal oral health.
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