I have cracked a tooth. It is on the bottom next to the back. An endodontist looked at it and suggested a crown. but was asked by my regular dentist to take out the filling to see how deep the crack was.This was not done.So my dentist tried to mend the crack.I cannot stand pressure on one side of tooth and it did not work. Since one side of tooth feels strong we are now considering an onlay. Do you feel a cracked tooth can be mended like this? Or should I go with the crown. I hated drilling away so much of my tooth that was not damaged.
– Pamela from Kentucky

Pamela,

I’m not going to be able to give you a certain answer to your particular situation. There are many degrees of cracks in teeth, from a superficial crack that is just in the enamel, to a deep crack that goes all the way into the dentin and could even involve the pulp of the tooth. And there are different places a tooth could be cracked. The crack could be horizontal, involving a cusp or a corner of the tooth, or it could be vertical, down the middle.

And to be clear, here, we’re talking about cracks and not fractures. If the pieces of a tooth move independently, then the tooth is fractured. The idea of treating a cracked tooth is to keep it from fracturing.

And there are different kinds of onlays. Some would work well for any type of crack and some would have restrictions.

An onlay covers all or most of the chewing surface of a tooth. It is a very nice restoration. It is hard to do, so a lot of dentists don’t do them. Since it doesn’t go down below the gumline except between the teeth, it is very gentle to the gums and helps promote good gum health. They can be made out of gold, porcelain, or hardened composite.

A gold onlay covering the entire chewing surface of a tooth would completely protect any type of cracked tooth. I would feel very comfortable with that. If the onlay is made of porcelain, I would only use it to protect the tooth in the case of a minor crack – either a superficial crack or a horizontal crack involving just a cusp or a corner of the tooth. The porcelain is not strong enough to hold a tooth together that has a serious vertical crack. Some supposed experts teach that the bonding strength of porcelain to the tooth is strong enough for this situation, and I believed that at one time, until I used an all-porcelain crown on a tooth that had a serious vertical crack. The porcelain crown and the tooth both ended up cracking all the way through, and I ended up repairing the situation at my own expense.

And hardened composite is considerably weaker than porcelain. I would not recommend that for any type of crack in a tooth.

This idea of repairing the crack with some other technique than a crown – no, that wouldn’t work. It might hold for a short period, but it’s not a long-term solution. Now if you were putting pressure on your dentist to find a more economical solution, then I understand. But if this was the dentist’s first choice of treatment, it makes me a little skeptical. I’m not sure what you’re meaning when you say that this treatment didn’t work, and I’m not following you when you talk about the pressure on one side of the tooth. I can’t visualize what you’re saying. And I don’t understand what that means, that a side of the tooth feels strong. So maybe your dentist is right. But I have this skepticism and would suggest a second opinion.

Dr. Hall