Dental crown alternatives. -

Do you always need a crown?   What other options are there? / What are the advantages, disadvantages and risks associated with alternative approaches?

If your dentist recommends a crown, do you have any other options?

You may find yourself in the position where your dentist has recommended the placement of a dental crown but there are reasons why you are hesitant to commit to having this work done. If so, you'll need information about what other alternatives you have.

That's what this page does. It explains what other treatment approaches might be taken in lieu of crown placement. And the various advantages, disadvantages and outcomes that might be expected with each of them.

Are there any exact equivalents to a crown?

Yes and no.

No other type of dental restoration cups over and encases its tooth as extensively as a (full) dental crown. And for that reason, there is no perfectly equivalent substitute.

But there are other types of restorations that can help to reinforce or improve the appearance of teeth. Their suitability as an alternative simply depends on what is trying to be accomplished by placing the crown and what your objections to it are. Here are some possible options.

a) Onlays and 3/4 crowns.

These restorations are very similar to a crown. They cup over and encase the tooth they are placed on, just less so. (Onlays cover the chewing surface of teeth. 3/4 crowns encase all but one side.)

Advantages of this alternative.

Just like with crowns, these restorations help to reinforce their tooth. And from that standpoint they may serve as a very suitable equivalent. But also like crowns, a substantial (although less so) amount of tooth structure must be trimmed away when making them.

In cases where expense is the issue there is no advantage. All three types of restorations are likely to cost just about the same.

b) Veneers.

This type of restoration is used to cover over the front surface of teeth so to give them a renewed appearance. Because less tooth structure is trimmed when placing one, a dentist should always recommend this procedure instead of a crown if appropriate.

If your dentist has recommended a crown for your situation, it's unlikely that placing a veneer would provide a suitable alternative. (We explain more about crowns vs. veneers on this page.)

Other options and alternatives to the placement of a dental crown.

  1. Have a filling placed instead. (Fillings vs. Crowns)
  2. Delay having the crown placed.
  3. Temporize the tooth, so the placement of the crown can be postponed.
  4. Ask about financial arrangements that make immediate treatment possible.
  5. Confirm the need for the crown with a second opinion.
  6. Have the tooth extracted.

a) Have a filling placed instead of a crown.

Having your dentist place a dental filling instead of a crown can sometimes be a workable alternative. However there are a number of factors that must be taken into consideration before selecting this option.

A big cavity repaired using a big dental filling.

Big fillings don't strengthen teeth like crowns do.

Fillings vs. Crowns.

Using a filling as an alternative, especially one that will need to be quite large, isn't generally considered to be "ideal" treatment. That's because you can't expect a filling to provide the same type of lasting service, or have a shape that's as functionally perfect, as a crown.

Possibly more important, fillings don't provide the same level of protection for a tooth from fracture (details). And that means that a filled one may crack or break sometime in the future, possibly irreparably.

Having said that, despite its trade-offs a filling approach often works out just fine. Based on their knowledge and experience a dentist can relate to you what may be likely to happen. But no one can see the future.

A crown can still be placed at a later date.

Having a filling placed now doesn't mean that you can't have a crown placed later.

  • In some cases so much structure is missing from a tooth that a dentist places a "dental core" as a replacement for it before a crown is made. Doing so can help to improve the crown's stability and retention. So the filling you have placed now may serve that beneficial function later on.
  • In regard to the risks mentioned above, even when a filling is placed going a head and having a crown made whenever circumstances (financial or time) finally permit makes the safest and most predictable plan.

Sometimes a filling-first approach is referred to as "phasing" your treatment (as in phase 1 involves filling placement, phase 2 the more definitive restoration).

Advantages of this alternative.

There are some general advantages that placing a filling instead of a crown offers. They include:

  1. Less cost, possibly significantly so. (Fees for: fillings, crowns.)
  2. A crown usually takes two dental visits to place, a filling just one.
  3. Less tooth structure is trimmed away when placing a filling vs. a crown.

Of course none of these advantages really exist if choosing a filling leads to an event that causes further, possibly irreparable, damage to the tooth.

b) Delay having the crown placed.

Delaying placement of a crown can provide an appropriate alternative in some situations. With others however, doing so might make the absolute worst choice. For this reason, you should never choose this option without the advice and concurring opinion of your dentist.

  • Many times a tooth's need for a crown is diagnosed during a routine dental exam when the dentist first notices that a filling has begun to deteriorate.

    In the case where it is "serviceable although less than ideal," postponing the placement of a crown may make a reasonable choice.

  • But in cases where decay is already present or the tooth has broken, delaying your treatment could very well lead to more serious complications or even tooth loss.
Advantages of this alternative.

Delaying treatment really doesn't offer any advantages for your tooth. Expenses or scheduling may make postponing your procedure a necessity. But keep in mind that in the mean time your tooth remains at some level of risk.

c) Temporize the tooth so its crown placement can be delayed.

Some teeth that require a crown have some type of immediate issue that needs to be addressed. This might be tooth decay, missing portions or a fragile state.

In some cases it might be possible for the dentist to temporize the tooth, thus providing a somewhat extended time frame before its permanent restoration must be placed.

Examples:

1) Temporary fillings.

If a tooth has an area of decay, it might be possible for the dentist to stabilize it by removing the cavity and then placing some type of temporary filling.

  • Some temporary restoratives have a very short effective lifespan (in terms of the seal they create, resistance to wear, or the protection they provide such as resistance to fracture), and therefore only offer a short-term solution.
  • Others, including dental amalgam (a "silver" filling) or dental composite (a "white" filling), might be used to create a "semi permanent" temporary restoration that the dentist feels is durable enough to provide interim service for several months or even longer.
2) Temporary crowns.

If a substantial portion of the tooth is missing, a dentist might go ahead and place a temporary crown so it receives some protection. The crowning process could then be resumed at a later date.

A literature review by Schwass (2013) [page references] reported that:

  • The typical "chairside" temporary (one made by a dentist during the patient's appointment) can be expected to provide service for up to 3 months.
  • Laboratory fabricated ones (made from heat-cured plastics) can last as long as 1 year.
Advantages of these alternatives.

While either of these approaches may provide an adequate solution, neither would be considered "ideal" treatment. The temporary nature of these kinds of restorations places your tooth at some level of risk.

If this alternative is chosen, you should ask over what time frame it would be expected that your tooth's temporization should remain stable. You'll also need to ask what precautions you should take during this period.

d) Ask if financial arrangements can be made.

For many people, it's the cost of the crown that creates the barrier to having their work performed.

Since this is such a common obstacle, it's likely that your dentist will have some type of financial arrangements or credit plan available so your crown can be placed now and paid for over time.

Advantages of this alternative.

Arranging so your dental work can be performed now offers a great solution for your tooth but may be hard on your pocketbook. Financing dental work is a type of "unsecured" consumer debt. As such, it's usually a comparatively expensive source of funds.

e) Confirm the need for the crown with a second opinion.

Different dentists have different training and clinical experiences, as well as different skills and abilities. Conferring with a second dentist may offer varying views or insights as to what might be considered usual and appropriate treatment for your tooth.

There isn't always just one right solution to every problem. Hear each dentist out and see whose approach makes the most sense to you.

A missing tooth allows the neighboring teeth to shift.

The loss of just one tooth can significantly change your bite.

f) Have the tooth extracted.

This seemingly cheapest and simplest alternative is often the most expensive and worst choice in the long run.

Potential problems.

When a tooth is extracted its neighboring teeth will tend to shift position, possibly significantly so. The resulting misalignment can have a major impact on a person's dental health.

Even the removal of a single tooth can lead to problems with chewing ability, jaw joint function, or create a situation that makes remaining teeth harder to keep clean (and therefore at greater risk for tooth decay or gum disease).

Additional dental work will be needed.

So to avoid these types of complications, your dentist will probably recommend to you that you replace any tooth that has been extracted with an artificial one. Replacing a missing tooth (using a dental implant, bridge, removable partial denture) can easily cost more than simply having a crown placed.

Advantages of this alternative.

As opposed to the routine placement of a crown as a way of salvaging a tooth, from a dental-health standpoint extracting the tooth instead offers no advantages.

There may be issues in your life that necessitate the need to choose this alternative (such as time or financial constraints). But if a way can be found around these obstacles, your oral health will benefit.

 

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