How do you choose between an onlay and an extraction?

How do you choose between an onlay and an extraction?

[Steve Bader, DMD]

I am just going through your q&a here.  Your questions are quite technical.  The bottom line remains - if the tooth can be restored to near 100% with a crown or onlay, it is likely your best choice.  In the end you need to be evaluated by a qualified restorative dentist who can fix broken teeth.  You mentioned the pulp is exposed previously.  You may or ma not require root canal therapy before any restoration depending on the health of the remaining pulp tissue, the size and position of the pulp exposure, and how long it has been left exposed. Without an examination, an xray and some testing of the tooth your last question regarding whether your tooth needs a root canal cannot be answered over the internet.  We are here to help and advise, which is our pleasure.  I hope this helps.  Best of luck.

[Sam Delfino]

There is a huge gap between these two options. Onlay is to save your tooth and extraction is to get rid of it. I can not tell you why you should not have the onlay done, because that seems like the most conservative form of treatment for a tooth and most cost effective way long term, unless there are reasons why this treatment is not going to be long term. But if you opt into having an extraction done, then you have to deal with replacing this tooth with either a bridge, a removable denture, or an implant, which might end up with needing bone graft, and more complicated procedures which will cost more money. If you just remove and not replace the tooth, you will have to deal with the neighboring teeth shifting into this space, the opposing tooth pushing up into this empty space, jaw bone damage and osteoprosis, sinus droppage (if it is an upper tooth in the back) and more complicated situations. When a tooth is removed, the jaw bone gets destroyed more and more over the years and this can cause more complicated problems which can even affect the bone level and gum level around the neighboring teeth. The key is proper diagnosis and proper options to be given along with pros, cons, and longevity. This is what a highly trained dentist can do for you. Each case is different from another and options need to be customized for each individual, not only based on your dental and medical conditions, but also, based on your values, and needs, and wants. I hope this helps,

[AdeWb]

Thanks for your reply, but specifically I was wondering though how a *dentist* decides when looking at a tooth whether it should be extracted or an onlay.

[Sam Delfino]

If the tooth is savable, if the amount of bone around the tooth is adequate, if the bone quality is good, if the gum is healthy, if the tooth is solid and not loose, if there are no cracks to the bone, these are all indications for keeping a tooth and restoring it with an onlay.

[AdeWb]

If the bone is fine, and gum is fine, the tooth is solid but the tooth has a big hole then its still ok?

Even if most of the crown has gone and bit of the pulp is exposed?

[Sam Delfino]

Hi Adewb,
Sorry for the delay, now, what needs to be evaluated the the crown to root ratio. If most of the top part of the tooth is gone, and the ratio of the amount of root that is in the bone and what is going to be sticking out, then it is better to remove and get an implant. But if there is still adequate tooth structure to hold an onlay, and if the pulp is exposed, root canal would be needed, then the tooth can be built up and after the root canal and onlay an be bonded on which will give adequate bond strength. The key is to find the right dentist who knows how to use and choose the right materials. I am always more for saving a tooth unless the risk factors are too high for keeping it. From what you are describing, I would try to keep the tooth.

[AdeWb]

"adequate tooth structure to hold an onlay"

In the situation where you recommend root canal, what if the pulp is fine?

Do you get rid of a healthy root so the onlay will hold?

So just to be clear, if the pulp is not exposed then a root canal isn't needed and an onlay by itself will do?

[Steve Bader, DMD]

Your questions are specific now and highly technical.  Only an exam, and xray and some testing can specifically answer them for your tooth.  Overall, I agree that if the tooth can be repaired near 100% with an onlay then that is choice one.  If it also needs a root canal, that still would remain my first choice.  If there are additional factors preventing a near 100% restoration, or additional procedures like periodontal surgery needed, the pendulum swings towards an implant for long term success.  I hope that helps.  At this point, you would be best to find a qualified dentist like the team at top3dentists.com.

[mands90]

A related discussion, chances of being pregnat was started.