Recently I was talking to a friend about some of the dental services Midtown Dentistry offered and I mentioned onlay. She was very quick to note that not everyone knew what an onlay was and suggested I make ‘onlay’ the subject of the blog for this month.
Prior to writing this blog post, I decided to do an informal little survey with my patients, by just throwing “onlay” into the conversation and see how they react; it occurs that most of them were not familiar with the term, some stopped me and ask about the meaning, while others just glanced a little and let me continue. I became convinced this would be an interesting subject for the month.
When a tooth is decayed, in the best case scenario, it can be treated with a filling or a crown after removal of the caries. What most patients are unaware of is that there is an alternative treatment between “filling” and “crown” to treat a decayed tooth. A small decay can be easily restored or fixed with a filling (resin, amalgam, etc); it is, in most case, the ideal solution because it maintains the integrity of the tooth after removal of the affected area and restores function.
When the affected area is big and involves more than one surface of the tooth it may require a bigger filling, which in some case weakens the tooth instead of strengthening it. Most dentists, in this case recommend a crown; it covers the whole tooth and maintains its integrity, therefore preventing further breakage and reestablishing full function.
However there is a more conservative treatment that has been around for many decades; it is used when a big part of the tooth is missing due to fracture or decay and it will reestablish function while maintaining the remaining healthy tooth surface intact. An onlay can be made of gold, resin or porcelain and is custom made to fit the missing part of the tooth where the decay was removed, like a jigsaw puzzle piece. One of the main benefits of onlay is that the healthy part of the tooth that is kept as opposed to a crown which requires significant tooth reduction for tooth coverage.
While dental fillings are molded into place during a dental visit, an onlay generally requires a couple of appointments and is fabricated in a dental laboratory. The dentist then fits and bonds it to the damaged tooth. The onlay presents several advantages over the crown:
- Superior fit.
- Best choice for moderate tooth decay extending into the flossing area.
- Allows preservation of the greatest amount of healthy tooth structure.
- Makes the tooth easier to clean because the fit is tailored and the preparation minimal.
- Better restoration if you want to seal a tooth to keep out bacteria.
In addition, their superior fit and durable material make onlays a great choice that can actually strengthen a damaged tooth. An onlay can protect the weak areas of the tooth. The procedure does not require the reshaping of the entire tooth.
Despites all of these benefits, onlays are rarely recommended by dentist when required. One of the main reasons I learned from personal experience is the fact that most insurance company rarely pay for onlay; when and if they do they “downgrade” the fee to the price fee of a regular filling. Some colleagues will not even propose it to patients as an alternative to crown in the right situation.
Fabrication of an onlay is very technique sensitive both for the dentist and the lab. In addition it requires more time and several different material are used to prepare to tooth, temporize it and finally cement the onlay. There is also the added cost of the lab fee, which is about the same as a crown more or less. Given the choice, it makes more sense economically for the dentist to just slap a filling on the tooth and be done. However, hundreds of studies have shown that when a regular filling is placed where an onlay is indicated, the filling usually fails within a few months to a year.
There are specific requirement for recommending an onlay as treatment; and a these requirements however most insurance company ignore or rarely follows them in their denial of payment. It is important for patients to know the different treatments available so they can become informed customers and can have a voice in the choice being made on their behalf either by their providers or policy carriers.
Visit http://www.charlottemidtowndentistry.com/general-dentistry/onlay-restorations for more information about onlay or http://www.charlottemidtowndentistry.com/ask-the-doctor if you want to ask any specific question about a procedure.