A Crown Versus a Filling

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My father used to say to me: “We are not rich enough to buy cheap stuff.” This statement was confusing to me as a child as I understood the less you pay, the more you retain. Now as an adult I know about compiled interest as well as compiled expense, which makes this statement very plausible and current.

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A CROWN VERSUS A FILLING
My father used to say to me: “We are not rich enough to buy cheap stuff.” This statement
was confusing to me as a child as I understood the less you pay, the more you retain. Now
as an adult I know about compiled interest as well as compiled expense, which makes this
statement very plausible and current.
At Dental Arts San Diego, we hear many times the same question from our patients:“Should
I get a crown or a filling? Why can’t you just fill the tooth?”
To answer this question, let’s look into the pros and cons of each restoration.

FILLINGS

A filling needs 4 walls of the tooth to be
present to be able to be properly
attached. It can look very beautiful on the
tooth because the filling’s color can be
matched flawlessly to the tooth. It is also
quite inexpensive in comparison with
other restoration, which is a plus.
On the other side of the coin, if a patient
walks in with a large, old, and faulty metal
filling (picture), after cleaning of the
cavity, some of the 4 walls might
beabsent, therefore commanding
placement of thecrown, which is
consequently more expensive.
It’s also impossible to fill a tooth when one
or more of its cusps are missing as a
result of a preexisting cavity or a trauma.
A factor that you might want to consider
when choosing your restorative procedure
is the amount of compressive stress that
different kinds of fillings can withstand.




Metal filling: 250-300 MPA
Composite resin/white filling: 250-

CROWNS

This patient decided to put a crown on his
last two molars with Zirconia instead of
placing larger fillings like he has on the
other side of his mouth. Life expectancy of
a crown can range from 5-45 years
depending on the material picked. Also a
strong factor in determining how many
years of service can be received will be
parafunctional habits of patients, such as
clenching or grinding teeth.

As with fillings, different types of
material used in crowns also possess
different ranges of their tolerable
compression strength. Some of the
compression ratings have been listed
below for your comparison.
 Porcelain fused to any metal
coping crown: 450-550 MPA
 Zirconia layered (esthetic crown):
450-700 MPA
 Solid zirconia (crown designed for
people who grind their teeth): 750-

450 MPA
Life expectancy: 2 –
5 years

Different materials possess different
compression strengths which relate to
that material’s fatigue limit. Every
restorative material has a fatigue
limit, which determineshow often you
need to replace your filling/crown. For
example for a large filling, placed in
the second molar, the expectancy of
service will be between 2 and 5 years
before the sign of wear and tear will
become obvious.
Speaking conservatively, it will be
much better to make a restoration
which would last longer, giving a
patient a great span of years with no
additional work on a the tooth. Every
single time a filling is replaced, more
and more of the tooth structure will be
missing, making the tooth weaker and
predisposing to possible fractures,
especially in the back of the mouth as
those would be the teeth to get the
heat of chewing stress.

980 MPA.
Life expectancy: 5 –
45 years

Obviously, these numbers would invoke
a question of how much strength do we
really need?
Masseter (one of the 4 biggest chewing
muscles) can develop anywhere from
350-600 MPA, depending on gender,
body mass, anatomy, genetics, etc.
Granted, if our muscles develop more
compression then the fatigue limit of a
restorative material in the mouth, you
will be needing more cycles of
replacement, the opposite is also true.
The bottom line is there is a fine line
between common sense, priorities,
possibility or inability to perform certain
actions which will reflect in our choices.
And an informed choice is the best
choice.

I’m looking forward to answering any questions you might have regarding these
restorative options.
Alena Nawrocki, DDS
Dental Arts San Diego

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