My bottom right second molar is cracked, and I would like to know if an onlay will work. I visited an endodontist who suggested a crown for the tooth. However, the endodontist did not do as my dentist asked and took out the filling to see the extent of the crack. My dentist tried to mend the tooth, but it hurts when pressure affects it. I am trying not to chew on that side of my mouth, and my jaws are beginning to hurt. My dentist wants to try an onlay next. Although I don’t want a crown, I do not want to keep trying different methods, especially if an onlay won’t work. Is an onlay likely to work, or should I ask for a crown? Thanks. Andrew from NM

Andrew,

A cosmetic dentist would need to examine your tooth and x-ray it to see the extent of the crack.

What Is the Treatment for a Cracked Tooth?

Treatment for a cracked tooth depends on the crack’s extent, location, and severity.

• The extent of the crack – A crack can be limited to the tooth enamel or extend deep into the dentin (the layer beneath enamel) or the pulp (living tissue inside).
• Location of the crack – A crack can be horizontal or vertical.
• Crack or facture – If any part of the tooth moves independently, the tooth is fractured. A dentist must treat a cracked tooth to avoid a fraction.

Will an Onlay Work for a Cracked Tooth?

There are different types of onlays—some that work well for any crack and others that have restrictions. Gold and zirconia onlays are stronger and can withstand the biting forces of your teeth.

What Is an Onlay?

An onlay is a custom-made dental ceramic, gold, or hardened composite covering most or all of your tooth’s chewing surface. Many advanced cosmetic dentists use onlays instead of crowns. Your dentist must take impressions of the tooth. Your dentist or a ceramist will make a custom onlay to cover your tooth precisely. An onlay requires the skill and advanced cosmetic dentistry training.

• Gold onlay – A gold onlay can cover the entire chewing surface of your tooth and prevent the crack from spreading.
• Porcelain or ceramic onlay – A porcelain onlay can protect minor cracks affecting a tooth’s cusp or corner. Porcelain might not be strong enough to hold a molar tooth together. Zirconia is a high-strength dental ceramic. High-strength ceramic onlays are more substantial than all-porcelain. Advanced cosmetic dentists use them to preserve teeth.
• Hardened composite onlay – Weaker than porcelain, a hardened composite onlay is not strong enough to protect a crack in a molar tooth.

We recommend getting a second opinion from a cosmetic dentist trained in occlusion and bite. They will explain your options for a restoration that fits well, protects your tooth, and prevents the crack from worsening.

San Antonio dentists Dr. Gilberto Tostado and Dr. Karina Acuña sponsor this post.