Do You Need a Crown or Just a Filling? How Dentists Decide
CROWN VS FILLING: HOW WE DECIDE (Edmonds, WA)
If you’ve been told you “might need a crown,” it’s normal to wonder if a filling would be enough. The honest answer is this: a filling repairs missing tooth structure, but it does not always protect the remaining tooth from cracking. A crown protects the tooth, but it requires more removal of tooth structure and costs more. The goal is to choose the option most likely to last for your specific tooth.
THE SIMPLE RULE WE USE
Choose a filling when the tooth is strong enough to hold it long-term.
Choose a crown when the tooth is at high risk of cracking or the filling would likely fail repeatedly.
WHAT WE LOOK AT (THE REAL DECISION FACTORS)
How much tooth structure is left
The more tooth you’ve lost (decay, old fillings, fractures), the harder it is for a filling to hold up. When cusps become thin or undermined, the tooth becomes a crack risk.
Size and location of decay or the old filling
Small to moderate areas can often be handled with a filling. Larger areas, especially those spanning multiple surfaces or involving cusps, often need coverage.
Cracks and “bite pain”
If you have sharp pain when biting or especially on release, that pattern often points toward cracking. A crown may be needed to brace the tooth.
Bite forces and grinding (bruxism)
Heavy bite forces can destroy large fillings and crack weakened teeth. If you clench or grind, we lean toward protection when the tooth is borderline.
Tooth position matters
Back teeth take higher forces. A large filling on a molar fails more often than the same filling on a front tooth.
History of that tooth
If a tooth has had multiple large fillings replaced already, it is telling you it is structurally compromised.
Root canal status (if applicable)
Teeth with root canals can be more brittle, especially posterior teeth. Many need cuspal coverage to reduce fracture risk.
Gumline and margin control
If decay extends close to the gumline or below it, we may need a crown for proper seal and longevity.
WHEN A FILLING IS USUALLY THE RIGHT CHOICE
Small to moderate decay or a small broken area
Tooth walls and cusps are still thick and strong
No crack symptoms and no major bite issues
You can keep the area clean and dry during placement
What you get: faster, lower cost, more conservative tooth removal.
WHEN A CROWN IS USUALLY THE RIGHT CHOICE
A large existing filling with thin remaining tooth walls
Decay or fracture that undermines one or more cusps
Cracked tooth symptoms (bite pain or release pain)
Repeated filling failures on the same tooth
Root canal treated back tooth needing protection
What you get: better long-term protection, lower fracture risk, more predictable longevity.
THE “MIDDLE OPTION” MANY PEOPLE DON’T HEAR ABOUT (ONLAY)
Sometimes you do not need a full crown. A partial coverage restoration (onlay) can cover weakened cusps while preserving more tooth than a full crown. This can be a great option when the tooth needs protection but not full coverage.
HOW WE CONFIRM THE DIAGNOSIS IN THE OFFICE
We do not guess. We combine:
Clinical exam and photos
X-rays to assess decay depth and bone support
Bite testing and cold testing when needed
Crack evaluation (including transillumination when appropriate)
Then we explain the “why” behind the recommendation so you understand the risk tradeoff.
WHAT TO EXPECT: FILLING VS CROWN
Filling: one visit, remove decay, place bonded restoration, adjust bite.
Crown: typically two visits (or one if same-day is available), shape tooth, take scan/impression, temporary crown, final crown cementation and bite adjustment.
COMMON QUESTIONS (FAQ)
“Are crowns recommended just because a filling is big?”
Not automatically. Size matters because it changes strength, but we focus on remaining tooth structure and crack risk.
“Can I try a filling first?”
Sometimes. If the tooth is borderline, a filling may be an acceptable short-term plan, but it can increase the chance of cracking later. If that happens, treatment becomes more complex and expensive.
“Does a crown last forever?”
No. Crowns can last a long time, but they can chip, leak at margins, or need replacement. The goal is reducing repeat repairs and fracture risk.
“If it doesn’t hurt, why not wait?”
Decay and cracks often do not hurt until they are advanced. Waiting can turn a filling into a crown, or a crown into a root canal, or a tooth into an extraction.
“What about tooth sensitivity after treatment?”
Mild temporary sensitivity can happen with either option. Lingering or worsening pain is not normal and should be checked.
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BOTTOM LINE
A filling repairs a defect. A crown protects a weakened tooth. The right choice depends on remaining tooth structure, crack risk, bite forces, and how predictable a long-term seal will be.
CALL TO ACTION
If you’ve been told you might need a crown and want a clear, honest answer, schedule an evaluation at Complete Dentistry in Edmonds, WA. We’ll show you what we’re seeing and explain the most predictable option for your tooth. Please call us at 425-361-1343 or the Book Now button on the top right.