Filling vs. Crown: How Dentists Decide the Best Treatment for a Damaged Tooth

By Greg Vigoren, DDS

Experiencing tooth damage from decay, cracks, or wear can leave you wondering about the right fix. At Vigoren Restorative Dentistry in Newport Beach, CA, I’ve guided patients for nearly 50 years through this choice with advanced technology and a patient-first philosophy. This guide explains how dentists decide between a filling and a crown, highlighting the evidence on longevity and protection.

TL;DR

• Fillings are best for small to moderate damage; crowns protect extensively compromised teeth.

• Root-filled teeth with crowns show ~81% 10-year survival vs ~63% without crowns (Mannocci et al., 2020).

• Composite and amalgam fillings work well for minor cases but fail earlier when too large (BDJ review).

• Personalized evaluation with advanced imaging ensures the right treatment choice for long-term function and esthetics.

Dental Fillings: Conservative Repair for Minor Issues

A filling removes decay and seals the tooth with composite resin or amalgam. It’s fast, preserves more natural structure, and blends esthetically when composite is used. Fillings are ideal for small cavities or chips where tooth integrity remains high. Large studies confirm that composite and amalgam restorations are reliable in small to medium defects but have higher failure when they cover large portions of the tooth (BDJ).

Dental Crowns: Full Coverage for Compromised Teeth

Crowns encase the entire visible tooth, protecting it from further fracture or decay. They are essential when a tooth is weakened by large fillings, cracks, or root canal treatment. Long-term studies show five-year survival rates of ~94% and ten-year rates of ~89% for full-coverage crowns (Pjetursson et al., 2012). At Vigoren Restorative Dentistry, we use CBCT 3D imaging and high-magnification to ensure precise fits for longevity.

How Dentists Decide: Key Factors

• Extent of damage: Small cavities = filling; large or multi-surface damage = crown.

• Tooth strength: Weakened cusps or cracks call for full coverage.

• History of root canal: Teeth with root canals benefit significantly from crowns, with ~81% 10-year survival vs ~63% without crowns (Mannocci et al.).

• Patient risk factors: Bruxism, high bite forces, and poor hygiene influence choice.

When a Filling Is Sufficient

Fillings are recommended when damage is limited to one or two surfaces and the tooth is otherwise strong. This minimally invasive option can often be completed in one visit, with composite resins providing natural esthetics.

When a Crown Is Necessary

Crowns are best when over half the tooth structure is lost or weakened, or after root canal therapy. They prevent catastrophic fracture and provide long-term stability. Evidence shows crowns dramatically improve survival in root-filled teeth (Mannocci et al., 2020).

Real-World Evidence

A randomized controlled trial in Italy followed 117 patients with root-filled premolars, restored with either composite fillings or crowns. Over three years, catastrophic failures (requiring extraction) did not occur in either group, but non-catastrophic failures were lower in the crown group. This underscores crowns’ ability to stabilize compromised teeth (PMC trial).

FAQs

How do dentists decide between a filling and a crown?

By evaluating cavity size, tooth strength, and whether a root canal was performed. Fillings are for minor issues, crowns for major damage.

Are crowns more durable than fillings?

Yes. Crowns protect weak teeth and show ~89% 10-year survival compared to lower rates for large composite fillings (systematic review).

Can a filling be replaced with a crown later?

Yes. Many patients start with a filling, and if damage progresses, a crown can be placed to reinforce the tooth.

Will either procedure hurt?

With local anesthesia and modern adhesive techniques, both treatments are typically comfortable.

Next step: Unsure if you need a filling or crown? Schedule a consultation or call (949) 760-1152 to receive a personalized evaluation.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results may vary. Please consult a licensed dentist for diagnosis and treatment.

Author Bio

Greg Vigoren, DDS is a restorative dentist in Newport Beach, CA, with nearly 50 years of experience. He pioneered the use of high-magnification tools for precision dentistry and focuses on conservative, patient-centered care.