Why can’t you just fill it?

Q. Why can’t you just fill it?

A. This is one of the most common questions I get.  Often, when I inform a patient that a tooth needs a crown, onlay, or root canal, the next question is usually, “Why can’t you just fill it?”.  It’s an understandable question. Technological advancements have allowed restorative materials to be used with greater success and in a wider variety of situations that ever before. ‘Fillings’ of both the amalgam and resin variety have been one of the most common dental procedures for decades. They are also the most immediately economical option in many cases.  This can lead patients to believe, or at least hope, that all dental situations can be remedied with a ‘filling’.  They are not a one-size-fits-all solution to every dental problem, however.

There are minimum requirements that must be met for successful restoration of a tooth with a simple filling.  Below are a few:

  • Sufficient remaining tooth structure to hold the filling – This is necessary to withstand biting and chewing forces that can exceed 250 psi in the back teeth.
  • A healthy nerve – Even if enough of the tooth is left to hold a filling, decay that has reached the pulp of the tooth will require a root canal to clean out the resulting infection.
  • Uncompromised surrounding tooth structure – If a tooth has an extensive crack, the tooth structure may need more support that a filling can give.  This is typically achieved by tying the tooth together with an onlay or crown.
  • Normal bite forces on the filling – Habits like clenching or grinding can make it necessary to reinforce the tooth in order to withstand the extra force.
  • Sufficient number of remaining teeth – Missing teeth can also increase the pressure on the remaining teeth and may require more support than a simple filling can provide.

Although restorative materials are more versatile than ever, fillings still have their limits.  The key is to know those limits and not ask the filling material to do more that it is capable of.  When the requirements are met a filling can be a simple, economical, and durable way to restore the form and function of a tooth.  If the requirements are not met, it is best to opt for a sturdier solution.

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