Inappropriate filling (?) and proposed onlay - 2nd opinion needed

[GearShift]

Hi dentists

I had a very large filling put in by my dentist about a 6 months ago in one of my lower back teeth. Recently the front inner corner of the tooth has snapped off in front of the fillling. I discovered it in my mouth when eating.Photos below.

Since this happpend quite soon after having the filling I'm wondering if the filling was the correct approach since it must have left a rather narrow section of tooth left at the front which I would have thought would be inherently fragile since unsupported.
Should something more substantial eg an onlay or crown should have been used rather than a filling. Can anyone advise?

My dentist is now reccomending an onlay for this tooth and suggests it should be done quikly since they say they can see decay between the tooth and the filling.I have no pain or issues with it.I'm wondering if it's it's necessary or if there's a keeness to cover things up so to speak.

Is an onlay the best approach or can it be left as is? The onlay is as expensive for me as a crown but I gather wont last as long.

Advice appreciated.

 

[Busybee]

I had exactly the same happen to me as a teenager. To fix it at the time the dentist filled and smoothed the area that had broken off. I always hated it and ten years later I had a gold onlay, which lasted decades and was very strong in comparison. They tend to try to save the tooth with a filling in the first instance as more tooth has to be removed when you have an onlay. In my case the filling had no problems once they fixed up the area where the tooth broke but it was not as strong as my other filled teeth and the bite was better with the onlay. But in terms of dental health the amalgam filling my onlay replaced would have been fine too and may have lasted a lifetime. Onlays don't always last for decades. Amalgam is a great material, but there have been moves to ban it in many countries due to health concerns over the use of mercury. Some dental practices in the UK don't use it at all.

 

[MattKW]

Am I right that you're referring to the last tooth, i.e. the wisdom tooth?

 

[GearShift]

Am I right that you're referring to the last tooth, i.e. the wisdom tooth?

No it's the second from last, in the centre of the red circle in the first photo.

 

[GearShift]

I had exactly the same happen to me as a teenager. To fix it at the time the dentist filled and smoothed the area that had broken off. I always hated it and ten years later I had a gold onlay, which lasted decades and was very strong in comparison. They tend to try to save the tooth with a filling in the first instance as more tooth has to be removed when you have an onlay. In my case the filling had no problems once they fixed up the area where the tooth broke but it was not as strong as my other filled teeth and the bite was better with the onlay. But in terms of dental health the amalgam filling my onlay replaced would have been fine too and may have lasted a lifetime. Onlays don't always last for decades. Amalgam is a great material, but there have been moves to ban it in many countries due to health concerns over the use of mercury. Some dental practices in the UK don't use it at all.

Thanks, Ah i didn't consider that an onlay would need more tooth removal but it makes sense now you explain it.

The material for the proposed wasn't gold. I think it was some kind of metal alloy IIRC.

I did some research into the whole amalgam vs alternatives before but decided that it seemed ok.

 

[Busybee]

It's possible your dentist thinks the tooth structure needs an onlay for long term durability, but you could ask whether they can do this without removing much tooth and perhaps using the existing amalgam filling as part of the support. I had something like this done by a conservative dentist. It meant that my tooth had reduced risk of a root canal as my dentist did not go near the nerve. Otherwise if they don't have enough tooth they have to create a post to attach the crown or onlay. Maybe worth looking for a conservative/minimally invasive dentist. My main problem with the onlay was that after about ten or fifteen years it developed a gap between the tooth and the gold. That allows decay to develop. There are risks and long term issues with any dental work, but these days it's considered best to retain as much healthy tooth as possible, if it's feasible to do so and if it doesn't compromise function, durability etc. .

 

[MattKW]

The wisdom tooth is impacted down the back side of the 2nd molar, and should be removed before doing any more extensive work on the 2nd molar. I'd extract the wisdom tooth first, allow for healing, then place a crown over the 2nd molar. it is possible the existing filling needs to be replaced first if there is any chance of existing decay.