Notes from the Chair: “Do I Really Need a Crown?”

By Wesley Wong, DDS

Every day in the dental chair, I hear a version of the same great question:
“Is there anything else I can do instead of a crown?”
It’s a completely fair question, especially when patients are hoping to preserve as much of their natural tooth as possible. What many people don’t realize is that yes, sometimes there is a fantastic alternative: a porcelain inlay or onlay.

So, What’s the Difference?

A crown covers the entire visible part of the tooth. It’s a strong, reliable solution, especially when a tooth is significantly damaged or has undergone a root canal. Crowns are also typically covered by dental insurance, which makes them a go-to choice for many.
But when the tooth is structurally sound enough, an inlay or onlay may be a better, more conservative option. These restorations are fabricated outside of the mouth (what we call "indirect restorations") and bonded to the tooth, preserving more of your natural tooth structure than a crown would.
Even better? Thanks to modern technology, we can often design and place these same-day in the office—no second appointment required.

When Is an Inlay or Onlay a Good Fit?

Here’s when I typically recommend an inlay or onlay:

• The tooth is moderately damaged but does not need a full crown
• There’s no root canal and the nerve of the tooth is healthy
• You want a durable, esthetic solution that blends beautifully with your natural teeth

These restorations are incredibly strong, long-lasting, and—honestly—pretty beautiful. Patients love the natural look, and I love giving people the option to keep more of their original tooth whenever possible.

 
The Insurance Factor

Now here’s the one catch I always like to be upfront about: Inlays and onlays are often not covered by insurance. Many plans will only pay for a crown, even if a more conservative treatment would serve you better. That said, if long-term strength and appearance are your priorities, this is often worth the investment.

My Promise to You

My job is to make sure you know all your options, and to help you understand which one is truly best for your specific situation. Not every tooth can get an inlay or onlay. If there's been a root canal, or if we suspect one is needed, then a crown is going to be the safest choice. But if there’s room to be conservative, I’ll always let you know.
If you’re ever unsure about a treatment plan, or just want to understand what alternatives might be available, I hope you’ll ask. I believe great dentistry starts with great conversations.

Wesley Wong, DDS