onlay v. crown on molar

Ricta

I have a molar with an extensive amalgam filling, recently a piece of the tooth broke off, about 60/70% of the surrounding tooth remains. My dentist advises that it would not be a good idea to redo the filling and that an onlay would be a better fix. He can do all the work in one day, which I now think must be the CEREC system I have read about in this forum. Most of the posts I found here about CEREC are quite old, 5 years or more, some of them are not encouageing. I wonder has that technology proved itself as time has gone by? Is it suitable for a molar? (sixth tooth in on lower left jaw) I do clench and grind a fair bit, I'm told there are signs of wear on some fillings, so I am wondering if an onlay would be up to the job on a molar or should I go for a crown of some type in that position? I apreciate any of your thoughts.

capnsparkles

CAD-CAM technology has advanced considerably in the last 5 years. There is a massive difference in the software now versus then.
I use the system quite a lot and it is flexible in the restorations that it provides.
I restore quite a few lower molars , personally I am very happy with the results. My material of choice in the last few years is E-MAX(lithium disilicate). However the best material in my opinion for a crown is full gold . For inlays and onlays the best I have seen have been gold , a lot have been in for 20 years. However most of these were done by a Dentist who has long passed away. And in fairness to the Dentist he was exceptionally talented.
Maybe some of the prostodontists on this forum could give their view. In my opinion in certain cases crowns made at the chairside are at least equal to their laboratory made counterparts.
Inlays and onlays show a higher rate of failure in my eyes, but these are far more technically challenging , however with CAD-CAM you can easily remake if there is a fit issue , this is not as easy if you have sent it to a laboratory.

Dianthus

If you've a tendancy to grind, &/have a heavy bite, seriously consider a gold onlay or crown. It's robust, it's durable, it's conservative, and the literature on it would be far more comprehensive than any CAD CAM counterpart. Practically the only disadvantages to gold are cost& aesthetics.

Also consider wearing a hard splint to reduce any liklihood of further fractures of other teeth.

Esel

Dianthus wrote: »

If you've a tendancy to grind, &/have a heavy bite, seriously consider a gold onlay or crown. It's robust, it's durable, it's conservative, and the literature on it would be far more comprehensive than any CAD CAM counterpart. Practically the only disadvantages to gold are cost& aesthetics.

Also consider wearing a hard splint to reduce any liklihood of further fractures of other teeth.

Not asking actual average prices, but percentage-wise how much more expensive would a gold crown be?

(Of course, if you want to give average prices (say for a molar), please do.)

Ricta

Dianthus wrote: »

Also consider wearing a hard splint to reduce any liklihood of further fractures of other teeth.

Indeed. I had a soft splint made for me many years ago but I could not abide the thing. It kept me awake all night and I had difficulty breathing with it, and it felt like there was a thick layer between my back teeth not allowing my jaws to rest, keeping my front teeth about 5mm apart, so it rapidly got regulated to the back of the drawer.

Thanks for the advice on the gold, I will ask about the relative costs, cosmetically I would not have an issue.