When are they used, and what are their advantages and limitations?

A patient-friendly guide to repairing damaged teeth and replacing missing ones

A chipped tooth, a cavity or a gap where a tooth is missing can affect more than your smile. It may make chewing uncomfortable, trap food or change the way your teeth meet. Dental restorations are treatments that rebuild damaged teeth or replace missing teeth. The right choice depends on how much healthy tooth remains, where the tooth is, your bite, appearance goals and oral health.

There is no single restoration that is best for everyone. A small cavity may need only a filling, while a badly weakened tooth may need a crown. A missing tooth may be replaced with a bridge, denture or implantsupported tooth. Your dentist will explain the options after examining you and, when needed, taking X-rays.

Simple idea: A restoration repairs or replaces tooth structure. The goal is to restore comfort and function while keeping as much healthy natural tooth as possible. 

First, what does “restoration” mean?

A restoration is a material or appliance used to repair a tooth or replace a missing one. Some restorations are placed directly in the mouth during the appointment, such as a filling. Others are made to fit your mouth and then bonded or cemented in place, such as an inlay, onlay or crown. Bridges, dentures and implant-supported teeth replace missing teeth.

A sealant is slightly different: it is a thin protective coating placed in the grooves of selected teeth to help prevent decay. It is preventive care, rather than a repair for a large cavity.

Restorations for a damaged tooth

1. Tooth-coloured composite filling

Composite is a tooth-coloured material that the dentist shapes directly in the cavity and hardens with a special light. It can be used for many small or medium cavities and some chips, depending on the tooth and the forces on it.

Advantages: It can be matched to the tooth colour, bonds to tooth structure and is often completed in one visit.

Considerations: It may wear, stain or chip over time, and a very large filling may not be strong enough for a heavily loaded tooth. Keeping the area dry during placement is important.

2. Glass ionomer filling

Glass ionomer is a tooth-coloured material used in selected situations, including some smaller restorations, areas that are difficult to keep dry, or as an interim restoration. Some formulations release fluoride.

Advantages: It is tooth-coloured, can bond to tooth structure and is useful in particular clinical situations.

Considerations: It is generally less resistant to heavy chewing forces and wear than materials used for larger, high-load restorations, so it may not suit every back tooth cavity.

3. Amalgam filling

Amalgam is a silver-coloured metal alloy that has been used to restore teeth for many years. Where it is available and appropriate, it may be considered for some cavities in back teeth.

Advantages: It is durable and can work well in areas that experience chewing forces.

Considerations: It does not match the natural tooth colour, and placement may require a different cavity shape from adhesive tooth-coloured materials. Material availability and recommendations can vary by country and situation.

4. Inlay and onlay

An inlay or onlay is a custom-made restoration, commonly made from ceramic or a resin-based material. An inlay fits within the raised edges of a tooth. An onlay covers one or more of those raised points, called cusps. These are options when a tooth needs more support than a filling can provide, but a full crown may not be necessary.

Advantages: They can rebuild a larger area and may preserve more of the remaining tooth than a full crown. They are made to fit the prepared tooth.

Considerations: They usually cost more than a direct filling and may need more than one appointment, although some clinics can make them in one visit. They still require preparation of the tooth and can chip or loosen.

5. Dental crown

A crown is a cover that fits over most or all of a tooth above the gum. It may be recommended when a tooth is badly broken down, has a large restoration, is weakened after root canal treatment, or needs substantial rebuilding.

Advantages: It covers and protects much of the remaining tooth and can restore its shape and chewing function.

Considerations: The tooth must be shaped to make room for the crown, so this is a more extensive treatment than a filling. Crowns may need repair or replacement over time, and the tooth underneath still needs careful cleaning.

Crowns can be made from different materials, including metal, ceramic, or a combination. The choice depends on the tooth’s position, bite, appearance needs and other clinical factors.

6. Veneer

A veneer is a thin covering bonded mainly to the front surface of a tooth. It may be used to improve the appearance of selected teeth with staining, small chips, gaps or shape concerns. It is not usually the right solution for every damaged or decayed tooth.

Advantages: Veneers can improve tooth colour and shape while covering less of the tooth than a full crown in suitable cases.

Considerations: Some enamel may need to be removed, and that change may be permanent. Veneers can chip or come loose, and active decay or gum problems should be addressed first.