Dental Crowns and Bridges
in Henderson
What decides a crown is how much sound tooth stands around the repair, not how large the cavity looked on the X-ray. Dr. Goh reads that at the chair, once the decay is out and he can see what remains. A filling while there are solid walls to bond to. An onlay when only the biting surface has given out, and a crown when the walls themselves need cover.
You have probably heard the sentence, maybe twice.
A tooth you have already had filled needs work again, and this time the answer is a crown rather than another filling. It sounds like a bigger number for the same problem. It is an argument about structure, and it takes two minutes to see.
A filling sits inside the tooth and leans on the walls around it. Part of every bite travels sideways, out against those walls, and a wide filling leaves less wall to take it. Those walls flex a little under that push, thousands of times, for years. What that flexing does next is the part that decides your appointment.
The crack starts in a corner nobody can see
Stress gathers at the deepest inside corner of a filling, where its floor meets a wall. Cracks begin at that corner, and they travel down toward the root rather than out to the surface where you might spot one. Nothing hurts while a crack grows, because it has not reached the nerve. The first sign is usually a sharp twinge when you release a bite rather than when you press down. The crack opens as you load the tooth, and the two halves rub together as that pressure comes off.
Where it breaks decides what you can keep
Sooner or later a cusp shears away, and the height of that break changes everything. A break above the gum leaves a rim of tooth for a crown to grip. A break that runs below the gumline and into the root leaves far fewer options. That is the real reason to look at a tooth that twinges now, while the crack is still short.
What a crown does that a filling cannot
A crown covers the cusps and wraps the outside of the tooth. The same bite force then squeezes the walls together instead of spreading them apart. That is the whole difference between the two, and it is mechanical rather than cosmetic. Once the repair would be wider than the walls still standing, cover beats fill, whatever the X-ray looked like.
A crown costs you something, and you should hear it before you agree to one.
Shaping a tooth for a crown takes healthy structure from every side, and enamel does not grow back. That is exactly why Dr. Goh will not reach for a crown while a filling still has solid walls to bond to. Watching a small finding and checking it again at the next visit stays a real option here, not a stalling tactic.
A crown reduces the whole tooth, including walls that never gave out.
An onlay does less. It covers only the cusps that failed and bonds onto the sound structure beside them, so your own outer walls stay where they are.
That puts an onlay in a narrow band of cases. There has to be more damage than a filling can carry, and enough solid tooth for the onlay to bond to. Once several walls have gone, an onlay has nothing to hold, and a full crown becomes the honest answer. Dr. Goh makes that call after the decay is out, with you looking at the same tooth he is.
A bridge is one piece, not three separate crowns sitting side by side.
A gap does not stay a gap
You may have lost a back tooth years ago and simply learned to chew on the other side. The empty space is the smaller half of the problem. Each tooth holds its position because of the two teeth beside it and the tooth it meets in the opposite jaw. Take one out of the row and the neighbors tip slowly toward the space, while the tooth above or below drifts because nothing meets it. Your bite changes shape, food packs into the tilted contacts, and the space grows harder to restore later.
Two teeth carry all of it
One crown goes on the tooth in front of the gap, another on the tooth behind it, and a middle unit joins them. That middle unit, the pontic, rests against the gum and draws no support from it. Your two anchor teeth carry the entire load, so two roots now do the work that three teeth used to share.
Both anchors need shaping for crowns before they can carry the span.
When those teeth already hold large fillings or crowns, that shaping costs you little. When both are sound, a bridge asks you to spend healthy structure on two teeth in order to replace one. Dr. Goh says that out loud before you decide, because it is the real trade and the call belongs to you.
Cleaning under the middle unit decides how long it lasts
The three units join into one piece, so ordinary floss will not pass between them. You thread it underneath the pontic instead, with a floss threader or a water flosser, once a day. Decay starts at the margin where each crown meets its anchor tooth, and that margin sits right at the gumline.
A bridge almost never fails in the middle.
It fails from the anchor teeth inward, and because the units join, trouble in one anchor takes the whole span off.
The ridge of gum under a pontic can also change shape over the years, so a small space may open beneath it. The shape Dr. Goh gives that middle unit, and the way you clean under it, are what keep that space from packing with food.
An exam and the imaging that matters come first.
Dr. Goh tells you which path your tooth is on before he starts, not after.
Numb, clear and shape
You get a written, itemised plan before any work starts. On the day, Dr. Goh numbs the tooth with local anesthetic, and nitrous oxide is there if you want the visit to feel easier. He clears out the decay and the old filling material. Then he shapes what remains, so the crown carries an even thickness of ceramic all the way around.
Local anesthetic · nitrous availableScan, design and mill
A digital scan of the shaped tooth replaces the old tray of impression material. Dr. Goh designs the crown on screen and mills it from a ceramic block in the office. He checks how it meets the teeth beside it and the tooth above it. He adjusts the bite while you can still tell him how it lands, then bonds it in place. For the cases that suit it, that is one visit with no temporary crown and no second appointment.
One visit when the case suits itThe cases that take two visits
Not every case suits the mill, and you should know which one you are. A front tooth often reads more naturally in layered ceramic from a lab. A margin that sits below the gum sometimes needs the tissue to settle before anything final goes on. A bridge always runs over two visits, because a lab builds the span between them.
Two visits · lab-built spanA crown replaces structure.
It does not remove the force that broke the tooth.
If clenching, bracing and grinding cracked one molar, that same load lands on the new crown and on the tooth next to it. Bruxism arrives in bursts through the night rather than as steady pressure, and most people have no idea they do it. A night guard protects the surfaces of your teeth, and on its own it does not address the cause.
So the exam looks past the broken tooth.
Dr. Goh checks how your teeth meet, where the wear facets sit, and whether your jaw feels tired in the morning. Restoring a tooth without asking that question is how people end up restoring it twice.
The honest answers.
11 questionsBring the tooth in before it decides for you.
A crown consultation takes twenty unhurried minutes, with the imaging that matters. You leave with an honest read on whether that tooth wants a filling, an onlay, a crown, or nothing at all for now. You also leave with a written, itemised plan and no pressure to start the same day.
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