Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/22/2008

Question
It's my impression that onlays should last decades when well treated. I've worn a night guard to protect my teeth from grinding when I'm asleep, and I never chew really hard, hot, or cold things. My dental hygiene is good.

I've had this permanent onlay for 3 years in a molar, and it just popped out when I was flossing. I had orthodontics (put on and taken off) in the mean time [there was a metal ring around that molar]. Could this have weakened the onlay? SHould my orthodontist partly be responsible?

How should I approach my dentist? I am mad that her work didn't last, and wonder if her repair will, but figure there's no benefit in expressing this, as she is going to just defend herself. I'm also wondering if she'll give a price break on the repair vs. going to a different dentist for the repair. Should I phone around for price comparisons?

How long can I leave my tooth in this state without risk to it? My remaining tooth is not causing me severe pain; just sensitive to heat/cold.

PS I stopped seeing this dentist a few years back as I thought her prices were on the high side as her office advertises expensive cosmetic dentistry, and I hadn't been happy with how the office manager handled a previous debockle, nor a  gum specialist she referred me to.

Answer
Dear Gillian,

I certainly understand that it is distressing to have your onlay fall out in only than three years.  Onlays should last longer, but ocassionally they do not. If it is not broken, it maybe possible to be recemented.

You should visit a dental office within a week or less, to see if the onlay can be reused.  If it still fits and there is no decay it maybe possible for a dentist to reinsert it.

Although onlays are touted as the "best" and most conservative restoration for restoring a tooth missing extensive tooth structure, I have found them to have a higher failure rate than some other types of restorations.

Gold Onlays are a durable restoration and can last from 10-50 years, but occasionally they can come loose if they are not impeccably made. Some studies have found a relatively high failure rate for porcelain onlays as compared to direct composite fillings or cemented crowns.

If you were my patient and your Onlay had failed in only three years, I certainly would extend you a courteously towards your next restoration, if I was not able to re-insert the onlay.  Usually I extend a 50% fee reduction for the replacement restoration.

I would call the dentist office ASAP and 'politely' ask for the dentist's "advice" and ask if she will extend any courteously for a replacement restoration if it is needed. If not, you are not going to her any way. If you are not happy with her response, you should find a dentist that you like.  Do not necessarily choose the low bidder! Find one that answers your questions and makes you feel comfortable.

I have written a short article on the subject of how to choose the best dentist and you can find it at:

http://www.lspindeldds.com/how_do_i_choose_the_best_dentist

If this link doesn't work, just copy and past the web address into your browser.

I hope I have answered your questions and please feel free to contact me again with any future dental questions.