Patients told they need a crown often ask the same question: do I actually need a full crown, or is there a less invasive alternative? It is reasonable to ask, because a full crown involves removing significantly more tooth structure than alternatives such as inlays or onlays. At Fitzroy Dental Practice in Fitzrovia, London, our restorative team takes time to explain the reasoning behind each recommendation so that every patient understands what is being done and why.
What exactly is a dental crown, and how does it differ from an inlay?
A dental crown, also called a tooth cap or crown, is a custom-made restoration that covers the entire visible portion of a tooth above the gumline. It requires the dentist to reduce the tooth on all surfaces to create a uniform thickness of space for the crown to sit over, typically removing 1.5 to 2mm of tooth structure circumferentially.
An inlay, by contrast, fits within the cusps of a tooth and replaces only the damaged or decayed portion that sits inside the biting surface. An onlay extends slightly further, covering one or more cusps but not the full tooth. Both require significantly less tooth reduction than a crown, making them more conservative restorations when clinically appropriate.
What is the difference between a tooth cap and a crown?
There is no clinical difference. “Tooth cap” and “dental crown” describe the same restoration. The word “cap” is simply the more colloquial term patients and older dental literature use, whilst “crown” is the standard clinical term. Both refer to a full-coverage restoration cemented over a prepared tooth. Similarly, “crown teeth” simply means teeth that have had crowns placed.
Is a dental crown the same as a tooth crown from the lab?
Yes. All conventional crowns are fabricated in a dental laboratory from an impression or digital scan of the prepared tooth. The laboratory mills or presses the crown from the chosen material, and the dentist cements it permanently at a separate appointment, typically one to two weeks later. Some practices with chairside CAD/CAM milling equipment can produce a crown in a single visit, though this is less common in the UK than in some other markets.
When does a tooth genuinely need a full dental crown rather than an inlay?
The key clinical indicators for a full crown over an inlay or large filling are:
- More than approximately 50% of the natural tooth structure has been lost to decay, fracture, or previous restorations, leaving the remaining walls too thin to reliably support a partial restoration
- The tooth has undergone root canal treatment and is at risk of fracture due to the brittleness that develops after the pulp is removed, particularly in back teeth.
- One or more of the tooth’s cusps have fractured or are cracked, requiring full-coverage protection.
- A large existing filling has failed, and insufficient sound tooth structure remains for a direct replacement.
- Significant wear from grinding or acid erosion has reduced overall tooth height and requires restoration of vertical dimension.
Where decay or damage is more limited, and the surrounding tooth walls are sound, an inlay or onlay often provides a better clinical outcome than a crown: less tooth removal, better long-term periodontal health around the margin, and comparable or superior longevity in the right case.
What are the disadvantages of dental crowns compared with inlays?
The primary disadvantage of a dental crown is the extent of tooth preparation required. Removing healthy tooth structure is an irreversible step, and once a tooth has been prepared for a crown, it requires a full-coverage restoration for the rest of its life. Exposed dentine after preparation can cause temporary sensitivity, and the preparation process carries a small but real risk of pulpal irritation that may occasionally lead to a need for root canal treatment, particularly in teeth with large existing restorations.
Inlays avoid much of this by working within the existing tooth architecture. They are bonded into place and, in experienced hands using ceramic materials such as E.max, can achieve excellent longevity comparable with crowns in many situations.
Can an inlay fail and then require a crown afterwards?
Yes, and this is worth understanding before choosing between the two. If an inlay cracks, debonds, or if further decay develops around the margins in the years following placement, the remaining tooth may at that point have insufficient structure for a replacement inlay, making a crown the next step. This is not a reason to choose a crown unnecessarily at the outset, but it is a reason to maintain good oral hygiene and attend regular reviews so that any marginal changes are caught early.
What materials are used for dental crowns, and does the material matter clinically?
The three main crown materials at a quality London private practice are zirconia, E.max lithium disilicate, and porcelain-fused-to-metal (PFM). Each has a different profile in terms of strength, aesthetics, and appropriate clinical use:
- Zirconia: the strongest all-ceramic option, with flexural strength of 800 to 1,200 MPa. Preferred for back teeth under heavy load and for patients with grinding habits
- E.max lithium disilicate: superior optical translucency that closely mimics natural enamel. The preferred choice for front crowns and premolars where aesthetics are the priority
- PFM: a porcelain outer layer bonded to a metal coping. A durable option with a long clinical track record, though the metal margin can show as a grey line at the gumline over time as gums naturally recede
Gold remains a clinically valid choice for specific situations, particularly upper molar crowns in patients not concerned about aesthetics, where its durability and minimal preparation requirements are genuine advantages.
Is a tooth crown worth it if the tooth is not causing pain?
Yes, in most cases where your dentist has identified genuine structural reasons for one. A tooth that lacks sufficient wall strength to withstand normal chewing forces may crack catastrophically without warning, potentially resulting in a fracture that cannot be restored and requires extraction. A crown placed before this happens protects both the tooth and the bone supporting it. Waiting until a tooth causes pain often means waiting until damage has extended further, making treatment more complex and more expensive.
How much does a dental crown cost in the UK, and what affects the price?
A private dental crown at a quality London practice typically costs between £800 and £1,800 per tooth, depending on the material, the complexity of preparation, and the laboratory used. Zirconia and E.max crowns sit toward the upper end of this range; PFM options typically cost somewhat less. NHS crowns fall within Band 3, which carries a fixed patient charge of £332.10, regardless of material or number of crowns within a single course of treatment.
Additional costs to factor in include root canal treatment if needed before the crown is placed, any post-and-core build-up where insufficient natural structure remains, and the initial consultation and CBCT imaging if not already carried out. At Fitzroy, we itemise all anticipated costs in a written treatment plan before any work begins.
Is a dental crown covered by the NHS, or do I need to go private?
Crown treatment is available on the NHS under Band 3 (£332.10). However, NHS crowns offer limited material choice and less appointment time than private treatment, and the availability of NHS dental treatment in central London is restricted. Patients seeking a specific material, a more refined aesthetic outcome, or faster access to treatment typically opt for private provision. At Fitzroy Dental Practice, we are a private clinic and do not provide NHS treatment.
How long does a dental crown last, and when does it need replacing?
Well-maintained crowns from reputable laboratories typically last between ten and twenty years, with many lasting longer. The most common reasons for replacement are decay developing beneath the crown margin, fracture of the porcelain layer (most common in PFM and E.max under heavy grinding forces), and gum recession exposing the margin. Regular dental examinations allow your dentist to monitor the crown and identify early changes before they require immediate intervention.
How do I know whether my dentist's recommendation for a crown is the right call?
Ask your dentist to show you, on an X-ray or clinical photograph, what is driving the recommendation. A good restorative dentist will explain the remaining tooth structure, the extent of any cracks or decay, and why a crown is preferable to an inlay or large composite filling in your specific case. If the explanation makes sense clinically and the tooth genuinely has limited remaining structure, the recommendation is almost certainly sound.
A second opinion is always your right if you are uncertain, particularly for a treatment as significant as a crown that requires irreversible tooth preparation. Reputable dentists welcome informed patients who ask questions, and the right answer should be the same regardless of which qualified clinician you ask.
If you have been told you need a crown and want an honest assessment of your options, or if you would like to understand whether an inlay might suit your situation, the team at Fitzroy Dental Practice is here to help. Visit our dental crowns or inlay page for more information or find us at 14 Fitzroy Square, Fitzrovia, London W1T 6AH. Call us on 020 7387 3317 or book online.
Common Questions Asked About Crown vs Inlay
Should I get a crown or an inlay?
A crown covers the entire tooth, while an inlay restores damage within the tooth without covering the whole tooth. Your dentist selects the appropriate restoration based on the amount of remaining tooth structure, the location of the damage and the tooth’s strength.
How do I know if I actually need a crown?
You might need a dental crown when decay, a large filling, fracture or other damage has significantly weakened the tooth. Your dentist assesses the remaining tooth structure and considers whether a filling, inlay, onlay or other restoration provides sufficient protection.
At what point can you not put a crown on a tooth?
A dental crown requires enough healthy tooth structure to support and retain the restoration. Extensive damage, decay or insufficient remaining tooth structure can prevent successful crown placement, requiring alternative treatment such as root canal treatment or extraction.
Is an inlay more expensive than a crown?
An inlay is not necessarily more expensive than a dental crown because the cost depends on the material, laboratory work and complexity of treatment. Both restorations are custom-made treatments, and your dentist should explain the available options and costs before treatment.
Why do dentists push for crowns?
Dentists recommend dental crowns when a tooth needs full coverage to restore its strength, function or appearance. A crown is not automatically appropriate for every damaged tooth, so your dentist should explain the clinical reason, alternatives, risks and expected outcome before treatment.
