A Guide to Restorative Dentistry: Restoring Damaged Teeth, Prognosis, Longevity and Cost
This guide to restorative dentistry is for anyone with a decayed, cracked, worn or broken tooth who wants to understand their options. It orders dental restorations by how much healthy tooth remains, from fillings and onlays to crowns, root canal treatment and replacement, then explains prognosis, how long each can last, what affects cost and how to look after them. In general, the less tooth lost, the smaller the repair.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, the practice's principal dentist, reviewed this page. He is a General Dental Practitioner registered with the General Dental Council, number 301711, and his qualifications are BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What is a dental restoration?
A dental restoration is a treatment that repairs or rebuilds a damaged tooth, or replaces a lost one, so it can work normally again. Fillings, inlays, onlays, crowns, bridges and dentures are all restorations. Root canal treatment is the treatment that can save a tooth whose nerve is infected, and the tooth is restored afterwards.
A tooth is built in layers of enamel, dentine and pulp. Enamel is the hard outer shell, dentine is the softer layer beneath it, and the pulp at the centre holds the nerve and blood supply. Damage that stays in the enamel usually needs far less treatment than damage that reaches the dentine or the pulp, which is why one word, restoration, covers everything from a small filling to a crown.
Restorations are made in one of two ways. A direct restoration, such as a white composite filling, is placed and shaped in the tooth at the appointment. An indirect restoration, such as a ceramic onlay, a crown or a bridge, is made outside the mouth from a scan or impression and then fitted. Composite is a tooth-coloured resin; ceramic restorations use materials such as porcelain, lithium disilicate and zirconia.
This guide is ordered by how much healthy tooth remains, because the amount of sound tooth left is a central factor in which restoration can work. The treatment sections follow that ladder at an overview level and link to the pages that go into more depth.
Why do teeth break down?
Teeth break down mainly through decay, cracks and fractures, tooth wear, and old restorations that fail. Each one removes tooth structure in a different way, and the pattern of loss shapes the repair.
Tooth decay
Tooth decay is often caused by too much sugary food and drink and not cleaning the teeth and gums regularly, according to the NHS. Bacteria form a sticky plaque that gradually damages the tooth surface. Early decay may cause no symptoms at first, and NHS guidance notes that fluoride can help reverse decay at that earliest stage, before a hole forms. Once a hole, or cavity, has formed, a filling is usually needed, and decay that reaches the pulp may need root canal treatment.
Cracks and fractures
Teeth can chip, crack or break after an injury or from grinding. Research on back-tooth fillings links larger fillings with more failures, with fracture one of the main reasons. In NHS guidance a chipped or broken tooth may be treated by bonding the fragment back on, with a filling or a crown, or with root canal treatment where the nerve is exposed. If you have chipped, cracked or broken a tooth, the NHS advises seeing a dentist; for urgent treatment, call a dentist, or call 111 if you have no dentist or cannot get an emergency appointment.
Tooth wear
Tooth wear is the gradual loss of tooth surface from acid erosion, grinding and other causes. Erosion can come from frequent acidic or fizzy drinks, or from reflux and vomiting, and grinding can wear teeth down. European consensus guidance separates the normal wear that comes with age from wear that needs managing, and puts finding the cause, prevention and monitoring before any restoration. The page on teeth that are wearing down covers the causes and stages.
Failing restorations
Fillings, crowns and other restorations do not last indefinitely. Research on white fillings in back teeth finds the main reasons they fail are new decay and fracture, and that failure is more likely in people at high risk of decay and in fillings that cover more surfaces of the tooth. A tooth that has been filled and refilled over many years can have little original tooth left, so a weakened tooth is worth checking before it breaks.
If you have noticed a change in a tooth and want to know what it might mean, the signs in our restorative symptoms section are a sensible place to start.
What is the remaining-structure principle?
The remaining-structure principle says the right restoration is the smallest one that will protect what is left of the tooth. The more healthy tooth remains, the more conservative the repair can be, which makes it a practical starting point for the question of what restoration you need.
In general, three things are weighed. The first is how much tooth is missing and where: a hole in the biting surface is different from a lost corner or a thin, undermined wall. The second is whether the cusps, the raised points a back tooth chews with, are still strong. When they are weak, a restoration that covers and protects them is usually advised, which is called cuspal coverage. The third is the health of the nerve, the gum and the bone around the root.
For a heavily broken tooth, one more measure matters: the ferrule. This is the collar of sound tooth, ideally 1.5 to 2 mm high, that a crown grips above the gum. A research review found a ferrule improves a root-treated tooth's resistance to fracture, and that even an incomplete ferrule is better than none.
Your bite, or occlusion, also plays a part. Grinding and clenching put high forces on teeth and restorations, and the NHS notes that grinding can lead to worn-down or broken teeth and the loss of fillings, so the bite is considered when a material and design are chosen.
Laboratory research comparing tooth preparations shows the trade-off: inlay and bonded designs remove far less tooth than a full crown. Tooth removed to make room for a restoration does not grow back, so keeping what can be kept is the starting point.
| How much tooth is affected (general guidance) | Restoration usually considered | What it aims to keep |
|---|---|---|
| Early decay in the enamel, no hole yet | Prevention and monitoring; fluoride can help reverse early decay | The whole tooth |
| A small or medium cavity | A white (composite) filling | Most of the natural tooth |
| A large cavity or a lost wall, with the cusps still strong | An inlay | Healthy cusps and side walls |
| A large cavity with one or more weakened cusps | An onlay, which covers those cusps | The remaining cusps and walls |
| Cusps undermined, or a root-treated back tooth | A crown (full cuspal coverage) | The root and the remaining core |
| Too little tooth for a crown to grip | A post and core (root-treated teeth only) or crown lengthening, then a crown | The root |
| Infection in the pulp | Root canal treatment, then a restoration chosen by the rows above; a back tooth is often crowned | The tooth, without its nerve |
| A tooth that cannot be restored | Extraction, then a bridge, denture or implant | Chewing and the look of the smile |
The ladder is a guide, not a rule. Two teeth with the same size of cavity can need different repairs because of the bite, the nerve or the gum, and only an examination can show which rung applies.
Which restorations are there, from smallest to largest?
Restorative treatment options run from a small white filling to rebuilding the whole mouth, in roughly the same order as the remaining-structure ladder.
White fillings
A white filling is a tooth-coloured composite resin bonded into a cleaned cavity and shaped in the same appointment, and the page on white fillings for decay and damage explains it in more depth. At the practice, a white filling appointment takes around 60 minutes, and replacing old amalgam fillings with white fillings is one of the treatments our dentists provide. Repairs for broken and chipped teeth and replacement of lost fillings are also provided.
Inlays and onlays
An inlay fills a large cavity between the cusps of a back tooth; an onlay also covers one or more cusps. Both are made to fit outside the mouth and then bonded in, and they usually keep more natural tooth than a crown, as the page on inlays and onlays for larger cavities explains. Composite and ceramic inlays and onlays are both offered at Deepcar Dental Care, and each takes 2 visits.
Crowns
A crown is a cap that covers the whole visible part of a tooth, used when a tooth is too weak or broken for a filling or onlay to protect it. The page on crowns for damaged teeth explains when full coverage is needed.
At the practice, a crown takes 2 to 3 visits, with around 1 week from preparation to fitting, and a temporary is provided in most cases. Recementing crowns that have come loose is also provided. No overseas laboratory work is used: the practice works with more than one laboratory and chooses one to suit the case.
Post crowns and crown lengthening
When a tooth has broken down close to the gum, there may not be enough left for a crown to hold on to. A post crown uses a post placed in the root of a root-treated tooth to support the crown, and post crowns are offered at the practice with either fibre posts or cast metal posts. Crown lengthening is minor surgery to the gum, and sometimes the bone, that exposes more tooth so a crown or filling can be placed, and it is done in house.
Bridges
A bridge is a fixed replacement for one or more missing teeth, supported by the teeth next to the gap, and the page on replacing a missing tooth with a bridge explains how it works. The bridges offered at the practice include conventional bridges, adhesive (Maryland) bridges and cantilever bridges. Which type is suitable depends on the teeth beside the gap and the bite, and a bridge takes 2 to 3 visits.
Dentures
Dentures are removable replacement teeth made to fit the gums. Flexible dentures and immediate dentures, which are fitted when teeth are removed, are both offered at the practice. A full denture takes 1 to 4 visits. Denture relines, which refit a denture to the current shape of the mouth, are also provided. Dentures held in place by implants are part of implant treatment, covered in the implant section of the site.
Rebuilding worn teeth and the whole mouth
In general, when many teeth are worn or damaged, restoration is planned across the whole bite rather than one tooth at a time. Tooth wear management is offered at the practice, and options include composite added to worn back teeth to rebuild the bite and bite raising appliances, and occlusal adjustment is provided where the bite needs balancing. Full mouth rehabilitation, where several teeth are rebuilt together, is also offered. Each treatment has its own page among the options in our restorative treatments section.
How are restoration materials chosen?
In general, restoration materials are chosen by balancing strength, appearance, how much tooth must be removed and the forces of your bite. No single material suits every tooth.
In general, NHS guidance describes crowns made from metal, ceramic or porcelain fused to metal. Composite is tooth-coloured and bonds to the tooth, and it is used for fillings and for some inlays and onlays. Ceramic is made outside the mouth and can match the colour of natural teeth. Two widely studied ceramic types are lithium disilicate, a reinforced glass ceramic used for inlays, onlays and crowns, and zirconia, an oxide ceramic used for crowns.
A large review of single crowns found that most all-ceramic crowns survived about as well as metal-ceramic crowns over five years. Its authors advised keeping weaker feldspathic ceramics to front teeth, and they found zirconia crowns had more technical problems in the studies included. The choice for any one tooth depends on where it sits, how much tooth is left and the bite.
To ask about restoring a damaged tooth, book online or call 0114 288 2121.
What happens when the nerve is involved?
When damage reaches the pulp, the nerve can become infected, and root canal treatment is usually the way to save the tooth. Without it, the NHS says the tooth may need to come out.
In root canal treatment, the infected pulp is removed, the canals inside the root are cleaned and shaped, and the tooth is sealed. The NHS lists tooth decay, gum disease, a chipped, broken or cracked tooth and a dental abscess as causes of pulp infection.
An infected tooth often causes toothache. The NHS advises seeing a dentist if toothache lasts more than 2 days, does not settle with painkillers, or comes with a high temperature, pain when biting, red gums, a bad taste or a swollen cheek or jaw. Out of hours, call your dentist, whose answerphone may say what to do; if you have no dentist or cannot get an emergency appointment, call 111.
Go to A&E if the area around your eye or your neck is swollen, or if swelling in your mouth or neck makes it hard to breathe, swallow or speak, and ask someone to drive you or call 999 for an ambulance rather than driving yourself.
At Deepcar Dental Care, root canal treatment is provided by a dentist with a special interest in root canal treatment and typically takes 1 to 2 visits. Rubber dam is used routinely, and a dental operating microscope, a rotary endodontic system and an apex locator are on site.
A root-treated back tooth is often protected with a crown afterwards. In one study, root-treated teeth that were not crowned were lost at about six times the rate of those that were, and reviews link a good ferrule and more remaining tooth with better survival. At the practice, a crown after root canal treatment is placed soon after where the tooth is at higher risk, or after around 3 months to let the tooth settle, decided case by case.
If infection persists after root canal treatment, an apicectomy may be an option: a surgical procedure that cleans the infection out of the bone and removes a small part of the tip of the root. A good root filling needs to be in place before an apicectomy is carried out. At Deepcar Dental Care, apicectomy is done in house. The section on root canal treatment covers each stage in more depth.
What happens when a tooth cannot be saved?
A tooth may not be worth saving when too little sound tooth, root or supporting bone remains for a repair to last. In research on root-treated teeth, cracks, the amount of remaining tooth and the ferrule are among the factors that affect whether a tooth survives.
Simple, surgical and same-day extractions are carried out at the practice. After a tooth is removed, the bone and gum where it sat shrink, fastest in the first few months, so it helps to plan any replacement before the extraction.
A missing tooth can be replaced with a bridge, a denture or a dental implant. A bridge is fixed to the teeth beside the gap, and a denture is removable and rests on the gums. An implant replaces the root as well as the tooth and is covered separately in our guide to replacing a tooth with an implant.
If you are weighing up root canal treatment against an extraction for one tooth, the page on deciding between root canal treatment and extraction sets out the trade-offs. For other choices between two treatments, you can browse the restorative comparison section.
What are the limits and risks of restorations?
Every restoration has limits: any of them can fail, and some need healthy tooth shaped away first, which does not grow back. Knowing the trade-offs helps you weigh the options.
- Crowns need more tooth shaped away than inlays or onlays, and a bridge relies on the teeth beside the gap for support.
- Grinding raises the risk of a restoration fracturing.
- Root canal treatment does not always clear an infection, and a tooth may still need further treatment or removal.
- Dentures can become loose as the gums and jawbone shrink or change shape over time, and the NHS notes that immediate dentures often need adjusting or replacing up to a year later.
- Any restoration needs good daily care and regular checks to reach the longer end of its expected life.
When two options are open for the same tooth, it helps to ask what each will need from the tooth over the years ahead, not only on the day it is placed.
How long do restorations last?
How long a restoration lasts depends on your decay risk, your cleaning, any grinding and how much tooth was left to start with. The figures below are ranges, not promises.
Prognosis is the likely outcome for a tooth over time. A tooth with a good prognosis has enough sound structure, a healthy nerve or a well-sealed root filling, healthy gums and a bite it can cope with; each problem on that list lowers it.
As a realistic guide, the practice gives these lifespan ranges: 5 to 10 years for a white filling, 5 to 20 years for a crown, 5 to 20 years for a bridge, and 5 to 10 years for a denture before it needs relining or remaking. Outcomes depend on the individual patient, their oral hygiene and their habits.
| Restoration | Realistic lifespan range (practice guide) | What published research reports |
|---|---|---|
| White (composite) filling | 5 to 10 years | Annual failure rates of 1 to 3% for back-tooth composites (Demarco and colleagues, 2012) |
| Ceramic inlay or onlay | - | About 91% still in place at 10 years (Morimoto and colleagues, 2016) |
| Crown | 5 to 20 years | Five-year survival of about 92% to 97% for most crown materials; lower for feldspathic or silica-based ceramic crowns (Sailer and colleagues, 2015) |
| Bridge | 5 to 20 years | - |
| Denture | 5 to 10 years before relining or remaking | - |
| Root-filled back tooth | - | About 87% of teeth kept at 8 to 20 years (Patel and colleagues, 2024) |
A dash means no figure is given in that column. The practice's ranges are a guide, not a promise: outcomes depend on the individual patient, their oral hygiene and their habits. Research figures are given as the studies report them, some as yearly failure rates and some as the share still in place. They are pooled from many studies and settings, so they describe groups of restorations and do not predict how any one tooth will do.
Fillings, crowns and bridges, dentures and porcelain veneers carry 12-month aftercare cover at Deepcar Dental Care, which gives free repair, free replacement or remake, and free adjustments. The cover does not apply where damage results from accidental trauma or infection, and for dentures gum recession is also excluded.
For more on how restorations and their materials work, see the options in our restorative science section.
How much does restoring a damaged tooth cost?
The cost of restoring a tooth generally rises with the size of the restoration, because larger repairs usually take more time and materials.
On the current fee list, white composite fillings are £150 to £220 and the All Ceramic Crowns & Veneers line is from £750 to £1,000. Root canal treatment is from £450 and full dentures are from £990. The new patient examination, including X-rays, is currently £39 for anyone new to the practice (one per person), usually £85.
The fee list says all its prices are “from” prices based on individual clinical needs. It names the factors that may affect the final fee as the extent of decay, damage or wear, the position and accessibility of the tooth, the condition of the surrounding gum and bone, and the time and materials required for safe treatment.
Cost is worth weighing against what a restoration keeps and how long it tends to last. A conservative repair that keeps more natural tooth leaves more options open later, while protecting a weakened tooth before it breaks may avoid a larger repair.
Restorations without their own line on the fee list, such as inlays, onlays and bridges, are covered on our page on treatment costs. If you would rather pay monthly, spreading the cost of treatment explains the options.
How do you look after restorations?
Restorations last longest in a clean mouth with a low risk of decay.
NHS guidance is to brush twice a day for about 2 minutes with a toothpaste containing at least 1,350 ppm fluoride, spit out rather than rinse afterwards, and clean between the teeth with interdental brushes, single-tufted brushes or floss. Cutting down on sugary food and drink lowers the risk of new decay around fillings and crown edges.
If you grind or clench your teeth, NHS guidance says a mouth guard or splint worn at night can help protect them. Night guards for patients who grind are provided at the practice and are charged separately.
Dentures need daily care too. The NHS advises brushing your gums, tongue and any remaining teeth morning and evening, cleaning the denture with soft soap or washing-up liquid rather than toothpaste, and taking it out at night unless your dentist recommends otherwise. See a dentist if a denture clicks, slips, no longer fits, hurts, or is worn or damaged. At the practice, dentures are reviewed every 6 to 12 months.
Regular examinations help find problems with a restoration early. At Deepcar Dental Care the standard recall interval for a healthy adult is 6 months, as part of routine dental care at our practice. More on caring for each type of restoration is in our restorative aftercare section.
Who carries out restorative treatment at Deepcar Dental Care?
At Deepcar Dental Care, crowns, bridges and dentures are provided by our restorative dentists. Root canal treatment is provided by a dentist with a special interest in root canal treatment, and fillings by our dentists.
Frequently asked questions
Should I have a filling or a crown?
It depends on how much sound tooth is left around the damage. A filling suits a cavity with strong walls and cusps around it. When the cusps are thin or weakened, a restoration that covers them, such as an onlay or a crown, is often advised, and a root-treated back tooth is often crowned.
Can a cracked tooth be repaired?
It depends on the damage. The NHS lists bonding the piece back on, a filling, a crown, or root canal treatment for an exposed nerve. Research on root-filled back teeth counts cracks among the factors affecting tooth survival. See a dentist; for urgent treatment, call a dentist, or 111 if you have no dentist or cannot get an emergency appointment.
Are crowns, bridges and dentures available on the NHS?
Yes, when they are clinically necessary. In England, crowns, bridges, dentures, inlays and onlays fall under NHS Band 3, currently £332.10, which includes everything in Bands 1 and 2. Fillings, root canal treatment and extractions fall under Band 2, currently £76.60.
Can a failing filling be repaired instead of replaced?
Sometimes. Research on back-tooth fillings finds that repairing a filling, rather than replacing it, is a valid option that can extend its life. Whether repair suits depends on how much of the filling is sound and whether there is new decay around it, which an examination shows.
Is laboratory work sent overseas?
No. No overseas laboratory work is used at Deepcar Dental Care. Laboratory work goes to more than one dental laboratory, and the practice chooses the laboratory to suit each case rather than sending all of its laboratory work to a single laboratory.
Does grinding damage fillings and crowns?
It can. Research on white back-tooth fillings counts grinding among the patient factors behind fractures, a main reason they fail. A dentist may recommend a mouth guard or splint worn at night, and the NHS advises seeing a dentist if you grind your teeth and have tooth damage, sensitive teeth or pain in your jaw, face or ear.
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You can contact Deepcar Dental Care online or by phone, and the practice is open 8am to 8pm, Monday to Sunday. If you are new to the practice, your medical history can be completed online before the visit, and it helps to bring a list of your medicines.
The practice is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH. There is free parking directly outside, and the practice is on the ground floor and wheelchair accessible. You can read what patients say about the practice in our patient reviews.
This guide sits within restorative dentistry at Deepcar Dental Care, the part of dentistry focused on saving and rebuilding natural teeth, as distinct from implant treatment.
334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
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