Hi Everyone,

So I got two different opinions for what I should do with my
Tooth #31 bottom, back, right-side molar:

Dentist #1) Surface: DOLB, Code: D2394, Prov: DDS2, Resin
Composite-4+s, posterior, Fee=$162.

Dentist #2) Surface: DO, Code: D2642, Provider: DTS, Onlay-
Porcelain/Ceramic-2, Fee=$624.

So whose recommendation would you all go with? What is the difference in the filling materials? Why are the surface, code, and providers different?

Thanks for your advice....

Slick

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On 5/24/2018 8:34 PM, Dr. Slick wrote:

Hi Everyone,

So I got two different opinions for what I should do with my
Tooth #31 bottom, back, right-side molar:

Dentist #1) Surface: DOLB, Code: D2394, Prov: DDS2, Resin
Composite-4+s, posterior, Fee=$162.

Dentist #2) Surface: DO, Code: D2642, Provider: DTS, Onlay-
Porcelain/Ceramic-2, Fee=$624.

So whose recommendation would you all go with? What is the difference in the filling materials? Why are the surface, code, and providers different?

Thanks for your advice....

Slick

Are you sure these codes relate to the same tooth? The surfaces ARE different--DOLB vs. DO. You see that the DOLB is 4-surfaces (4+ = four
or more) while DO (the second dentist) is 2 surfaces.
Depending upon the width of the restoration, there is a certain amount
of clinical judgment as to how to extend the margins of a restoration,
based generally on both the condition of the tooth and the perceived
qualities of the material. So if you went to 2 different dentists and
got 2 different proposed restorations, there is not always a clear "one
is right, the other wrong". Were I to examine you, I might agree with
one or the other, or I might well come up with a third option.
A porcelain restoration will generally be considerably costlier than a composite restoration, as it requires more time, generally a lab or an in-office milling machine. This is reflected in the much higher price
for the second dentist's choice.
Old farts like me will also consider amalgam, cast gold or other
restoration, given that it is rare that anyone but your dentist is
likely to be able to see it after it is done.
The materials themselves have various relative strengths and weaknesses
which we can discuss in general, but there could well be particular
factors related to you that could also affect the choice of restorative material.
For instance, porcelain is not the best choice for a patient who
clenches or grinds his/her teeth during sleep.
Hope this helps.

Steve

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On Tuesday, May 29, 2018 at 8:49:59 AM UTC-7, Steven Bornfeld wrote:

On 5/24/2018 8:34 PM, Dr. Slick wrote:

Hi Everyone,

So I got two different opinions for what I should do with my
Tooth #31 bottom, back, right-side molar:

Dentist #1) Surface: DOLB, Code: D2394, Prov: DDS2, Resin
Composite-4+s, posterior, Fee=$162.

Dentist #2) Surface: DO, Code: D2642, Provider: DTS, Onlay-
Porcelain/Ceramic-2, Fee=$624.

So whose recommendation would you all go with? What is the difference in the filling materials? Why are the surface, code, and providers different?

Thanks for your advice....

Slick

Are you sure these codes relate to the same tooth? The surfaces ARE different--DOLB vs. DO. You see that the DOLB is 4-surfaces (4+ = four
or more) while DO (the second dentist) is 2 surfaces.
Depending upon the width of the restoration, there is a certain amount
of clinical judgment as to how to extend the margins of a restoration,
based generally on both the condition of the tooth and the perceived qualities of the material. So if you went to 2 different dentists and
got 2 different proposed restorations, there is not always a clear "one
is right, the other wrong". Were I to examine you, I might agree with
one or the other, or I might well come up with a third option.
A porcelain restoration will generally be considerably costlier than a composite restoration, as it requires more time, generally a lab or an in-office milling machine. This is reflected in the much higher price
for the second dentist's choice.
Old farts like me will also consider amalgam, cast gold or other restoration, given that it is rare that anyone but your dentist is
likely to be able to see it after it is done.
The materials themselves have various relative strengths and weaknesses which we can discuss in general, but there could well be particular
factors related to you that could also affect the choice of restorative material.
For instance, porcelain is not the best choice for a patient who
clenches or grinds his/her teeth during sleep.
Hope this helps.

Steve

Ok, thanks for the response, Steve. I was told that I grind my teeth
mildly during sleep, or mild bruxism.

Here's what someone else said:

"If it were my tooth I'd go with the composite and see if that fixes the symptoms. I have had a tooth with a crack successfully treated in this way. I'd personally go for a gold onlay if it's needed further down the line. But hopefully a dentist
will answer your query and give you the technical response. Bear in mind that all dentists have their own preferences on such treatment. The composite would be favoured by a conservative dentist because it removes less tooth and that's considered better
for the long term health of the tooth. In my case it worked but it really depends on the skill of the dentist because composite as I understand it is not always easy to work with."

So do you agree that the composite would be better for the long term health
of the tooth, because it removes less of the tooth?

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On 6/5/2018 6:47 PM, The Man wrote:

Ok, thanks for the response, Steve. I was told that I grind my teeth
mildly during sleep, or mild bruxism.

Here's what someone else said:

"If it were my tooth I'd go with the composite and see if that fixes the symptoms. I have had a tooth with a crack successfully treated in this way. I'd personally go for a gold onlay if it's needed further down the line. But hopefully a dentist

will answer your query and give you the technical response. Bear in mind that all dentists have their own preferences on such treatment. The composite would be favoured by a conservative dentist because it removes less tooth and that's considered better
for the long term health of the tooth. In my case it worked but it really depends on the skill of the dentist because composite as I understand it is not always easy to work with."

So do you agree that the composite would be better for the long term health of the tooth, because it removes less of the tooth?

Porcelain is generally not a great choice for people who grind or clench
their teeth. You don't say that composite would be used to onlay the
cusps (as you said for porcelain). Resin will put less stress on the
tooth, but considerations such as need to cover the cusps will determine
the extension of the restoration. Composite MAY be more conservative in
that the cavity does not need to be engineered for retention as much.
But other considerations may require it to cover just as much tooth
structure as other materials. And especially in someone who clenches or grinds, it will wear more rapidly than most other materials. This may
be a satisfactory trade off, if you can accept that bonded resin may not
last as long and may need replacement sooner.

Steve

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