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Teeth that have decay with cuspal involvement usually require onlays or crowns for additional strength. An onlay is a restoration that is fabricated to restore one or two cusps, while a crown is needed to restore or cover all the cusps. Unlike an onlay, a crown requires more removal of tooth structure to allow the crown to fit similar to a cap. An onlay would only require the removal of structure that is decayed, leaving healthy tooth structure intact.

Maintaining tooth structure increases the prognosis of the tooth if the restoration should fail in the future. If the restoration should fail, a second restoration would not be possible if there is not adequate tooth structure to support it. As dentists, we encourage the long-term prognosis of the tooth, and to work together with our patients to select the best and most minimally invasive procedures