General Dentistry · Decision Guide · Last reviewed May 2026
Cavities: The Right Restoration
For The Size of Decay.
Picasso Dental treats cavities with the smallest restoration that will reliably last, escalating in six clear tiers from a composite filling for small decay, to a porcelain inlay or onlay for larger cavities with cusps intact, to an overlay when a cusp is lost, to a full porcelain crown when most of the tooth is gone, to a root canal plus crown when decay has reached the pulp. The choice is made after a clinical exam and bitewing X-ray, no oversized fillings, no new amalgam, no upselling.
How Cavities Are Treated
A cavity is treated by removing the decayed tissue under local anaesthetic and rebuilding the tooth with the smallest restoration that will reliably last under chewing load. The right restoration depends on how much healthy tooth structure remains after the decay is cleaned out. Small to moderate cavities are filled directly with tooth-coloured composite. Larger cavities, where the chewing surface is involved but the cusps are still intact, are restored with a porcelain inlay or onlay made in the lab and bonded into the tooth. When a cusp has been lost, an overlay or tabletop covers and protects the remaining structure. When more than 70 percent of the tooth is destroyed, only a full crown distributes chewing forces safely. When decay has reached the inner pulp, the pulp is cleaned out (root canal treatment) and the tooth is then restored with a crown. The decision is made after a clinical exam and bitewing X-ray, sometimes assisted by transillumination or CBCT, before any drilling begins.
The Decision Matrix
How our general dentists size the restoration to the cavity. Every escalation step has a clear clinical reason, oversized fillings simply do not last.
| Cavity Stage | Tooth Loss | Best Restoration | Visits | Lifespan |
|---|---|---|---|---|
| Small (white spot or surface) | Minimal | Fluoride or ICON resin infiltration | 1 | n/a (preventive) |
| Small to moderate cavity | <30% | Composite filling | 1 | 5 to 10 years |
| Large cavity, cusp intact | 30 to 50% | Porcelain inlay/onlay (Emax) | 2 | 10 to 15 years |
| Cavity with cusp loss | 50 to 70% | Porcelain overlay/tabletop | 2 | 10 to 15 years |
| Cavity destroying tooth structure | >70% | Crown (Emax/Zirconia) | 2 | 10 to 15 years |
| Cavity reached pulp | (variable) | Root canal + crown | 2 to 4 | 10 to 15 years |
For per-tier pricing see our cost guide.
Why Picasso for Cavities
The treatment is technically straightforward, the discipline is in choosing the right tier and stopping there.
Composite Only, No New Amalgam
Every filling we place is tooth-coloured composite. We do not place new amalgam (silver) fillings under any circumstance. Existing amalgam can be replaced on request.
Digital Cavity Detection
Bitewing X-rays catch interproximal decay (between teeth) that is invisible to the naked eye. Transillumination picks up early enamel cracks and shadow patterns. CBCT is used for unusual cases.
Conservative Preparation
We remove decayed tissue, not healthy tooth. Modern adhesive composites bond to less invasive cavity preparations than older filling materials required, so we keep more of your natural tooth.
Autoclave Sterilisation
Autoclave sterilisation across all six branches. Single-use burs where appropriate.
English-Speaking Dentists
Treatment is explained, quoted and consented to in English. Every option is presented with its tradeoff, you decide before any drilling begins.
Transparent Escalation Policy
We do not place oversized fillings to keep the price low and we do not push you up to a crown when an inlay would do the job. The escalation table above is exactly how we decide.
Signs You May Have a Cavity
Many cavities are silent until they reach the inner layer of the tooth. If you have any of these signs, book an exam.
Visible Dark Spot
A dark or brown spot on a tooth surface, often on the chewing surface or near the gumline, that does not brush off. Early decay often shows as a chalky white spot before it darkens.
Sensitivity to Sweet, Cold or Hot
A sharp, short-lived twinge when you eat sugar, drink something cold, or sip hot tea. This usually means decay has reached the dentine layer beneath enamel.
Pain on Biting
A specific tooth that hurts when you bite down on it, often on one side. Suggests the cavity has weakened the tooth or that a cusp is starting to crack.
Food Trapping in One Spot
Floss catches or food packs into the same spot every meal, where it never used to. Often the first sign of decay between two teeth (interproximal cavity), invisible to the naked eye.
Broken or Rough Filling Edge
An older filling has chipped, has a rough edge, or shows a dark line at the margin. Decay frequently restarts under or beside an aged filling.
Intermittent Throbbing (Advanced)
A dull, throbbing ache that comes and goes, sometimes worse at night, sometimes triggered by hot food. This is a late-stage sign that decay is approaching or has reached the pulp, and root canal treatment may be needed.
Cavity Treatment Pricing
Per-tooth pricing across the full restoration range is published on our cost guide. Quotes are written before any treatment and do not change without your consent.
When ICON Resin Infiltration Is the Right Choice
ICON is a non-drilling treatment for the very earliest stage of decay, the white-spot lesion. A low-viscosity resin is infiltrated into the demineralised enamel, sealing the lesion before it progresses to a true cavity. It is the only realistic option for stopping decay without drilling, but it only works at the white-spot stage. Once the surface has broken, ICON is no longer enough and a composite filling is needed. Indications: surface white-spot lesions, early decay caught at six-monthly check-up, post-orthodontic decalcification marks.
How We Diagnose
A cavity that looks small to the naked eye can extend deep between teeth or under an old filling. Diagnosis matters as much as the restoration that follows.
Visual Examination
Direct inspection of every tooth surface under operating light, looking for dark spots, broken margins, white-spot lesions and stained pits and fissures.
Bitewing X-ray
Catches decay between teeth (interproximal cavities) and under existing fillings, where visual examination cannot reach. Standard at every six-monthly check-up.
Transillumination
A bright fibre-optic light shone through the tooth makes early enamel cracks and shadow patterns from interproximal decay visible without radiation.
Soft Probe
A blunt periodontal probe checks the integrity of suspect surfaces. We do not push a sharp explorer into early lesions, doing so can break through enamel that fluoride could otherwise remineralise.
CBCT for Unusual Cases
Three-dimensional cone-beam imaging is used when a cavity is suspected but not visible on bitewings, when a tooth is unusually painful without obvious cause, or when planning a root canal on a complex tooth.
Photographic Records
Clinical photographs document the cavity before treatment so progress and any re-treatment over the years are traceable in your record.
Aftercare for Composite Fillings
Composite is set hard at the moment of placement, you can eat as soon as the anaesthetic wears off. A few short-term cautions.
First 24 Hours
Mild sensitivity to cold is normal, especially with deeper fillings. Avoid extremely hard or sticky food on the filled tooth for the first day while the bite settles.
First Week
Cold sensitivity should fade gradually over the first week. If your bite feels high (the tooth touches before others when you close), call us, a quick adjustment takes minutes.
Sustained Pain Beyond One Week
Return for assessment. Occasionally a deep cavity has irritated the pulp and the tooth may need additional care, including the possibility of root canal treatment.
Long-Term Care
Brush twice daily, floss the contact points either side of the filling, and keep six-monthly hygiene visits. Decay restarting beside an old filling is the single most common reason fillings need replacement.
The Doctors Treating Cavities
Dr. Thao Tran
General Dentist. Routine and complex cavity restorations across the full escalation range, from small composite fillings to inlays, onlays and root canal therapy.
Dr. Nhung Duong
General Dentist. Composite fillings and restorative dentistry, focused on conservative preparation and shade-matched aesthetics on both front and back teeth.
Dr. Emily Nguyen
Founding Clinical Director. Sets clinical standards group-wide for case selection and prosthetic delivery, including the escalation criteria from filling to inlay to crown to root canal.
Common Questions
How do I know if I have a cavity?
Common signs are a visible dark spot or hole on the tooth, sensitivity to sweet, cold or hot food, pain on biting, food trapping in one specific spot, a rough or broken edge to an existing filling, and intermittent throbbing in advanced cases. Many cavities are silent until they reach the inner layer of the tooth, which is why six-monthly check-ups with bitewing X-rays catch decay long before symptoms appear.
Can a cavity heal itself?
Only the very earliest white-spot lesions, where decay has demineralised enamel but not yet broken through it, can be reversed with fluoride or remineralising treatments. Once the surface is broken and a true cavity has formed, the tooth cannot heal itself and a filling or other restoration is needed. Catching decay at the white-spot stage is the only window for non-drilling treatment.
Do you place silver amalgam fillings?
No. Picasso does not place new amalgam fillings. Every cavity restoration is tooth-coloured composite, porcelain inlay, porcelain overlay or full ceramic crown. We can replace existing amalgam fillings with composite or porcelain on request.
Will the filling match my tooth?
Yes. We shade-match composite to your natural tooth before placement. On front teeth, a well-placed composite is invisible at conversational distance. On back teeth, the difference between a tooth-coloured filling and natural enamel is also virtually undetectable.
Will the cavity treatment hurt?
Cavity treatment is performed under local anaesthetic and is not painful at the time. Mild sensitivity to cold for a few days afterwards is common, especially with deeper fillings, and usually resolves within a week. Sustained pain beyond a week should be reported, occasionally a deep cavity has irritated the pulp and may need additional care.
How long do composite fillings last?
At Picasso, composite fillings carry a clinical expectation of 5 to 10 years before replacement, depending on size, location, your bite and your hygiene. Smaller fillings on front teeth tend to last longer; large fillings on back teeth carrying heavy chewing load wear faster. Once a composite filling becomes large enough to occupy more than half the tooth, the next restoration is usually an inlay, onlay or crown, not a bigger filling.
What if my cavity is too big for a filling?
When the cavity occupies roughly 30 to 50 percent of the tooth and the cusps are still intact, a porcelain inlay or onlay (Emax) is the right restoration. When 50 to 70 percent of the tooth is gone or a cusp is fractured, an overlay or tabletop covers the chewing surface. When more than 70 percent of the tooth is destroyed, a full porcelain crown is the only restoration that will reliably last.
When do I need a root canal?
A root canal is needed when decay has reached the inner pulp of the tooth, where the nerve and blood supply live. Signs include sustained throbbing pain, pain that wakes you at night, severe sensitivity to hot food, swelling around the tooth, or a darkened tooth. After root canal treatment the tooth is restored with a crown because the now-hollow tooth is more brittle than a live tooth.
Can I just leave a small cavity untreated?
No. Cavities do not stop on their own. A small cavity that needs only a composite filling today becomes a large cavity that needs an inlay or crown in two to three years, and potentially a root canal plus crown if it reaches the pulp. The cost curve of untreated decay is brutal, the time window for cheap treatment is short.
Do you do white fillings on back teeth?
Yes. Every filling we place, front or back, is tooth-coloured composite. Modern composite is strong enough to handle posterior chewing forces in moderate cavities. Once a back-tooth cavity becomes large enough that a filling cannot reliably support the chewing load, we switch to a porcelain inlay, onlay or crown rather than placing an oversized filling.
Start Here
Catch Decay Early.
Pay Less. Keep More Tooth.
Book a free consultation. We'll examine every tooth, take bitewing X-rays where indicated, identify any cavities by stage, and quote the right tier of restoration in writing before any drilling begins.