DENTAL CROWN PROCEDURE

CROWNS:

• What is a Crown and The Dental Crown Procedure
• Why Are Teeth Crowned
• Large Amalgams and Crowns
• Contributing Factors
• What Are Crowns Made Of- Full Gold vs Full Porcelain, Porcelain Fused to Metal/Gold, Lava
• Crown Failures, Occlusion, Open Contacts, Fractured Porcelain, Decay

Tooth Bridges:

• Pontics and Abutments
• Bone Grafts
• Maryland Bridges
• Cantilever Bridges
• Dentures, Dental Plates, Partial Dentures

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WHAT IS A CROWN (also called a CAP) and WHAT IS THE DENTAL CROWN PROCEDURE?

Usually done in two appointments, the preparation appointment, then the seating appointment.

PREPARATION:

The first appointment of the dental crown procedure is the preparation. The tooth is reduced on all 4 sides plus the top in order to make room for the crown. This is also when any decay is removed and filled accordingly. The dentist will take an impression of the tooth and make a temporary crown, which will stay on for 2-3 weeks until the final crown is seated (at the second appointment).

THE SEATING:

The second appointment of the dental crown procedure involves seating the crown. The temporary crown is removed and the final crown is fitted onto the tooth. This normally involves some adjustments, and then the crown is cemented onto the tooth.

The crown will be made on a model in a LAB (this is the reason for the 2 appointments).

Some dental offices have CEREC milling machines, in which case your dental crown procedure can be done in a single visit. This is not available in the majority of dental offices at this time, although the technology points towards this in the future.

SO WHY ARE TEETH CROWNED??

Teeth are crowned for a number of reasons... most often being because of INSUFFICIENT TOOTH STRUCTURE.

When a tooth BREAKS, IF there is not enough tooth structure to SUPPORT A FILLING, you may need a crown.

HOW MUCH TOOTH IS NOT ENOUGH??

In POSTERIOR teeth (in the back), if part of it fractures, a crown would be the next logical step. Large fillings can sometimes be placed, but if the tooth has fractured once already, most likely if you put a larger filling in a tooth, it will fracture again.

WHY ELSE are teeth crowned??

Many dentists will have you believe that teeth NEED to be crowned to PREVENT fracture. This IS TRUE in BACK TEETH that have had ROOT CANALS done.

LARGE AMALGAMS:

Large amalgam fillings can cause fractures in teeth over time. More and more dental offices are equipped with intraoral cameras (cameras which take pictures of your teeth from inside your mouth), and it is very common to see fracture lines on teeth with large amalgams.

Once the dentist can detect the fracture with his or her instruments, it is likely that that tooth will fracture at some point. Doing the dental crown procedure can prevent that from happening.

Yes, crowns are expensive, but if it is not done and the tooth fractures, it is possible that that tooth may be lost, or need to be root canaled , or even extracted . Both of which would be much more expensive than that single crown.

CONTRIBUTING FACTORS???

Patients who have bad PERIODONTAL DISEASE may not be the ideal situation to place a crown, but if the tooth is going to break without one, just be aware that your tooth is compromised so the long term prognosis is decreased.

If you CLENCH OR GRIND YOUR TEETH , you are more likely to FRACTURE teeth. So crowns MAY BE necessary.

IS IT POSSIBLE TO PREDICT WHICH TEETH WILL FRACTURE AND WHEN?? Unfortunately not, but if there are existing fractures in a tooth, it is like playing Russian Roulette with your teeth.

WHAT ARE CROWNS MADE OF??

CROWNS can be GOLD, PROCELAIN, or PORCELAIN FUSED TO GOLD/METAL (PFM/PFG).

WHY GOLD?

The hardness of gold is very close to natural tooth hardness, therefore it does not wear against the opposing tooth. PORCELAIN is much harder than natural tooth structure, therefore can wear down the opposing tooth/teeth. Gold crowns also require less reduction of tooth structure during the dental crown procedure, which in general is better for the longevity of the tooth.

WHY NOT GOLD?

ESTHETICS. In the current day of everyone wanting whiter teeth and looking more natural, gold is esthetically less acceptable, unless it is in the back of your mouth.

PORCELAIN vs PORCELAIN FUSED TO METAL?

Like gold, the metal hardness is closer to that of natural tooth structure, so part of the tooth can be PORCELAIN (for esthetics) and part of it can be metal/gold (part that hits the opposing tooth). The metal is normally an alloy of gold, with the amount of gold and other metals varying depending on the type of crown.

Because of the metal substructure, the esthetics of PFM crowns can be close to your natural tooth, but not normally as good as the following 2 options.

LAVA CROWNS:

Lava crowns are like PFM crowns, except the metal substructure is primarily cubic zirconia, which has a white appearance rather than a silver or gold appearance. This allows for much better esthetics, but may still not be suitable for all posterior teeth under high stress.

WHY 100% PORCELAIN??

ESTHETICS. Full porcelain crowns look very good and natural, but they do not tend to hold up too well in the posterior region. In the anterior region, if they are not subjected to too much force, they should be ok.

As mentioned in the gold crown section, when porcelain crowns are done, the preparation phase of the dental crown procedure requires more tooth structure to be removed in order to make room for the porcelain on porcelain crowns.

CROWN FAILURES, ISSUES

After a crown is placed, the tooth still needs to be flossed and brushed, because it is still possible to get cavities under a crown.

There are other issues that can arise after crown placement.

• Occlusion: This is one of the more common concerns with new crowns. If your bite feels off, your dentist can probably just adjust the crown to feel better. When a tooth is contacting prematurely, it can cause a great deal of discomfort to that tooth, any opposing tooth, sensitivity to hot/cold or biting, or a variety of other symptoms. This is one of the first things dentists check if a patient is having problems with a new crown.

• Open Contacts: If the crowned tooth does not contact the adjacent teeth, you will likely get food packed in the space. This should be addressed before the crown is cemented, but if not, the only way to fix this is to either redo the crown, or do a filling or modify the adjacent tooth.

• Fractured Porcelain: If you have a porcelain fused to metal/gold crown and the porcelain fractures off, the metal/gold underneath will still protect the tooth. The crown does not necessarily need to be replaced, as long as the margins of the crown are intact. Some people elect to replace crowns when this happens if there is an esthetic concern, or if there are open contacts (as described above).

• Decay: If you get recurrent decay under the crown, most likely the crown will need to be redone.

• Open Margins: This means that there is a space between the crown and tooth, and is not a good situation. If you have open margins around any part of the crown, the crown should be redone, because leaving open margins leaves the tooth at a much higher risk for getting decay. Open margins around new crowns can often cause sensitivity to hot, cold, air, and or sweets.

In general, there are 3 ways to replace your missing teeth.

• Implants
• Fixed Prosthetics
• Removable Prosthodontics

Each area has POSITIVES and NEGATIVES.

We’ll start at the top.

DENTAL IMPLANTS:

Implants are a very good way to replace missing teeth. They function as individual teeth, and do not need to be supported by adjacent teeth. Basically what the procedure consists of is SCREW(S) surgically placed into your jaw bone, the bone is allowed to heal around the screw(s)- called osseointegration, and then a CROWN is attached to the screw!

Click here for more on TOOTH IMPLANTS

FIXED PROSTHETICS:

Fixed Prosthetics include anything that is cemented in and is not intended to be removed. Like CROWNS and tooth BRIDGES.

TOOTH BRIDGES are multiple crowns fused together. For example, if you were missing one tooth, the teeth on either side of the space would be prepared for crowns, and 3 crowns fused together (the 2 anchor crowns plus the crown to fill the space) would be cemented into place. dental crown procedure

They FUNCTION like NORMAL teeth, BUT, you do need to FLOSS UNDER the tooth bridge to keep it clean!

The other drawback is that you are CROWNING teeth that may not necessarily NEED to be crowned.

WHAT ARE THE RISKS OF CROWNING TEETH THAT DO NOT NEED TO BE CROWNED??

If the teeth have fillings on them already, probably not too much. If the teeth are UNCUT, there is a RISK of SENSITIVITY to elements such as HOT AND COLD, or even the possibility of ROOT CANAL THERAPY.

The dental crown procedure is a bit invasive to the tooth, and while these symptoms are UNLIKELY, they are still POSSIBLE.

THE ABUTMENTS:

The two (or more) teeth on either side of the space that are crowned, are called, abutments. Because these teeth are going to be assuming a heavier load from the missing tooth or teeth, the abutment teeth need to be very strong, and in good condition. If they have periodontal disease for example, that is not an ideal situation.

THE PONTICS:

The fake tooth that is going over the space where the missing tooth is, is called the pontic. If the tooth bridge is long span, there can be more than one pontics.

BONE GRAFTS:

A bone graft is a surgical procedure where bone is added to an area to try and build up the ridge, in order to help support the teeth or provide better esthetics when trying to restore an area.

When a tooth is removed, the gum and bone will normally shrink in that area. Sometimes a bone graft needs to be done during the extraction in order to preserve the bone from shrinking too much. Bone grafts can also be done as a seperate procedure.

There are 4 different types of bone graft material:

• Autograft, which uses bone transplanted from one region to another in the same person
• Allograft, which uses bone transplanted from one individual to another individual (of the same species, i.e, humans)
• Xenograft, which uses bone transplanted from one species to another, i.e, animal to human
• Alloplast, which is a synthetic bone graft material

MARYLAND BRIDGES:

This is a type of bridge that is usually only done in the front of the mouth., and to replace ONLY ONE tooth. Instead of putting full crowns on the two adjacent teeth, a false tooth is attached to two metal wings which are glued to the adjacent teeth. Because of the limited strength, they are not the best options for all patients. In those who grind or have inappropriate bites, MARYLAND BRIDGES will not be successful. This dental crown procedure is much less invasive on the teeth, as only a thin layer of tooth is removed on the back of the two abutment teeth (teeth holding the fake tooth).

CANTILEVER BRIDGES:

Cantilever bridges are fixed bridges that are not supported by teeth on both sides. They are attached to one or more teeth on one side, but are free standing on the other side.

This is sort of like holding a fishing pole over the water, in that you are holding the pole on one side but the tip/end of the pole is not supported by anything.

Because it is not supported on both sides, the tooth that is supporting it on the one side, is overloaded, and this is not an ideal situation. On the other hand, there are some cases when this is acceptable.

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