Dental Crowns

A crown is a tooth-shaped cover placed over a tooth that is badly damaged or decayed. A crown, which many people call a cap, is made to look like your tooth.



Crowns may be placed for several reasons, but generally the tooth has been extensively damaged by decay or breakage and filling material can't replace the missing tooth structure and make the tooth strong enough. A crown may hold together parts of a cracked tooth and can be used to hold a bridge in place. Crowns also are used for cosmetic purposes to cover misshapen or badly discolored teeth.

Crowns can be prefabricated or made in a laboratory. Prefabricated crowns are made of plastic or stainless steel and can be used as a temporary restoration until a permanent crown is manufactured. In some cases, prefabricated crowns can be used as a permanent restoration.
Crowns can be all metal, porcelain fused to metal (PFM), or all ceramic. Metals include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). The all-metal or PFM crowns are stronger and are better choices for back teeth. PFM and all-ceramic crowns look just like normal teeth.

Usually, crowns last at least 7 years, but in many cases they last much longer, up to 40 years or so.

For teeth that are badly damaged, dental crowns can be an effective treatment option. The dental crown procedure utilizes tooth-shaped coverings made of metal, ceramic, or porcelain to restore strength and eliminate discomfort. In addition, dental crowns may be used to anchor a dental bridge or to cap a dental implant post.

Why do teeth need dental crowns?

A dentist might recommend placing a dental crown for a variety of reasons but, in general, most of these reasons will usually fall within one of the following basic categories:

• To restore a tooth to its original shape.
  
  
• To strengthen a tooth.
  
  
• To improve the cosmetic appearance of a tooth.



• To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth



• To restore an already broken tooth or a tooth that has been severely worn down



• To cover and support a tooth with a large filling when there isn't a lot of tooth left



• To hold a dental bridge in place



• To cover misshaped or severely discolored teeth



• To cover a dental implant

Dental crowns be used to restore a tooth's shape and strength

Since a dental crown that has been cemented into place essentially becomes the new outer surface for the tooth, it is easy to imagine how the placement of a crown can restore a tooth to its original shape. It's also easy to see how a dental crown can help to strengthen a tooth by way of being a hard outer shell that encases the tooth structure that lies within it. For both of these reasons, dental crowns are routinely made for teeth that have broken, worn excessively, or else have had large portions destroyed by tooth decay.

It is conceivable that a dental filling, as an alternative, could be used as a means to restore a tooth's shape. Dental crowns however offer your dentist a big advantage over dental fillings by way of the fact that they are fabricated "away from your mouth." By this we simply mean that dental crowns are fabricated in a dental laboratory (by a dental technician using plaster molds your teeth). Dental fillings, in comparison, are created "in your mouth" by way of your dentist placing the filling material directly upon your tooth.

When a dental crown is made the dental laboratory technician can visualize and examine all aspects of your bite and jaw movements, from a variety of angles, and then sculpt your dental crown so it has the perfect anatomy. In comparison, when a dentist places a dental filling they have far less control over the final outcome of the shape of your tooth because it is often difficult for them to visualize, evaluate, and access to the tooth on which they are working.

From a standpoint of strength considerations, there are some types of filling materials that can bond to tooth structure. For the most part, however, dental fillings are not considered to substantially strengthen a tooth in the same way that a dental crown, with its rigid encapsulation a tooth, can.

Porcelain dental crowns be used to improve the cosmetic appearance of teeth

Since a dental crown serves to cup over and encase the visible portion of a tooth, any dental crown that has a porcelain surface can be used as a means to idealize the cosmetic appearance of a tooth. Possibly you have heard it rumored (especially in past decades) that certain movie stars have had their teeth "capped." This simply means that the person has obtained their "Hollywood smile" by way of having dental crowns placed.

Actually, getting your teeth "capped" just to improve their cosmetic appearance can at times be a very poor choice. Dental crowns are best utilized as a way to improve the cosmetic appearance of a tooth when the crown simultaneously serves other purposes also, such as restoring a tooth to its original shape (repairing a broken tooth) or strengthening a tooth (covering over a tooth that has a very large filling).

In general, a dental crown probably should not be used as a means to improve the appearance of a tooth if there is any other alternative dental treatment that could equally satisfactorily achieve the same cosmetic results. This is because a dentist must grind a significant portion of a tooth away when a dental crown is made. If a more conservative dental procedure could equally well improve the tooth's appearance, such as a porcelain veneer, dental bonding, or even just teeth whitening, then it is usually best to consider that treatment option first.

What Types of Crown Materials Are Available?

Permanent crowns can be made from all metal, porcelain-fused-to-metal, all resin, or all ceramic.

• Metals used in crowns include gold alloy, other alloys (for example, palladium) or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, they rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
  
  
  
  
  
• Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown's porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown's porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
  
  
  
  
  
• All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more prone to fractures than porcelain-fused-to-metal crowns.
  
  
  
  
  
• All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
  
  
  
  
  
• Temporary versus permanent. Temporary crowns can be made in your dentist's office whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by the dental laboratory.

What Steps Are Involved in Preparing a Tooth for a Crown?

Preparing a tooth for a crown usually requires two dentist visits, the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.

First Visit: Examining and preparing the tooth.

At the first visit, your dentist may take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.

Before the process of making your crown is begun, your dentist will anesthetize (numb) your tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used (for instance, all-metal crowns are thinner, requiring less tooth structure removal than all-porcelain or porcelain-fused-to-metal ones). If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to "build up" the tooth to support the crown.

After reshaping the tooth, your dentist will use impression paste or putty to make an impression of the tooth to receive the crown. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions are sent to a dental laboratory where the crown will be manufactured. The crown is usually returned to your dentist's office in 2 to 3 weeks. If your crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using a temporary cement.

Second Visit: Receiving the permanent dental crown.

At your second visit, your dentist will remove your temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.

The Dental Crown Procedure

Typically, the dental crown procedure is completed in two stages. During the first stage, the dentist removes portions of your natural tooth’s structure to accommodate the dental crown. Surrounding teeth may also be prepared in this way. An impression is made and sent to the lab, where your dental crown is created in about two weeks. A temporary crown will be in place between visits to ensure the most natural look and feel. When you return to the dentist’s office, the temporary crown is removed and your new, custom dental crown is securely bonded in place.

For some patients, the dental crown procedure is altered to meet specific goals. For example, if crowns are being utilized to anchor a dental bridge or as a dental implant restoration, the steps in the dental crown procedure will be slightly different. Also, teeth with extensive damage may require that a root canal be performed prior to placing the crown. Additionally, new technology has made it possible to complete some dental crown procedures in a single office visit. A consultation with your dentist can help you better understand the unique steps in your dental crown procedure.

Replacing Old Dental Crowns

Individuals may be interested in replacing old dental crowns for a number of reasons. Concerns about the appearance of metal crowns on prominent teeth may compel some patients to have their dental work restored with all ceramic or porcelain crowns. Other times, dental crown problems like wear, decay, or poor fit may lead patients to inquire about replacing older dental crowns. Typically, patients should expect to replace their dental crowns after approximately 10 to 15 years.

Porcelain Crowns vs. Porcelain Veneers

Both porcelain crowns and porcelain veneers have unique advantages and limitations that make them appropriate for treating specific dental concerns. For example, all ceramic or porcelain dental crowns improve both the appearance and function of injured or damaged teeth. They cover and protect the entire surface area of the tooth, eliminating pain and restoring strength. Porcelain veneers, on the other hand, typically address only cosmetic concerns and are applied to otherwise healthy teeth. Stains, minor chips, misalignment, or other imperfections can be concealed with the thin porcelain shells, which slide over the front surface of teeth. Also, because they cover less of the natural tooth, less tooth structure has to be removed to accommodate porcelain veneers.

A dentist can provide more information on porcelain crowns versus porcelain veneers and help determine which treatment is best for you based on cost and your unique goals and needs.

What is the Average Cost of Dental Crowns?

The average cost of a dental crown varies. Often, the type of dental crown plays the most significant role in determining its price. For example, all ceramic or porcelain crowns tend to cost more than other types of dental crowns because they are more time-consuming and require greater skill to be applied correctly. Additionally, because all porcelain crowns provide the most natural appearance, they typically cost more than porcelain fused to metal or all metal crowns. Most doctors offer cosmetic dentistry financing to make the dental crown procedure more affordable for patients.

How Should I Care for My Temporary Dental Crown?

Because temporary dental crowns are just that—a temporary fix until a permanent crown is ready, most dentists suggest that a few precautions be taken with your temporary crown. These include:

1. Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
   
   
   
   
2. Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of your mouth.
   
   
   
   
3. Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
   
   
   
   
4. Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.

What Problems Could Develop with a Dental Crown?

1. Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush your teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix this problem.
   
   
   
   
2. Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.
   
   
   
   
3. Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact your dentist's office.
   
   
   
   
4. Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit or a lack of cement. If this happens, clean the crown and the front of your tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for your tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement your crown in place; if not, a new crown will need to be made.
   
   
   
   
5. Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.
   
   
   
   
6. Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.

Preparing the Tooth

If you need a crown, you may also need endodontic or root canal treatment on the tooth, due to extensive decay or the risk of infection or injury to the tooth's pulp. Not everyone who needs a crown will also need a root canal.

Besides the crown, your dentist may need to build up a foundation to support the crown. A foundation is needed if large areas of the natural tooth structure are decayed, damaged or missing. If you are receiving the crown after root canal treatment, your dentist may insert a post-and-core foundation.

To place a crown, your dentist must file down the tooth to make room for it. If you are receiving an all-metal crown, less tooth structure will be removed because these crowns are thinner than PFM or all-porcelain ones.

After filing down the tooth, your dentist will use a piece of thread or cord to push the gum down around the tooth, and then make an impression of the tooth. The impression material sets in five or six minutes and is removed. Your dentist will also take an impression of the teeth above or below the tooth that will receive the crown, to make sure the crown will not affect your bite.

The impressions are sent to the lab, where the crown is made. During that time, you will have a temporary crown. These crowns are usually made of plastic and are made in your dentist's office on the day of your visit. They are not meant to last. If a temporary crown is left in the mouth, the cement eventually washes out and the tooth can decay.

At a second visit, your dentist will remove the temporary crown and test the permanent one. Sometimes crowns need additional polishing or glaze or some other adjustment before they are placed. Once the crown is ready, it's cemented to your tooth.

After a Crown

You shouldn't feel any discomfort or sensitivity after a crown is placed, though if your tooth still has the nerve in it, you may have some hot/cold sensitivity. If you notice pain or sensitivity when you bite down, you should contact your dentist. Usually this means that the crown is too high on the tooth. This can be fixed easily.

You may notice a dark line next to the gumline on your crowned tooth, particularly if you have a PFM crown. This dark line is the metal of the crown showing through and is normal. A crowned tooth is not protected from decay or gum disease. You should continue practicing good oral hygiene.

Crowns, especially all-porcelain ones, can chip. This can sometimes be repaired in the mouth. Your dentist will etch the porcelain with acid and bond composite resin to it to fix the chip. If the chipping is extensive, you may need a replacement crown.

It's also possible that the cement could wash out from under the crown, but the crown does not fall out. Under these conditions, bacteria can leak in and cause decay. If your crown seems loose, contact your dental office.

Your crown may fall out, due to a lack of cement or an improper fit. If this happens, clean the crown and the tooth. You can replace the crown temporarily using denture adhesive or temporary cement sold for this purpose. Contact your dental office immediately and try to schedule a visit for the next day. If you are away from home, seek a dentist in the area who can evaluate the problem. You may need a new crown or it may be possible to re-cement the old one on the tooth.

What Problems Could Develop With a Dental Crown?

• Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush your teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix this problem.

• Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.
  
  

• Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If your crown feels loose, contact your dentist's office.
  
  
  
  
  
• Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit or a lack of cement. If this happens, clean the crown and the front of your tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist's office immediately. He or she will give you specific instructions on how to care for your tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement your crown in place; if not, a new crown will need to be made.
  
  
  
  
  
• Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.
  
  
  
  
  
• Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through.

What Are "Onlays" and "3/4 Crowns?"

These are variations on the technique of dental crowns. The difference between these crowns and the crowns discussed previously is their coverage of the underlying tooth - The "traditional" crown covers the entire tooth; onlays and 3/4 crowns cover the underlying tooth to a lesser extent.

What will the finished crown look like?

Your dentist's main goal is to create crowns that look like natural teeth and feel comparable. To achieve this, a number of factors are considered. These include the color, occlusion or "bite," shape in length of both your natural teeth and your artificial crown. Any one of these factors alone can significantly affect your appearance.Although your dentist may be able to accommodate your request for a particular esthetic effect, your first choice may not be possible due to technical limitations or oral health concerns. If you have a certain look in mind for your crown, discuss it with your dentist at your initial visit. When the procedure is complete, your teeth may not only be stronger, they may be the most attractive feature of your face -- your crowning glory.

Will The Crown Be Noticeable?

No. The crown will be made to match your other teeth exactly. The shade of the neighbouring teeth will be recorded, to make sure that the colour looks natural and matches the surrounding teeth. This is done using both a shade guide and digital photography. The technician will be able to match the characteristics of your own teeth with the help of the digital image. In some cases, the characterisation is so detailed, the only way to ensure a perfect match is to visit the laboratory and allow the technician to see your teeth himself. This can be arranged. A temporary crown, usually made in plastic, will be fitted at the end of the first appointment to last until the definitive one is ready. These temporary crowns may be more noticeable, but they are only a temporary measure.

Does It Hurt To Have A Tooth Prepared For A Crown?

No. A local anaesthetic is used and the preparation should feel no different to that of a filling.

Are Post Crowns Different?

Post crowns may be used when the tooth has been root filled or if there is no tooth remaining above the level of the gum. The weakened crown of the tooth is drilled off at the level of the gum. A double-ended 'post' is constructed to fit into the root canal. This can be either prefabricated Stainless Steel or custom made of gold. One end of the post is cemented into the root canal, and the other end holds the crown firmly in place.

Are There Any Alternatives To Post Crowns For Root-Filled Teeth?

If a root-filled tooth is not completely broken down, it may be possible to build it up again using filling material. This 'core' is then prepared in the same way as a natural tooth and the impressions are taken.

How Long Will A Crown Last?

The life of a crown will depend on how well it is looked after. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. It is very important to keep this area as clean as your other teeth, or decay may occur which could endanger the crown. Properly cared for crowns will last for many years.

How Are Crowns Fixed To Teeth?

Once the fit and appearance of the crown has been checked - and approved by you - it will be cemented in place with special dental cement. The cement also forms a seal to help hold it firmly in place.

Will The Crown Feel Different?

Because the shape of the crown will be slightly different from the shape of the tooth before it was crowned, you may be somewhat aware of it to begin with. Within a few days it should feel fine, and you will become unaware of it. The crown may need some adjustment if it feels proud of the surrounding teeth. If it is at all uncomfortable you should return so it can be checked and adjusted.

How Long Does The Treatment Take?

At least two visits are needed, the first for the preparation, impression, shade taking and fitting the temporary crown, and the second to fit the permanent crown. The first appointment would normally be an hour.

How Long Do Dental Crowns Last?

On average, dental crowns last between 5 and 15 years. The life span of a crown depends on the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting your fingernails and using your teeth to open packaging).

Dental Crowns Cost

Modern dental crowns use a variety of materials and techniques. The price associated with your procedure will, in a large part, depend on the material and method of placement you choose. Although the cost of dental crowns is covered by most insurance carriers, the price of treatment may be a factor when reviewing your options for care. Those who wish to receive the most natural-looking smile will likely choose porcelain dental crowns over other materials, such as gold. With insurance coverage, the cost of porcelain dental crowns ranges from $40 to $100 per tooth; while the cost of gold crowns ranges from $10 to $50 per tooth. While prices may vary, one thing does not; each type of dental crown offers a long-lasting and highly effective means of repairing damaged teeth.

Dental Crowns – Pricing Breakdown

Because porcelain dental crowns offer not only a greatly improved and more aesthetically pleasing smile, but also a medically necessary repair on a damaged tooth, the procedure is typically covered by insurance. With sufficient insurance coverage, gold dental crowns typically cost between $10 and $50 per tooth. The more natural looking porcelain crowns typically cost between $40 and $100 per tooth. Without insurance coverage, the costs associated with the placement of a dental crown are between $650 and $1,200 per tooth.

The Importance of Choosing an Experienced Cosmetic Dentist

When choosing between porcelain and other types of dental crowns, it is best to first determine the cost associated with each material based on your individual insurance coverage. Only an experienced cosmetic dentist can determine what treatments you will need to maintain a healthy smile. Since both the price and aesthetic appearance of metal, ceramic, and porcelain dental crowns vary, your cosmetic dentist will provide you with detailed information regarding all your options. In addition to the material used, dental crowns pricing also varies based on a dental crown which is prefabricated as opposed to one that is custom fit to the patient, the extent of damage to the tooth, and the experience of the dentist, as well as the area of the country in which your dentist practices. Contacting your cosmetic dentist today will help you make an informed decision by determining if a dental crown is needed and, if so, the prices of porcelain and other types of dental crowns based on your individual insurance coverage.

Dental Crowns Financing

In most major dental practices, both traditional and porcelain dental crowns are increasingly obtainable, with a variety of financing options to choose from. Financing dental crowns and other procedures helps patients obtain the important treatments they need when they need them. Because dental crowns help repair badly damaged teeth, any delay in treatment can cause a patient both undue financial burden and physical pain. While metal, ceramic, and porcelain dental crowns can help repair significant tooth damage, they cannot be used when a tooth has been left untreated for a long period of time. For many patients, traditional and porcelain dental crowns — obtained through one of many available financing options — can help prevent dental problems that can lead to tooth extraction; all while achieving beautiful, natural-looking results.

How Financing Works

For patients seeking dental crowns and other treatments, modern healthcare financing offers a multitude of plans to meet patients’ needs. With convenient monthly payments, low interest rates, a variety of term options, online applications with instant approval for those who quality, and more, those seeking dental crowns through financing have never had it easier. To learn more about metal, ceramic, and porcelain dental crowns, and the many financing options available to you, it is best to consult your cosmetic dentist.

Does a Crowned Tooth Require any Special Care?

While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the underlying tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day-especially around the crown area where the gum meets the tooth.

How Much Do Crowns Cost?

Costs vary depending on what part of the country you live in and on the type of crown selected (for example, porcelain crowns are typically more expensive than gold crowns, which are typically more expensive than porcelain-fused-to-metal crowns). Generally, crowns can range in cost from $500 to $900 or more per crown. A portion of the cost of crowns is generally covered by insurance. To be certain, check with your dental insurance company.