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In an earlier post, we discussed how crown procedures aren’t happening as often these days. Are Americans trending toward having healthier teeth--probably not, especially with sugar consumption on the rise. The DentistryIQ.com article we referenced in the previous post posited that dentists may consider working on their case presentation. Patients probably still have a need for crowns, but dentists may not be looking at preventative scenarios for patients who aren’t experiencing tooth pain (yet). With that in mind, we wanted to take a deep dive into dental crown procedures, and cover the uses and types, as well as other pertinent information.
What Is A Dental Crown?
First off, let’s define what a dental crown is: a crown is a “cap” customized to cover a patient’s tooth. Typically, this procedure serves to restore a tooth’s shape and size, increase its strength, or enhance performance. In a successful procedure, the crown is cemented into place, perfectly encasing the tooth for full protection.
Dental Crowns and Their Possible Uses
Crowns are often necessary for the following scenarios:
- Large cavities that can’t be filled.
- Missing teeth when a bridge is needed.
- Coverage for dental implants.
- Cracked, worn down, or weak teeth.
- Restoration after a root canal.
- Cosmetic reasons like discolored or badly shaped teeth.
- Crowns can also be used in pediatric dentistry; for example, if baby teeth have been damaged by decay, in extreme scenarios where poor oral hygiene or an aversion to general anesthesia demands the procedure, a crown might be appropriate.
The Different Types of Crowns
Temporary Crowns vs Permanent Crowns
Before installing permanent crowns, a dentist will prep their patient’s teeth by shaving them down to ensure there is a properly shaped base to adhere the crown to. Once the teeth are shaved down, temporary crowns created from a mold of the patient’s natural teeth will be placed. These temporary crowns help protect the newly shaved down teeth from damage and ensure that the patient can function normally until their permanent crowns are installed. Since the temporary crowns will only need to last for a few weeks, they are made from less expensive materials such as acrylic or certain types of metal.
On the other hand, permanent dental crowns are built to withstand the test of time. They’re crafted from ceramic, resin, or porcelain and some are fused with metal to provide additional support. Once the dentist has finished creating the permanent crowns, the patient will return to the office for the final phase of the procedure. The dentist will remove the temporary crowns, clean the patient’s teeth and gums thoroughly, and then install the permanent crowns with strong dental adhesive. Once the crowns are installed, the patient will be released with aftercare instructions.
Different Dental Crown Materials: What are Dental Crowns Made of?
Crowns can be made from a variety of different materials, depending on the patient’s need and preference. The factors that dentists will use to determine which type of crown is right for their patient include the position of their teeth, the color of the surrounding teeth, the condition of the tooth, and the necessary function of the tooth.
Temporary
As previously discussed, temporary crowns can be made right in your dentist's office to provide tooth coverage, while the permanent crown is made off-site, typically in a dental laboratory. Temporary crowns are often made of acrylic-based material or stainless steel.
Stainless Steel
Stainless steel crowns are typically a temporary solution used to protect a tooth or filling while a permanent crown (made from a different material) is being prepared. Stainless steel crowns are often used for children to protect a primary tooth from additional decay—that way, when the permanent tooth arrives, the crown comes out naturally.
Metals
Metal crowns normally include alloys with a high gold/platinum content, or base-metal alloys like cobalt-chromium and nickel-chromium. These alloys can endure the wear and tear of long-term biting and chewing, and are considered very durable since they rarely chip or break. The color is the main disadvantage, which is why they’re often used for molars near the back of the mouth.
Porcelain-Fused-to-Metal
This type of crown is a solid option for front or back teeth, or when a bridge demands the strength provided by the metal. The advantage of the porcelain is appearance, as the color can be matched to neighboring teeth. However, porcelain does have its disadvantages: it shows more wear, can chip or break off, and a dark metal “line” can show through over time.
Zirconia
This is a relatively new type of crown that has picked up popularity in the past few years due to their great aesthetics and longevity. The strength and durability of this material translates to a lower risk of cracking and chipping compared to all-ceramic or all-porcelain crowns.
All-Resin
While dental crowns made entirely from resin are not as expensive as other crown types, over the long term, they do have the tendency to wear down or fracture at a higher rate than porcelain-fused-to-metal crowns do.
All-Ceramic or All-Porcelain
Easily considered the best cosmetic choice, these dental crowns provide a natural color match that’s far better than any of the other materials, and they’re definitely more suitable for patients with any metal allergies. All-ceramic or all-porcelain crowns are often used in front-teeth restorations because they give the most natural look. The biggest drawback to these crowns is they are not as strong as metal crowns but if maintained properly, they can last for many years.
When Is a Dental Crown Required?
There are a variety of reasons for a crown, but these are the four most common scenarios:
Reason #1: When a patient needs a root canal
When a tooth has become irreparably decayed or infected, a dentist will typically recommend a root canal. Once the root canal is completed, a crown will be utilized to restore strength to the weakened tooth.
Reason #2: For cosmetic reasons
If a tooth is damaged or discolored, its appearance can be enhanced with a porcelain or ceramic crown. If a patient has an obvious filling, a crown can be used to cover it up, too.
Reason #3: When a tooth is close to breaking
Cracked teeth often demand a crown since the structure of the tooth is at risk.
Due to increased sensitivity, a cracked tooth can be very painful, so a crown offers relief, all while making the tooth much stronger.
Reason #4: After dental implants
Think of a dental implant as a replacement for a tooth missing its roots. In this case, a crown can replace the missing tooth. Once the dental implant is placed into the jawbone, the crown covers the top of the implant, allowing the patient to chew normally. The crown is part of a permanent restoration.
How Long Do Dental Crowns Last?
Before spending a considerable amount of money on a crown procedure, potential patients want to know how long they can expect their new pearly whites to last. Depending on the material the crowns are made from, the lifestyle of the recipient, and the expertise of the dentist performing the procedure, they can last anywhere from 5 to 15 years. As a general rule, gold and porcelain-fused-to-metal crowns last the longest while all-porcelain and all-ceramic crowns last the shortest period of time.
The most important factor in prolonging the life of your crowns is maintaining proper oral hygiene. This includes brushing twice a day, flossing (yes, everyone’s favorite activity), and getting regular dental cleanings and check-ups. Additionally, lifestyle changes may help prolong the life of your crowns. Avoiding hard food, such as hard candy, ice, and nuts, can protect your crowns and make sure chips do not occur. Dental crowns won’t last you a lifetime but if you properly maintain them and listen to your dentist’s recommendations, you should expect them to last at least a decade.
How Much Do Dental Crowns Cost?
The cost of a dental crown varies. The price ranges from $1,000 to $3,500; however, each individual patient’s needs are unique. If a dental crown is not covered by an insurance policy—or if a patient doesn’t have insurance—third-party financing companies can be utilized to create a payment installment plan.
Breaking Down the Dental Crown Procedure
The Initial Appointment
The bulk of the dental work is done during the initial appointment. After the tooth is numbed, it must be shaped, where some of the tooth structure must be “trimmed” away. Typically, for front teeth, 63 to 73 percent of the teeth are trimmed away, while the range is 67 to 75 percent for the back teeth. Each patient’s individual scenario, along with the type of dental crown, will dictate how much of the tooth structure needs to be trimmed, so that the crown can easily be slipped on top of it. While cement will ultimately hold the crown in place, only the proper shape will provide long-term strength and stability.
Once the shape is ideal, the next step is to take an impression of the tooth—this is what allows for a perfect crown fit. The tooth is washed and dried; afterwards, a retraction cord is tucked around the tooth to push the gums back. That way the impression material will provide an accurate representation of the tooth. Next, the impression material is prepared, and the impression tray is pushed down over the tooth (as well as the adjacent teeth) until it melds into one unit.
Upon removal, the impression has solidified, offering a copy of the tooth that requires the crown. A “bite impression” is also taken to ensure that the patient’s teeth come together properly for optimal biting and chewing. Modern advancements allow for optical impressions, which some dentists now prefer. This allows the dentist to send a digital impression to the lab instead of a physical one.
Before placing a temporary crown on the tooth, a color match is made. Then the impression is off to the lab, where they make a plaster cast that is used to create the new crown. This can take one to two weeks.
The Follow-Up Appointment
This is also known as the “crown placement” appointment, and is not as involved as the initial appointment. Once the tooth is anesthetized, the temporary crown is removed. The crown will be placed on the tooth to gauge the fit and check the appearance. To ensure an ideal fit, the crown may be removed and adjusted multiple times.
Once that perfect fit is determined, the crown will be permanently cemented into place. The patient will bite down, often on cotton gauze or a nonwoven sponge until the cement is set. The final step for crown placement is scraping away the excess cement around the tooth.
Post-Dental Crown Care
Most of the post-procedure care tips are fairly obvious: avoid hard or chewy foods—like ice or candy—that have the potential to damage your crown. If you’re in the habit of clenching or grinding your teeth, most dentists will advise patients to wear a mouthguard at night to offer protection. Over time, repeated grinding will wear down a crown (or teeth in general). Keep in mind that standard oral care, like consistent brushing and flossing, will prevent decay and gum disease for the affected tooth.
Ensuring a Healthy Crown
The care tips mentioned above are critical for the long-term care of a crown. However, the fit of the crown goes a long way toward its longevity. When done properly, a crown provides strength and stability, protecting the tooth underneath. If a crown is a poor fit, bacteria build-up can cause tooth decay over time. Beforehand, a dentist will also evaluate the gums and supporting bone structure to make sure the tissue beneath is healthy. The ultimate goal is to protect the tooth, and reduce the chance of gum recession, which would expose what’s called the “crown margin.” If a crown is fit properly by the dentist, and cared for appropriately by the patient, it should last 10-15 years.
Crown Procedures: Essential for Protection and Pain Prevention
While a crown procedure is time-consuming for a patient—since it spans two appointments—patients are often thankful since a crown relieves tooth pain and protects a damaged tooth. In the end, a dental professional can advise when and why a patient needs a crown, and which materials work best. If dental professionals continue to hone their presentation skills, making the case for crowns even if pain is absent, then it stands to reason that those downward-trending numbers will soon reverse course.