A dental crown serves as a cover for a damaged tooth or as an anchor for a dental bridge. A crown is usually suggested when the root of a tooth is intact but the surface (enamel) area of the tooth is damaged. Dental crowns cover the entire visible surface area of an affected tooth and add strength, durability and stability to the tooth.

There are various situations that would require the placement of a crown, such as root canals, dental bridges, lost fillings,decay below a filling and chipping and cracking of tooth enamel. The cracking or breakage of teeth can be caused by age, fillings, tooth decay and/or an improper bite.

Approximately 85 percent of dental crowns and bridges are metal-based and 15 percent ceramic-based.

Patients over 50 tend to have more dental crown procedures done than patients in any other age group. As the baby-boom generation advances into middle age, a large number of adults will need dental crown procedures.

The use of ceramic crowns is quickly growing in popularity. Ceramic crowns have a more natural appearance, are free of metal and are the most aesthetically pleasing. The most commonly used crowns are called PFM (porcelain fused to metal) crowns and have a metal alloy core.

Crowns can usually last 10 to 15 years.

What’s Involved in a Crown Procedure?

During the first dental visit, the patient is given anesthesia for the dental crown procedure. The tooth is then ground to create a “core.” The dentist will make an impression of the tooth that will be sent to a dental laboratory where the customized crown will be made. While the permanent crown is being made, a process that may take approximately two to three weeks, a temporary crown is placed on the affected tooth.
In some cases cosmetic dentists may use a flipper device instead of a temporary crown. A flipper is a false tooth that temporarily takes the place of a missing tooth before placement of the permanent crown. A flipper appliance can be attached using either a wire or plastic piece that fits in the roof of the mouth.

During the second visit to the dentist and prior to cementing a crown, a filling may be put in place to stabilize the tooth. The permanent crown is then cemented onto the tooth.

The color of the cement affects the overall color of a porcelain (ceramic) crown, so it is important to discuss the cement color with your dentist. A try-in paste is used to check the color of the cement for the permanent crown.

Types of Dental Crowns

There are basically five types of crowns: metal, gold, ceramic, porcelain fused to metal (PFM), and resin and porcelain crowns.

Metal crowns are used in molars and areas where the forces from chewing and grinding are most prevalent. Metal crowns are extremely durable.

Gold crowns give the most precise fit of all crown types since gold is an extremely workable metal. The preparation of a tooth for a gold crown is the simplest and least complicated preparation for the dentist since there is minimal tooth structure removal. This allows for a large portion of the healthy tooth structure to remain untouched. Gold crowns also do not cause wear on opposing teeth over time. There is no possibility of chipping and they offer a healthier environment for the gum tissue. Appearance is a consideration when choosing a gold crown due to the color.

Ceramic crowns are used primarily for front teeth, as they best resemble the natural tooth color.

PFM (Porcelain Fused to Metal) crowns look like ceramic crowns and have the strength of metal crowns. PFM crowns are used to correct both the aesthetic and structural damage of the tooth. These crowns have a metal substructure and may require an opaque layering below the porcelain. Because of the opaque layer, it may be difficult to replicate the translucency of natural teeth.

Resin and porcelain crowns are made of reinforced resin or bonded all-porcelain. These crowns are metal-free and have the most natural appearance of all crown types as they are almost indistinguishable from natural teeth. Porcelain crowns have the possibility of chipping and, due to the thickness of the porcelain required for a good aesthetic, the removal of more tooth structure is required as compared to other crown procedures. Gingival (gum) inflammation appears to be more common with porcelain crowns and may cause additional wear on opposing teeth over time. All-porcelain crowns require a high skill level of both the cosmetic dentist performing the procedure and the dental laboratory creating the crown.

Costs of Different Types of Dental Crowns

On average, porcelain, PFM and gold crowns cost between $600 to $3,100 per crown.

New reinforced resin or bonded all-porcelain crowns cost more than other crown types because they require skilled dentists and dental laboratories. An all-porcelain crown costs approximately 20 percent more than a gold or PFM crown, ranging from $1,000 to $3,000 per tooth. This cost may exceed the insurance plan’s coverage for crowns.

The price of crowns increases with the number of dental office visits and treatments required by the patient. Dental insurance typically does not cover all the costs of crown procedures.

Ask a Dentist: Dental Q & A

How long does it take for a procedure?
The first visit to the dentist will be about one hour. If all goes well with the fitting, the second visit is about 45 minutes, but this could be longer if adjustments need to be made to the fit.

How many dental visits does it require?
Two or three visits. If the patient doesn’t experience complications, the procedure is performed in two visits. The first visit is for a temporary crown and the second visit is to fit the permanent crown and/or bridge.

What are the various things a patient should do to prepare for the procedure?
On the day of the appointment, it is highly recommended that patients clean their teeth thoroughly before arrival. The dentist will also check and clean the teeth prior to the procedure, but it saves time to be prepared.

What does the dentist need to know about the patient?
The dentist should be informed of any and all medicalconditions. This is necessary to avoid any complications that might occur during or after the procedure.

What should I expect during the procedure?
On the first visit, the patient will be given a local anesthetic. Depending upon the type of local anesthetic used, the patient can expect to be numb for one to four hours. The dentist will prepare your tooth in a specific way to retain the new porcelain to metal crown. A thin piece of retraction cord is placed around your tooth to get the impression material under the gum where the crown ends. The dentist or dental assistant will place a temporary crown (or bridge if multiple teeth are involved) on the tooth. These plastic restorations are placed on teeth to protect the teeth and the gum tissues between dental visits.

On the second visit, the temporary crown is removed and any temporary cement is cleaned from the prepared tooth. The dentist will fit the final crown, check for accuracy, make adjustments for any bite discrepancies and evaluate the aesthetics. The crown is then cemented to your tooth.

What should I do in between the first and the second visit to the dentist?
Home care is extremely important while your temporary crown is in place. The health of your gum tissue and the success of your final treatment depend upon it. Dentists recommend cleaning your teeth between visits.

Does the dentist use a laboratory for the procedure and is the cost of the lab included in cost of the procedure?
The impressions of the teeth are sent to the lab to get custom-made bridges. The cost of the lab work is usually included in the procedure cost and should be discussed with the dentist.

What do most people experience after the procedure?
After the first visit, a patient can experience a slight degree of discomfort, but nothing that cannot be remedied with ordinary Aspirin or Tylenol. It is not uncommon to have sensitivity to heat, cold or pressure, but if sensitivity persists beyond a few days, call your dentist. With bridges or crowns recovery is quick and teeth are back to normal within one or two days.

Are there any prescriptions provided after the procedure?
Take any antibiotics or other prescribed medications only as directed by your dentist.

What medical conditions would disqualify a person from getting a certain procedure?
It depends. Individuals with heart conditions should definitely inform the dentist.

How long do the results last?
With proper care, crowns and bridges can last five to 15 years, some significantly longer. The ultimate timeframe depends upon the oral health habits of the patient.

Post-Procedure recommendations

It is strongly recommend that patients avoid eating sticky foods like gum, caramels, and taffy. Avoid hard candy and definitely do not chew ice cubes!

If anesthetic was used during the procedure, avoid chewing  for at least 30 minutes to allow the temporary cement to set and the numbness to completely wear off. If possible, chew food only on the opposite side of your mouth from the new bridge and/or crown. Brush normally but floss very carefully. A dentist normally recommends special floss, brushes or other cleaning aids to keep the area free of bacteria.

Use one teaspoon of salt in one cup of warm water to rinse your mouth three times a day. This will reduce any discomfort or swelling in the mouth. It is normal for gums to be sore for several days.

Fitness & Wellness Week via NewsRx.com & NewsRx.net, September 25, 2004, DENTAL HEALTH; New ceramic bridge, Procera Scanner and tooth loss solutions launched; Pg. 353

Christopher A. Jordan, DDS