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Dental crowns : what you need to know

What is a dental crown ?

A dental crown is a cover that looks like a tooth. Broadly speaking, it is a tooth-shaped cap that is either placed over a damaged natural tooth or is part of a dental implant.

– When placed over a cracked tooth, the dental crown enables to cover the damaged tooth and helps to restore its size, shape and strength. This cap hides entirely the tooth beneath. It permanently bonds over the area it is placed using dental cement. So, it helps to improve the appearance of the underlying tooth and also your ability to bite and chew.

– When used for a dental implant, the dental crown is simply the last element that is placed after the implant and the abutment.

Why is a dental crown necessary ?

Dental crowns can be used for several situations :

  • Your tooth has been broken or pretty much damaged by decay, and it is so damaged that a filling cannot replace enough of the tooth, so the crown will restore your broken tooth by making it whole again.
  • To complete the whole dental implant structure after a tooth loss, once the implant (the screw) and the abutment are in place.
  • To hold together parts of a cracked tooth.
  • To protect from further damage a weak or worn tooth
  • To provide support to a dental bridge
  • To prevent fracture on a tooth that has just undergone root canal restoration
  • To serve as an alternative to veneers to cover deformed or discolored tooth.

Dental Crown Types and Benefits

1. Stainless steel
This material is more often used as a pediatric dental care solution to help protect damaged baby teeth until such time that the permanent teeth grow.

2. Metal
Metal crowns are often used to cap back molars as their strength works well in the chewing action done by the back teeth. The materials used as metal crowns are gold alloy, chromium, nickel, or palladium. Because metal crowns are pliable, especially the ones with thinner sides, dentists can easily adjust the fitting of the crown without the need to do file and grind the tooth too much. And there is another reason why metal crowns are used in the back teeth—aesthetics. You may not want to display that metallic smile, would you?

3. Porcelain fused to metal
This crown is composed of two materials—porcelain and metal. The metal part of the crown is used as the foundation where the porcelain is treat-heated and fused to the metal. The porcelain can be color-treated to match your real teeth and the crown can replace any teeth regardless of their position in the mouth. The downside of this material is its durability. It can chip easily and may cause wear-and-tear to the opposite teeth. The metal part of the crown may also appear as gray lining especially when the gum recedes.

4. All Ceramic
Ceramic crowns are made from natural materials like zirconia and feldspar. They are excellent substitute for people who have metal allergies or don’t prefer the metallic taste in their mouth. All ceramic crowns can also be easily tinted to match the original color of natural teeth. Like porcelain crown, however, all ceramics are also not durable.

5. All Resin
Acrylic polymers with silicon dioxide blend are used as composite resin to create all-resin crowns. This is the most affordable dental crown option and the material can be tinted easily to look like the natural color of your remaining teeth. Strength-wise, all-resin crowns are less durable than ceramic or porcelain fused to metal crowns.

Dental Crown Procedure

1. Initial Consultation
The condition of your teeth will be first examined by your dentist to determine if dental crown is the best option for you. X-rays may be taken as well as an impression of your bite. This will help determine the course of action needed. Local anesthesia will be applied to avoid pain and discomfort during the procedure.

If your dentist finds that you need other procedures, he will recommend you to see an oral surgeon, periodontist, or orthodontist for other dental exams or alternatives. A root canal procedure, for example, may be required if the root of your tooth is damaged. This is to prevent possible infection or injury to the pulp of your tooth.

2. Preparation
Once your dentist confirms that dental crown is your best option, your dental specialist will apply local anesthesia to numb your mouth. You can also choose not to have an anesthesia if you can tolerate minor pain and discomfort (no pain, no gain at work—you can save on the cost of anesthesia). If you are not comfortable witnessing or feeling the procedure, your doctor can prescribe some sedatives or put you to sleep.

The preparation process involves filing down of the enamel to the right shape that will support the crown. If the tooth is severely damaged, dental fillings will be needed to rebuild it.

Once the desired shape and form is achieved, you will be asked to make an impression of your teeth (full bite). The dental impression will be used to design and build the crown; the full bite impression will be used as guide to make sure that the crown matches your other surrounding teeth. The crown fabrication will take two to three weeks; in the meantime, you will be provided with an acrylic substitute crown while waiting.

3. Temporary Oral Care
While wearing a temporary crown, it is important that you take extra oral care measures. If you are using floss, always pull out the string rather than pulling it up. This will prevent the crown from being dislodged. You are not allowed to chew on tough, sticky, or chewy food to avoid the temporary crown from getting loose. you will also have to chew on the opposite part of the mouth to avoid the crown area. Always remember that the crown is based on the impression made after all the filing and filling were done. Take extra precautions to make sure that the shape, size, and form are intact when your return to your dentist for the crown fitting..

4. Crown Fitting
This will happen on your second visit when your dentist will remove the temporary crown and place the crown. Whether you need local anesthesia or not will depend on your level of comfort. You may want to discuss this with your dentist to determine if you still need one during the fitting.

A final check of the fabricated crown will be done to determine color and fit before it is permanently cemented in place. Precision is required during this process because there must not be any space between your tooth and the crown where bacteria can grow and cause damage. The number of sessions you need for crown fitting will depend on the condition of your teeth and the other treatments you might need ( root canal or gum treatment…)

Factors Affecting Dental Crown Cost

The cost of dental crowns can be divided based on two factors:
1. Dental related: costs involved in the actual dental crown procedure
• Condition, location, and size of the original tooth
• Additional procedures required (implant screws, bone grafts, root canals)
• Dental crown material
• Professional fee of services or specialists involved (x rays, dentist, oral care specialists, and anesthesiologist)

2. Indirect Costs: conditions that have indirect relation to the cost of the procedure
• Location of the dental clinic (urban or rural; cosmopolitan area or suburb)
• Years of experience, training, and popularity of the specialist
• Manufacturer of the dental crown
• Dental insurance or HMO coverage
Average Price per Dental Crown Type
Crown Type Average Cost With Insurance Without Insurance
Porcelain fused to metal $500 – $1500 $620 $1100
High-end all porcelain crown $800 – $3000 $953 $1430
Metal (high-noble or noble) $600 – $2500 $882 $1353
Remember, your insurance will only cover your dental crown cost only when it is deemed functional and not as a cosmetic solution, and only up to half the cost at most.

Oral Care after Dental Crown Procedure

Always remember that there is still a real tooth hidden beneath your dental crown; following a healthy oral hygiene routine is crucial in the maintenance of your crown. Habits such as ice chewing, finger nail biting, and teeth grinding or clenching are detrimental to your crown and to your other teeth—so get rid of them.

Aside from regular brushing and flossing, you also need to eat healthy foods that will help keep your gum and teeth healthy and strong. Avoid beverages—like carbonated drinks—that can erode the adhesion used in your crown.

You may also experience tooth sensitivity after the crown placement. You will notice this when you feel a hurting sensation when eating something hot or cold. This can be remedied by using toothpaste that is formulated for sensitive teeth when brushing.

Remedies to Dental Crown Problems

Getting used to dental crowns may take some time, but once you get used to them they would feel like natural teeth. The most common problem with dental crown is its fitting, especially in the beginning. Try not to put so much pressure on the crowned teeth to allow the cement to bond firmly with the teeth.

If the crown is loose or detaches easily, go back to your dentist and have it fixed. It may not have been properly placed the first time and this must be corrected. The cement might also have washed out or there is not enough cement placed to hold the crown and the tooth together. Re-cementing or crown replacement may help resolve this concern.

Chipping is also a common problem with dental crowns, especially with all-porcelain crowns. This can be remedied by applying composite resin.

Dental crowns can last from five to fifteen years, depending on the material used and the oral hygiene that you maintain. Aside from taking care of the crown, you also need to take care of the tooth underneath the crown. Remember, it is still susceptible to decay. Do not leave the tooth exposed for a long time without the crown. If you encounter a problem with your dental crown, go see your dentist immediately.

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