Crowns

What are crowns?
Crowns are dental restorations. A crown is a manmade tooth that replaces all or much of a damaged tooth above the gumline. In cases where teeth are too damaged (or decayed) to hold a filling, a crown is the perfect solution.

Crowns can be made of porcelain, gold, or porcelain fused to metal. Each type of material has its advantages and disadvantages.

Porcelain crowns look great. They match the color of your natural teeth. They work well and last a long time. However, since they are not as soft as gold, they are more susceptible to breaking than gold. If you were to bite down on something really hard, like a rock, the porcelain crown would be more likely to break than a gold crown. I'm not sure that's a good argument for gold, or an argument to avoid porcelain, but it's true. I generally recommend not biting on rocks. Porcelain crowns are the costliest. They are also the finest.

Gold crowns are generally the least costly. Gold crowns, though they were once the preferred material, are becoming less common. Because gold is soft, gold crowns have some give and a poorly fitted gold crown would not create as much of a problem to other teeth as a poorly fitted porcelain crown. Again, I'm not sure this is a good argument for gold. I recommend getting a well-made crown.

Porcelain-fused-to-metal crowns have the advantage of looking more natural than gold crowns. They are tooth-colored porcelain bonded to a thin layer of metal. Because the metal is softer than porcelain, it is easier to fit a porcelain-fused-to-metal crown than an all-porcelain crown, so they cost less than all-porcelain crowns. However, they leave a thin line of metal that is often visible. Since teeth are somewhat transparent (they allow light to pass through them), porcelain-fused-to-metal crowns generally have a tinny or silvery look. Porcelain-fused-to-metal crowns cost more than gold crowns and less than all-porcelain crowns.

Why and when are crowns used?
Crowns are used when a filling cannot adequately restore a tooth to full and natural function. When a patient has a severely damaged tooth, he or she may experience jaw or surrounding tooth pain as the mouth tries to compensate for the damaged tooth. (Missing and damaged teeth, when left untreated, often lead to Temporomandibular Joint Dysfunction - “TMJ.”) Food can collect in the crevices of a damaged tooth causing further decay. A crown solves these problems - keeping the jaw aligned while ensuring that no single tooth takes on too much of the bite work that could cause problems later in life. Crowns are sometimes used for patients who have bite dysfunction. The crown will match the size and shape of the original tooth when it was healthy, and should allow the jaw to function normally.

With the advancement of dental technology, it is possible to have an old, out-dated crown replaced with a newer, more attractive version. Porcelain crowns now allow for careful color matching, creating a natural look that makes them undetectable to the eye. Many patients choose the porcelain option for this reason, confident in the knowledge that their crown will be indistinguishable from their regular teeth. For crowns in areas such as the back molar where appearance is less of an issue than cost, a metal or porcelain-fused-to-metal crown can be preferred. Your dentist will discuss these options with you if a crown is recommended.

What is the process for getting a crown?
First all the unhealthy tooth material is removed. Then the dentist makes a mold of what is left of the tooth and the surrounding teeth. The dentist will make a temporary crown in the office that he will cement into place for a week or two until your new crown is made (usually at an off-site dental laboratory). At the laboratory, a crown will be constructed from the mold the dentist made. A week or two later, when you go in for the permanent crown, the dentist will remove the temporary crown, cement on the new crown, do some final shaping (to make sure the tooth looks perfect), and polish it.

Once you have had the crown in your mouth for a few weeks or a month, it will fill completely natural to you, and it will have all the durability as the original tooth.

Is any special follow-up care needed?
Once you have completed the crowning process, care and maintenance of the crown and the surrounding area is simple. Make sure the new crown is well-brushed, and floss below the gum line to prevent bacterial growth and gum disease. Use a soft-bristled brush when cleaning, and focus on where the gum and crown meet to dislodge any debris. With careful brushing and care, your crown will last a very long time.