Crowns & Bridges

What Are Dental Crowns?

Dental crowns can be considered a replacement for a tooth’s natural crown, to restore your tooth’s function and to replace a missing tooth. Dental crowns can either be cemented onto already present tooth structure if it is sufficient enough after preparation or bonded onto a post (small metal screw) that is inserted into a tooth’s root for support. They are also used to cover dental implants. They completely cover the tooth like a cap or encircle it, just like a ‘crown’ encircles the head when worn.

Dental crowns are indicated when a tooth’s crown has completely broken off, when root canal treatment has been performed or when a dental implant has been inserted into the bone.

They are made up of durable, biologically friendly materials such as porcelain, all-resin (organic) materials, metals such gold or inert metal alloys like palladium or nickel-chromium alloys and Porcelain Fused to Metal (PFM crowns).

Materials for the crown

Porcelain and all-resin materials offer the best match to natural tooth color and are the most esthetically pleasing materials for crowns. Their disadvantage is that they are not very durable and are subject to wear, so are not as long lasting as metal or PFM crowns.

Metal crowns are the most durable and long lasting but their only draw-back is their metallic appearance. They are best used for posterior tooth crowns since most mechanical forces are back there, and the crowns are more difficult to see.

By far the best crowns are PFM crowns as they offer the dual benefits of a natural appearance of teeth along with the metal core that offers greater durability and is longer lasting.

Do I need dental crowns?

You are a candidate for a dental crown if you have any of the following problems:

  • Cracked tooth
  • Missing, broken or worn natural crown
  • Internally discolored tooth
  • Have had endodontic or root canal treatment
  • Need support for a dental bridge
  • If you have a dental implant
  • If you have a very large cavity that compromises the functional vitality of your tooth

Dental crowns are generally a better and cheaper option for replacing lost tooth structure than getting a damaged tooth extracted entirely and replacing it with an implant. In such a case, a dental crown is still needed. Crowns offer protection to whatever tooth structure is left after extensive tooth decay or damage and should always be considered before a dental implant.

What Are Dental Inlays?

Dental inlays are also sometimes referred to as onlays.

When caries or decay happens on the flat surface of the tooth, a metal (amalgam) or composite filling can be used. However if the decay is not too invasive, an inlay or an onlay is sometimes a better option.

These restorations are used when there is a slight crack or splintering on the tooth. A dental inlay will be used when there is not enough damage to be removed and is preferable to having a crown as it is less invasive to the tooth structure.

These restorations are quite often made from composite filling material or gold, but the most popular choice is porcelain. Porcelain is used as an option when a patient is not content with the look of the metal, fillings in their mouths, and they wish for it to look a little nicer.

Dental inlays can be used in the following circumstances:

1. When there is small amounts of decay in the fissures (creases) of the tooth

2. Replacing cracked or broken or leaking Metal Fillings.

Inlays normally take two visits with your cosmetic dentist.

First dental inlays appointment

At the first appointment the decay or old metal filling is removed. An impression of your tooth will be made and sent off to the laboratory for them to make the inlay in porcelain.

A shade is then chosen to ensure the best match to your original tooth structure.

Finally, a temporary filling is placed and the patient should wait around a week for another appointment.

Second dental inlays appointment

At your second inlay dental appointment, the cosmetic dentist will remove the temporary filling, and the inlay that the laboratory made will be cemented in place.

There should be no colour difference, and the tooth should look like no procedure was performed on it.

Dental inlay procedure after-effects

There is normally no after effects of this treatment, and the patient can eat and drink normally after the procedure.

However some patients do complain of slight tenderness for a day or so after the treatment, however this soon passes.

Porcelain inlay advantages

The advantages of having porcelain dental inlays are:

– They are very hard wearing and are much stronger than your own tooth enamel.

– They look much nicer than metal fillings or composite resin fillings.

– These porcelain inlays are made specifically for your tooth and it is customized to fit exactly.

– As it is custom designed for your tooth, it seals perfectly ensuring that no bacteria can enter the cavity so no decay can take place under the porcelain inlay.

How to Care for Crowns and Bridges

You now have a crown or a bridge or both. You’ve expended plenty of time, effort and expense in that dental work so you surely don’t want to fail to take care of it properly. But how DO you take care of it?

You actually have two separate dental appliances to care for. First is the temporary crown or bridge, and then the permanent one. There are important things to remember about cleaning both the temporary and the permanent crown or bridge.

Crowns

You’ve finished the dental procedure to grind down your original tooth and prepare it for the permanent crown. But the dentist first has to cap your natural tooth with a temporary crown until your permanent one is ready, in a couple of weeks.

At home, you need to be extra careful with that temporary  crown. You’ll have to avoid chewing on anything hard, like ice or hard candy. And avoid those Tootsie Rolls, or anything else “sticky” like caramels. Brushing and flossing should be done gently, using a soft-bristled toothbrush—with extra care not to dislodge the temporary crown with the dental floss.

And, by all means, if that temporary crown does become loose or uncomfortable, call your dentist immediately.

Now you have your permanent crown cemented on. And you can treat it just like you do your natural teeth. Again, use a soft-bristled toothbrush. You should floss, at least once a day, if not two times, gently easing the floss between your teeth, and scraping it several times against the sides of your teeth. Avoid chewing on ice or hard food. Your crown isn’t invincible. Neither are your natural teeth, for that matter. Since your crown is cemented on, you may eat sticky foods, but be careful.

Bridges

Bridges should be cared for about the same as with a crown. Especially since you’ll have crowns on either side of the bridge, to support it. Once more, when it’s a temporary bridge, it can become loose very easily. Take extra care to softly brush and floss. In two or three weeks your permanent bridge will be cemented in. Then you still want to be reasonably gentle, but you won’t have to be so concerned that the bridge will be loosened.

A Water Pik is an excellent choice, especially if you use it with antibacterial mouthwash. Ask your dentist about which antibacterial mouthwash to get.

An electric toothbrush is preferable.

Good oral hygiene is vitally important if you want to keep your crown or crowns and bridge for a long time. Flossing can’t be emphasized enough. Just be careful flossing with your temporary crown and bridge. But DO floss, and brush. And brushing your gums and tongue along with your teeth will keep your mouth healthy.

Be sure to keep all your scheduled dental appointments, and call your dentist if anything becomes loose, uncomfortable or your bite isn’t right.

Crowns and Bridges vs Dentures

Which is best?

You have some missing teeth. Or maybe you need to have your teeth pulled. What to do? There are so many choices—and prices!

How exactly are they different?

A crown is a “cap” or “top” fitted over a prepared natural tooth. A bridge is a false tooth or two or more false teeth, suspended between, and attached to, crowns on either side of a section of one or more missing teeth.

A Denture is typically false teeth made, based on your mouth impression. The four types of dentures include:

1.  Complete—all the teeth are replaced, as well as the connecting tissue.

2.  Partials—one or more false teeth clasped to surrounding teeth.

3.  Immediate—dentures which are placed right after the natural teeth are extracted.

4.  Conventional—dentures placed after teeth have been extracted and the gums have completely healed.

The main difference is that crowns and bridges are “fixed”. In other words, no removal for cleaning and treated like your natural teeth. And dentures are typically removed at night or for cleaning.

But there’s now another choice—IMPLANTS.

Implants consist of titanium plugs inserted into the jawbone. These plugs can anchor dentures and your bridge can be attached directly to the jaw or under the gum tissue.

What to choose? Let’s look at some advantages and disadvantages of these choices.

With traditional full dentures there is a problem with the underlying tissue and bone diminishing—because there’s no tooth roots to hold it. Then the dentures become loose, and have to be relined or refit, periodically. Also, the overall shape of your jaw will change. And there are also the speech problems that can arise, and problems watching what you eat to avoid breakage, or food underneath the denture, irritating your mouth tissue.

Immediate vs. conventional is something to discuss with your dental professional. Everyone is different.

One advantage with removable dentures can be the cost.

Implants can make your dentures more permanent, and negate all the above disadvantages.

The disadvantage with implants could be cost, depending on the extent of your dental work.

As far as partial dentures, these have an advantage over full dentures. However, some do have to be removed for night and cleaning. A bridge or fixed partial denture would be easier to deal with, if that would work for you. You have natural teeth supporting the jawbone and underlying tissue, or you can have implants that accomplish the same thing.

Implants are the newest weapon in the arsenal of ways to protect your jaws and oral tissues—not to mention ease and comfort.

What you have to do is talk to your dental professional about all these choices. There is a lot more information you could have access to. He/she will explain all the advantages and disadvantages in relation to your unique circumstances. If you opt for a more expensive choice, most dental professionals can arrange a payment plan to fit your needs.

What to Do If My Temporary Cap Comes Off

When a temporary crown and/or bridge is put in, the dentist uses a temporary cement so he/she can get it off when it’s time to put in the permanent one. This is not as strong as the permanent cement, so you need to take care not to dislodge the temporary cap.

What to do

It’s important to follow your dentist’s instructions as closely as possible following crown and bridge work. You will be instructed to avoid chewing on ice or any hard food, and to stay away from anything sticky—like caramels, gum, or gooey chocolates. And you should try to chew on the other side of your mouth when you eat. Also, be careful flossing.

But in spite of these efforts (more likely if you don’t make the effort!) a temporary crown and bridge may come off. And it’s important to know exactly what to do:

  • Call your dentist and explain what happened
  • Secure the temporary cap and protect it.

If you can’t find it, a new one can be made.

The temporary protects the original tooth, plus, there could be a slight shifting of the teeth around the missing crown and/or bridge causing a bite problem. This is especially true for missing bridges. And for this reason your dentist will make every effort to get you in as soon as possible. The temporary cap can be easily re-cemented.

If you are out of town, or not able, for whatever reason, to get to the dentist, you can do the re-cementing yourself with over-the-counter dental filling material, found at most drug stores. In a pinch, toothpaste, Vaseline, or Fixodent will work, but not nearly as well. And by all means, get to the dentist as soon as you can.

How is it done?

If you have to do it yourself, certain important steps must be taken.

  • Clean the cement out of the temporary with a toothpick or bobby pin.
  • Place the temporary cap on your tooth, to see how it fits correctly. If the bite doesn’t feel right, it may not be correctly fit. Try again, and note how to put it in right when you cement it.
  • Mix the dental cement. It will set up fast, so be quick.
  • Dry your tooth carefully with gauze or wash cloth.
  • Put cement in the temporary.
  • Place the temporary on your tooth. Bite down gently and tap your teeth together to make sure the bite is right.

If you don’t feel extra pressure on the temporary cap when you bite down, place gauze or a wash cloth over it and bite down firmly for around 5 minutes. If, after doing this, the temporary still doesn’t feel secure, TAKE IT OUT. Never leave it in. You could aspirate or swallow it in your sleep.

Then get to the dentist, as soon as you can!

 

How Crowns and Bridges are Made

First, why do we need crowns and bridges?  A crown is called for when a tooth is broken, or is so decayed that it can’t handle that much filling without being weak. And sometimes, a crown is used if a tooth is severely discolored or misshapen. Another use is to have a crown on either side of a bridge, for support.

With a bridge, one or more teeth are completely gone, or there’s not enough tooth left to put a crown on, and the space needs to be filled.

Crowns

Crowns can be constructed with several different materials. But the most common are gold and porcelain.

  • Gold is typically used on back teeth only, where it won’t be seen that much. Its main advantage over porcelain is strength. Also, less tooth will need to be minimized before the impression and fitting are done.

Another advantage of gold is in the lab–it shrinks less when cast and is easier to polish.

  • Porcelain is just about always used for front teeth, but can be used for back teeth. Porcelain’s advantage is appearance. It’s made to look, size and color, just like the rest of the teeth in your mouth. That said, occasionally some porcelain crowns have metal inside to give strength and support, but it can give the crown a dull color. While this isn’t  a problem with back teeth, it definitely IS with front teeth.

At first, before the crown can be constructed, the original tooth must be minimized so that the crown will fit over it. The dentist will, using his drill, reduce the tooth in size. Then he/she takes an impression so an exact mold for the crown is possible. Also, if porcelain is to be used, a determination is made on exact shade to match your other teeth.

A dental lab, after receiving the information and impression, will begin the process of making your crown. But first, a temporary crown will be put in to cap the drilled down tooth, to protect it while the real crown is being made. After a week or two, you will then receive your new crown, placed permanently over your minimized tooth.

Bridges

They’re constructed in basically the same way. There is still the desire to match the shade of the surrounding teeth. Bridges are usually porcelain—seldom gold.

Usually, the teeth on either side of the open space will need to have crowns placed on them, for added support for the bridge. And again, a temporary bridge will be used first. Then a permanent tooth will be suspended between the two crowns and attached.

It’s important to get a missing tooth bridged, because if a tooth is missing, the surrounding teeth will shift to fill the space, and could easily become crooked, and will give you a bad, unbalanced bite.

Then you could be looking at gum disease or temporomandibular joint (TMJ) disorders.

What to Do If Your Permanent Crown or Bridge Comes Off

It’s not common, but not unheard of, for a permanent crown and/or bridge to come off. Usually it’s not long after the procedure, before the cement has fully set.

A bridge is actually two crowns with a “tooth” attached in between. And either the crown or the “tooth” can come loose.

Why would it come off?

  • When the cement used wasn’t isolated properly, like with saliva getting into the cement somehow.
  • If the person with the crown clenches or grinds his/her teeth. This causes the teeth to flex a lot, and the cement gets loose.
  • If the bite isn’t set correctly. With this, the cement will break down because of repeated hitting of the cement seal.
  • If good eating habits aren’t followed, like if, after getting the permanent crown in, you go home and eat the wrong thing. Maybe chew on ice, or have sticky chocolate candy, or peanut butter crackers. Or even worse yet, bubblegum!
  • Lack of adequate retention for the crown and/or bridge. In other words there’s not enough original tooth above the gum line to hold onto. No less than 2 millimeters of tooth structure is needed above the gum line, all the way around the tooth. And it must be free of decay—which will compromise the seal. And lacking good oral hygiene, decay can get started and progress underneath the crown.

Crown lengthening, a form of gum treatment, can create adequate tooth structure for the crown. Another treatment that works well is orthodontic treatment. It also creates more tooth structure

Very rarely, a lack of retention can depend on how the natural teeth are prepared above the gum line. And that, if not done right, will affect how the crown or bridge fits on the natural tooth structure. And if the fit’s not good, it could come off, even though it’s cemented.

What if it DOES come off?

You’ll need to act quickly. The longer the crown and/or bridge is out, the more chance your surrounding teeth will shift—as well as the teeth they chew against. You don’t want that to happen!

Start by storing your fallen out dental work safely. It oftentimes can be cleaned up and re-cemented in place. But you could have a retention issue to be addressed. Or, on the off chance that the crown/bridge or the underlying natural teeth have been damaged in some way, you may have to undergo a completely new dental procedure to have it done all over again.

But in any case, get to your dentist as soon as you can!

What Does A Cosmetic Dentist Do?

Latest technologies and advances in modern dental procedures has sprung a specialty in dentistry, the cosmetic dentist.  This dentist has gone for several years of training beyond his/her competency in regular dentistry for which examinations have been passed and proficiency has been demonstrated.

Treatments and procedures offered include:

  • Bonding

This is a method to repair chips, and cracks in existing teeth as well as addressing teeth stains and gaps between teeth. An enamel-colored composite resin is applied to the surface of a tooth and then contoured to the desired shape.

  • Whitening

This is the most popular cosmetic procedure because it is simple to perform and has a dramatic effect on one’s appearance.  There are several bleaching options but when done in a dental office can be accomplished in one visit with an upgrade of several shades by applying a bleaching agent to remove stains or discoloration and then curing it with a light source.

  • Veneers

Thin layers of porcelain are adhered to the tooth surface after the enamel has been prepared by shaving some of the enamel surface to make the thickness of the tooth natural. Advantages of veneers include strengthening of the existing teeth and repairing chips or cracks providing durability, as well as providing a whiter smile and removing any appearance of gaps.

  • Crowns

Caps for teeth that are not candidates for veneers due to extensive fillings with prior cavities can have crown placement.  The crown color can be made of composite material to match that of the surrounding natural teeth.

  • Bridges

Bridges are appliances that span a gap in the jaw line from missing teeth.  A false tooth (or teeth) are placed on the device which is attached to the adjacent natural teeth on either side

  • Dentures

Partial or complete sets of dentures are false teeth attached to a mold that is made from the palate and gum structure to maintain the facial muscles, allow for chewing and giving an aesthetic appearance.  Dentures are made when implants are not an option.

  • Tooth shaping

Although in recent times, some individuals have sought teeth shaping to mimic the fangs in their popular vampire movies and television shows, the more ethical reason for tooth shaping is to correct flaws by rounding pointed teeth or shorten long ones so that they follow the lower lip contour.

  • Gingivoplasty

This process contours the shape and length of existing gingival tissue, cutting away excess in order to lengthen crowns, and eliminate the “gummy” smile to provide an aesthetic appearance.

  • Implants

These are replacements for lost teeth and have the look and feel of natural teeth.  A titanium screw is inserted into a surgically prepared space in the jawbone and then a porcelain or composite resin tooth is placed over the screw.

  • Porcelain Fillings

Rather than the old amalgams or metal alloys, porcelain is now used in fillings to maintain a natural appearance.

The cosmetic dentist offers many options to provide aesthetic results for those dissatisfied with or embarrassed by their current smile.

 

Dental Veneers vs Crowns and Bonding

When determining whether application of veneers is the option for you or crowns and bonding is the better choice, there are benefits and disadvantages of both that should be kept in mind.

With latest technology, the choice to correct dental imperfections can be any of the three, unlike years ago when the only available option was to place a cap or crown over each problematic tooth.

Benefits of Veneers over Crowns and Bonds

  • Veneers last longer than bonding
  • Porcelain veneers resist staining
  • The exact color can be obtained with veneers
  • Veneers add strength and durability to the teeth
  • Only regular oral hygiene with brushing and flossing is required for maintenance.  No special routine is needed.
  • Less healthy tooth material is removed than with crowns
  • Teeth shape alteration is more moderate with veneers
  • Gives a more natural look and feel to the teeth
  • If brushed and taken care of properly, veneers can last up to 15 years.

The disadvantage of dental veneers is that it is not as strong as crowns.  They cannot withstand undue pressure so that people suffering from bruxism or grinding and clenching teeth at night can cause undue harm to the veneers.  (This can be addressed with a mouth guard).  A tooth would not be eligible for veneers if it has had extensive structural work done as in extensive fillings from decay.

Because of the decrease in strength compared to crowns, veneers chip or crack more easily. They also are vulnerable to decay and if enough of the enamel is lost, will necessitate covering the tooth with a crown, anyway.

Teeth covered up with veneers have the risk of becoming sensitive to exposure to hot and cold as in hot and cold beverages, ice, cold air. Sour and sweet foods may also trigger the sensitivity sensation.  This is characterized by sharp, sudden and shooting pain deep into the nerve endings of the teeth. The cause of sensitivity is exposure of dentin (the underlying layer to enamel) which has thousands of channels leading to the pulp (nerve center) and may be opened from manipulation of the tooth enamel or receding gum lines.

If the veneer develops a fracture or crack, which is either undetected or untreated, bacteria from plaque may enter the pulp from tubules, thereby causing inflammation and additional sensitivity.

Once the decision to have veneers or crowns is made however, the process is not reversible.  In either case, you will have a beautiful set of teeth and a dazzling smile!

Dental Implants vs. Bridges

When you think of Grandma, quite often a picture of her teeth in a glass of water humorously comes to mind.  This is natural.  For the majority of the population, bridges were the main method of restoring teeth- a tried and true technique for compensating for a lost tooth by dental crowns on bridges anchored to adjacent teeth.

Now, with modern technology, dental implants are available as an option for many more people. Here, a titanium screw type device, which acts similarly to roots of teeth, is inserted into the jawbone where the missing tooth originally resided.  When healing has taken place (about 2-3 months), a small tooth (abutment) is adhered to that device. A crown, which is made to look like a tooth, is attached over the abutment.  Now, you have what appears to be a tooth, replacing the missed one.  It has both the function, natural look and feel of the original.

Caring for the implant is the same as for all natural teeth including brushing and flossing to prevent tartar and plaque buildup as well as decay or gingivitis surrounding the implant.

Bridges are not as long lasting or durable for loss of teeth.  Since the crown, representing the lost tooth and now occupying its space, is connected to surrounding teeth, any problems that occur with these adjacent teeth will negate the function and placement of the bridge.  It will need to be devised again and replaced.  Also with a shift in the occlusion (bite) or malocclusion (bite which does not meet properly between top and bottom sets of teeth), breakage of the bridge or slight fractures is apt to occur.

Bone and gingival complications can occur with improper care of bridges. It is not unlikely (especially with a permanent bridge) for food particles and debris to lodge between the device and adjacent teeth. Without fastidious flossing technique application, this particulate matter will fester, creating decay and gingivitis (inflammation of the gums)

There is a significant time difference between dental implants and bridges due to the nature of reconstruction and insertion of each.  The bridge can be implemented for a patient in a much shorter time, considering that with an implant, the operative site must take 2-3 months healing before the second stage of the procedure can be performed.

Yet, in the long term, bridges will need to be replaced and redesigned, making up for additional time that was saved over implants.

Thus, dental implants, which give more permanence to a gap from lost teeth, have advantages over bridges, for those people that are candidates.

The natural look and feel of your implants makes you feel that you have grown another set of teeth.