THE COMPLETE GUIDE TO DENTAL CROWNS
The content in this guide is not available anywhere else on the Internet. The content is written and produced by Dr. Reza Khazaie, DDS, founder of the #1 rated dentist in Concord, California, Willow Pass Dental Care.
Dr. Reza Khazaie is a nationally known prosthodontist who is regarded as the smile expert. Dr. Khazaie is an expert on the specialized treatment of dental and facial problems that involve restoring missing teeth and jaw structures. He is a highly trained specialist in dental crowns, dental cosmetics, dental implants such as the All-On-4® treatment concept, bridges, dentures, implant-supported dentures, porcelain veneers, Ectodermal Dysplasia, TMJ/TMD, and many more dental procedures.
So if you're looking to learn as much as you can about dental crowns, you will find value in this guide about dental crowns.
So let's get started.
CHAPTER 1
Do I Need A Dental Crown?
High-Quality, Lifelike Tooth Restoration In One Visit
Dental crowns are a complete and lasting solution to the problem of an irreparably damaged, decayed, disfigured, or discolored tooth. Unlike other cosmetic procedures and treatments, such as porcelain veneers, crowns completely cover and encapsulate the exposed portion of the affected tooth. In effect, dental crowns are functional
tooth replacements which, unlike dental implants, do not necessarily require that the damaged or disfigured tooth be first removed. Like implanted teeth, however, dental crowns are a fixed permanent solution. Once installed, they are typically not removed and can, with proper care and hygiene, last an entire lifetime without needing replacement.
Why Dental Crowns?
Dental crown procedures are a mainstay of most restorative dental practices in the world. The ability to cap and completely cover a tooth for health and aesthetic purposes while still providing a high degree of functional strength and resilience is incredibly useful. To this end, dental crowns are most often employed to provide permanent reinforcement and protection for damaged and decayed teeth. Teeth with large cavities, extensive fillings, cracks, fractures, and other forms of physical damage that severely weaken their structural integrity are good candidates for dental crowns. However, damage may not be the only consideration to getting a crown.
Aesthetic considerations may also be a concern for a dental crown procedure. Some patients may not be suitable candidates for partially-retentive restorative procedures, such as dental bonding treatments, for a variety of reasons. Bruxers, or patients who suffer from teeth grinding and jaw clenching disorders, may require more resilient crowns for restorative treatments to combat the stress their conditions place on their teeth. Likewise, many patients will find that less durable solutions simply won’t hold up over time due to the high bite forces exerted on certain parts of the mouth.
When You May Need A Dental Crown
To repair a tooth with a large cavity
To reinforce a tooth with extensive filling work
To hold together a weakened tooth to prevent cracks and fractures
To repair a fractured tooth
To strengthen a tooth that has undergone root canal therapy
To cap a dental implant
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To aesthetically improve a tooth that must also withstand high bite pressure (i.e., for patients with bruxism)
To completely cover-up a worn-down, damanged, or discolored tooth
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To hold together a weakened tooth to prevent cracks and fractures
To serve as an abutment tooth for partially removable dentures
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To brace a dental bridge and hold it in place
Benefits of Today's Dental Crowns
Dental crowns offer a versatile aesthetic and functional solution that can be employed to address both aesthetic and practical concerns. Some restorative techniques, such as veneers and dental bonding, may not have the adequate longevity a patient requires. Other procedures may be too invasive, too time-consuming, or simply too expensive. Dental crown procedures offer a middle ground for patients looking to repair a severely damaged tooth without resorting to total extraction and still retaining functionality. Better yet, crowns can last a very long time.
Many patients, barring extreme circumstances, will never need to replace their crowns during their lifetime. Many dental crowns will last decades in spite of daily wear and tear with good dental hygiene and care. Most dental crowns are warrantied by the manufacturers for 10 years or more. As with many restorative dental procedures, longevity will vary from patient to patient depending on a broad range of factors including natural bite, preexisting conditions, the quality of the materials chosen, the manufacturer, and the experience of the dentist performing the operation. This is something Dr. Reza Khazaie and the team at Willow Pass Dental Care will address in your consultation to provide you with the best solution based on your pre-existing conditions and dental goals.
Situations In Which A Dental Crown May Be Called For
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Protecting a tooth post-root canal treatment
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Protecting and restoring a damaged tooth (such as a cracked tooth)
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Protecting and restoring a tooth with multiple fillings
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Restoring severely worn teeth
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Restoring fractured teeth
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Replacing a missing tooth via a dental implant
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Covering up a discolored or disfigured tooth
5 Benefits of Dental Crowns
Longevity (dental crowns can often last decades -- often a lifetime)
Durability (dental crowns can withstand extreme bite forces and wear and tear)
Highly aesthetic (dental crowns look and feel natural)
No additional maintenance necessary (good dental hygiene still required)
Highly functional (dental crowns can function just like your original teeth)
4 Signs A Dental Crown Is Right For You
One of the most appealing reasons to get a dental crown is to salvage an existing tooth. Recovering a natural tooth, versus total tooth extraction, is much preferable for a variety of reasons.
First, retaining natural dental structures ensures better oral and dental health. No matter how suitable a dental prosthetic is (and they can be made to look virtually indistinguishable from natural teeth), they still lack many of a natural tooth’s structural integration. In particular, non-implant-based prosthetics lack dental roots, nerves, and other dental tissues.
For example, dental roots help to transmit the forces of mastication (biting and chewing) into the jawbones, thereby promoting the retention of bone density and depth. When roots are extracted, bone resorption, or a wasting away of bone tissues, can occur. Extraction can also result in trauma to surrounding tissues and underlying bone structures that may require a lengthy recovery period to overcome.
It is far more preferable to salvage a damaged tooth than to extract it. Dental crowns do just that. While some material must be shaved off of a target tooth to accommodate a dental crown, a crowning procedure will save most of the tooth's natural structure.
If you have a damaged, fractured, cracked, or broken tooth, you may benefit from the placement of a dental crown. Depending on the location and extent of the damage, different types of dental crowns can be utilized to strengthen a compromised tooth. Furthermore, dental crowns are a great way to not only reinforce an ailing tooth but also give your tooth a brand new look.
Most root canal (endodontic) procedures are immediately followed by the placement of a dental crown over the affected tooth. While a dental crown isn’t required in every case after an endodontic procedure, it is highly recommended. That’s because the endodontic procedure and subsequent removal of material from the endodontic chamber often significantly reduces a tooth’s structural strength. As a result, a dental crown is almost always recommended to reinforce the treated tooth’s structure as well as keep germs and food debris out of the root canal. Teeth that have undergone a root canal are at a higher risk of experiencing dental fractures. Dental crowns prevent cracks and give your recently treated tooth a brand new look.
A crown can entirely or partially cover a tooth. As a result, dental crowns are an excellent way to enhance your smile one tooth at a time. Dental crowns can be a unique way to cover up unsightly blemishes on your teeth such as pits, cracks, and discoloration. Crowns can even be used to change the size and shape of your teeth.
All things being equal, a dental crown will look much more natural and blend in much more seamlessly with surrounding teeth than other restorative procedures such as conventional dental fillings or dentures.
When it comes to replacing missing teeth entirely with implant-based solutions, dental crowns are a must. Most individual implantation procedures include the use of a dental crown. After all, the implant itself merely serves as an embedded support structure. Once an implant is put in place, the visible portion of the replacement tooth, the crown, must then be attached via an abutment. Without a crown, an implant would be mainly nonfunctional pointless.
Dental crowns are one of the most popular dental prosthetics used today with millions of people around the world receiving dental crowns every year to replace, repair, or reinforce missing or damaged teeth. People have been placing crowns over their teeth for thousands of years. Ancient and pre-modern people used all kinds of crowns, including crowns made from gold, wood, and animal ivory.
Today, there are four primary types of dental crowns that you can get at your dentist or prosthodontist’s office. These include dental crowns made from porcelain (all-ceramic), metals, porcelain fused to metal, and resin.
Let’s explore each type of dental crown in more depth.
Strengths
Stunning natural aesthetics, seamless visual transition, non-allergenic.
Weaknesses
More expensive, can break more easily than metal options, more enamel must be removed to accommodate ceramic crowns.
Porcelain or all-ceramic, crowns are hands down the best solution for those looking for unmatched aesthetic qualities. Porcelain not only looks like natural teeth but also has surface translucency properties and shine much like natural teeth do.
They can be color-matched accurately and precisely to your existing teeth as well making them the perfect solution for patients who value a stealthy approach to cosmetic dentistry. Many dental professionals, let alone a casual observer, will have a difficult time telling a properly crafted and fitted porcelain crown from a natural tooth.
Ceramic materials also come with other very functional qualities beyond aesthetics. For one, ceramic is a highly durable material that is resistant to compression forces (such as those exhibited during chewing and biting). It’s naturally stain-resistant surface also resists bacteria and other undesirable microbes preventing them from forming dental plaque.
However, the unparalleled aesthetic and functional qualities of a porcelain crown come with certain costs. All-ceramic crowns are typically the most expensive option available today. Furthermore, while the rigidity of ceramic is excellent for dealing with compressive forces, it can become a liability when exposed to shear and diagonal forces. Unlike metals and other ductile material, ceramic will hold its rigid shape until a great force causes it to shatter. This brittleness can be a problem when it comes to the mouth since the mouth doesn’t only move up and down. People who play contact sports or have an unusual bite should recognize that while durable, porcelain teeth are still brittle and may break when exposed to unexpected lateral forces.
Strengths
A strong aesthetic statement, best long-term durability, economical, less removal of existing enamel.
Weaknesses
A strong aesthetic statement. It may cause an allergic reaction in people sensitive to certain metals.
Metal crowns are a classic solution that has been in use for centuries. From Etruscan kings to 18th-century pirates, to modern-day celebrities, metal teeth have been in fashion in one form or another for a very long time.
Metal dental crowns can be cast or made from a variety of metal alloys. Most popular amongst these alloys include gold alloys, nickel alloys, and chromium-infused metal alloys.
Other than bringing a real shine to your mouth, metal crowns have several essential benefits that patients should consider. First and foremost, metal crowns last the longest and exhibit a higher lifespan than any other dental crown material. While metal is not harder than porcelain, it’s ductility gives it far superior lateral strength allowing for some flex without breakage.
In contrast, a porcelain crown exposed to unexpected lateral forces might shatter. Furthermore, base metal alloys are typically much cheaper than porcelain teeth. While gold, silver, and other precious metals will certainly command a premium, they also come with all the strengths of a dental-grade metal solution, including ductility and toughness. Gold, in particular, is valued as a crown material for its inert nature and natural beauty. If you want to make a statement with your new teeth, go with gold.
Unfortunately, metals have also been shown to trigger an allergic reaction in a tiny minority of patients receiving a dental crown. More and more patients are asking for metal-free dental applications due to the concern about the potentially toxic effects of metals in a person’s oral cavity. While many studies have shown the long term safety of common dental-grade metals, such as nickel alloys, metal sensitivity remains a topic of concern for some. If you’re worried about how metal crowns may affect your health, consider opting for inert gold crowns or all-ceramic porcelain crowns.
Strengths
All the compressive strength of porcelain combined with the ductility of metal.
Weaknesses
More expensive, metal band is visible and can detract from overall aesthetics.
Porcelain fused to metal crowns is the dental industry’s attempt to solve the weaknesses of both porcelain (all-ceramic) dental crowns and metal alloy dental crowns by merging the two materials.
With a porcelain fused to metal solution, consisting of an inner layer of dental-grade metal alloy combined with an outer layer of porcelain. This gives the overall dental crown a better fit, higher ductility, and the ability to color match like conventional ceramic teeth.
Other benefits of ceramic, including stain-resistance and life-like appearance, also carry through to porcelain fused to metal crowns.
However, porcelain fused to metal crowns is still prone to breakage. The underlying layer of metal is often visible at the base of the crown. This darker layer of metal can create a visually distracting band at the base of your teeth leading some to find the aesthetic qualities less than desirable. For patients who opt to go this route, there are a few things a prosthodontist can do to lessen the visual impact of the metal band, including covering the base with gingival material.
Strengths
Inexpensive, easily fabricated and replaced.
Weaknesses
Extremely weak, not recommended for long-term usage.
While resin crowns are common, they are almost always used in a temporary capacity and very rarely used for permanent crowns. This is for many reasons.
First, resin is weak. Resin crowns can rapidly wear down and be prone to breakage. As a result, most prosthodontists only use resin crowns as a temporary while a permanent crown is being fabricated. For this purpose, resin is an excellent choice as it is cheap to make and easily replaced. That’s just as well since resin crowns usually don’t look very good either. While resin in other prosthetic applications can be made to look quite realistic and life-like, when used as a dental crown material, the effort expended to craft a quality resin crown isn’t worth it. We do not recommend the use of resin crowns.
CHAPTER 3
Steps In Preparing A Tooth for A Dental Crown
While a dental crown procedure is simple in concept, the actual preparation is quite involved. There are a few reasons:
First, an existing tooth itself must be trimmed down to accommodate a crown. This process requires a high degree of precision and accuracy to ensure the dental crown not only fits,
but remains in place, and is adequately and structurally supported.
Second, the ideal result in the shape and durability of the tooth will depend on the quality of materials being used and the natural aesthetic of the tooth.
Dental Crown Preparation
The preparation of a tooth before receiving a dental crown can be divided into four steps:
Digital Impression
Preparation and shaping
Crown fabrication
Permanent placement
Decay removal and dental build-up may be additional steps but most often are not necessary during a dental crown procedure. A patient with a cracked tooth with no decay, for example, will more than likely skip the second and third step.
In the old days, just a few years ago, dentists would begin preparing a tooth to receive a dental crown by creating a so-called reduction putty. This was a simple but messy and time-consuming process to obtain an impression.
That process though still used by many dentists is outdated.
A more innovative approach uses The CEREC Procedure which uses CAD/CAM technology to obtain a digital impression. No messy putty --- simple, fast, and accurate.
This is done with a special powder and digital photograph. Using the digital photo and the CEREC computer, the prosthodontist can then design the tooth restoration to provide the best function and aesthetic look.
This step involves trimming and shaping process, the existing tooth is meticulously shaped and fabricated, and permanently put in place the same day using the latest CAD/CAM technology.
What used to be a long process that required at least two visits to the dentist is now done in one day!
Finally, once the primary trim is complete, it’s time to finish the preparation. The dentist will employ a very fine grit dental bur to smooth out the trimmed tooth and remove any surface irregularities and sharp edges. This will allow for a better fit for the final crown and overall better aesthetics.
Finally, the target tooth is checked for proper fit and bite, then polished and bonded to your prepared tooth.
When damage to a tooth is too extensive for a direct filling to repair, dentists will turn to dental crowns. However, the problem is when some dental crowns don’t cover your entire tooth. While full dental crowns are popular and often necessary to salvage a severely damaged tooth, there are other choices such as partial dental crowns or indirect fillings.
Indirect fillings, or partial dental crowns, are a critical variation on full dental crowns.
What Are Partial Crowns (Indirect Fillings)?
Partial dental crowns are, as the name suggests, dental crowns that only cover a part of your tooth.
Partial dental crowns come in a variety of shapes and sizes from small inlays that are more like large fillings to extensive onlays that may cover three-fourths of your tooth. The latter is often referred to as a ¾ dental crown).
Partial crowns cover every type of crown that is not what is referred to as a full dental crown. This can be confusing for patients since many dental clinics use the general term “partial crown” and more specific terms such as “inlays” and “onlays” somewhat interchangeably. Furthermore, terms such as ¾ crowns only muddy the waters further. To keep things simple and to help you understand the differences, it is essential to remember the following:
- Partial crowns, or indirect fillings, are a type of dental crown.
- Inlays, onlays, & ¾ crowns are a type of partial crown.
- Inlays are generally less extensive and act as a big filling.
- Onlays are generally more extensive and cover more of your tooth.
- ¾ crowns are a type of onlay that covers most of your tooth.
- A full dental crown covers the whole tooth.
Inlays vs. Onlays
Both inlays and onlays are popular types of partial crowns. Like a conventional full crown, both inlays and onlays are used to cover and protect and reinforce parts of a tooth. The primary difference is in how they are deployed.
Inlays are often used when a cavity is too large for a simple filling to fix. Inlays will also rarely cover the cusps, or sharp pointy parts or your tooth.
An onlay, on the other hand, will often cover parts of the cusp. Both inlays and onlays are fabricated as a single piece that is then placed in or on a tooth. Because inlays and onlays are fabricated outside of the mouth then put in place, they are often referred to as indirect restorations. In comparison, a typical dental filling is built up in the mouth and known as a direct restoration.
Inlays are used when a simple filling is not enough to repair damage to a tooth as a result of dental caries or a tooth fracture. Inlays possess several significant advantages over simple amalgam or resin fillings.
Because inlays are fabricated offsite, they do not experience shrinkage. Furthermore, remote fabrication means that there is virtually no limit to the materials that can be employed. Inlays can be made from everything from metal to porcelain ceramic. In comparison, direct fillings often experience shrinkage when it hardens in a patient’s mouth and is limited to materials that can be rapidly cured in-situ. While much more expensive than a simple dental filling, dental inlays still have important advantages, including superior resistance to occlusal forces, resilience, aesthetics, and ease of maintenance.
Onlays are also fabricated outside of a patient's mouth, offering many of the same benefits as onlays. The primary difference is that onlays cover a significantly higher proportion of a person’s tooth. Onlays are often used to incorporate missing or damaged dental cusps and are usually employed when the perimeter wall of a tooth is compromised.
Inlay - Onlay Process
The process for creating and placing a partial crown begins with extensive dental preparations. Like a full dental crown, the dentist or prosthodontist executing the procedure will need to eradicate any traces of infection.
This is followed by a process of grinding down dental surfaces that the restoration will mechanically attach to. This is done to ensure that there is adequate surface space for the partial crown to adhere to.
Unlike direct restorations that are executed entirely within the confines of a dental clinic, partial crowns are often fabricated off-site. The process continues with a dental impression that records the existing conditions in a patient’s mouth. This data is transmitted to a lab where it is used to fabricate a precise partial crown that will fit exact specifications.
While the partial crown is being prepared off-site, a temporary inlay or onlay is often put in place. When the final partial crown is made, the patient will return to the dental clinic to have the temporary crown removed and replaced with the final tooth restoration.
- Tooth preparation
- Dental impression
- Fabrication and a temporary partial crown
- Final fitting
Why should I get Partial Crowns?
Natural teeth look, work, and feel much better than artificial ones. Partial dental crowns provide patients with the ability to salvage and retain as much of their natural teeth as possible while still providing reinforcement where it matters.
Full dental crowns require the removal of a significant amount of dental material to accommodate a full crown. There are many situations in which a full crown merely is unwarranted. For example, a filling that has failed can be more economically and expeditiously solved with a partial crown inlay. Likewise, a minor fracture, chip, or the loss of a dental cusp can be addressed with the use of a partial crown onlay.
More extensive tooth damage can often be sufficiently repaired with the use of more extensive crowns such as a ¾ crown.
Are Partial Crowns right for you?
To determine if partial crowns are right for you, it is essential to ask yourself and your dentist the following questions:
An unsalvageable tooth that requires extraction would not benefit from a partial crown.
If the damage is too extensive, but the tooth is salvageable, a dentist will likely recommend a full dental crown to ensure stability. In this case, a partial crown would be inadvisable.
Chances are if you have received a root canal, you will require a full crown, NOT a partial crown restoration to ensure that the tooth does not suffer a fracture or breakage.
If you have an unusually large filling or a filling that is repeatedly failing, it might be a good idea to get a dental inlay or onlay.
One of the best ways to repair your tooth and restore its aesthetic qualities is to invest in partial dental crowns such as inlays and onlays. Unlike direct restorations, such as dental fillings, partial crowns can be fabricated from any material, including beautiful and resilient porcelain. Inlays and onlays can be made to look almost like natural teeth.
Considering dental crowns? Look no further than Dr. Reza Khazaie of Willow Pass Dental Care in Concord, CA. We provide a broad range of holistic family dental care, including dental crown procedures, dental implants, and a friendly and professional environment you can call home.
Schedule a consultation today by calling 925-326-6114 or complete our online form below to schedule an appointment.
