You've been told that you need a dental crown, and you're wondering, "Why on earth do I need this?" Well, let's break it down. Dental crowns are a common dental treatment for various reasons, and here are some of the most frequent scenarios that call for the royal treatment:
Why You Might Need a Crown?
Inadequate tooth structure for traditional fillings.
Multiple broken or weakened cusps.
Post-root canal treatment protection.
Cosmetic concerns involving shape, size, or color.
Post-crown lengthening procedures.
Decay or fractures reaching the gums.
Full mouth rehabilitation for bite correction.
What are the treatment stages for a crown?
The Diagnostic Phase: Crafting the Perfect Smile
Beauty is subjective, and patient preferences are paramount.
A diagnostic phase often includes a wax-up and mock-up.
Impressions and bite records are taken for study models.
A diagnostic wax-up helps visualize desired tooth improvements made by a lab technician on the study models.
Mock-up transfers the wax-up information to the patient's mouth for visualising the end result ,communication and consent.
Subtractive mock-ups might require tooth preparation to fully appreciate the result.
The Treatment in Two Stages:
First Appointment:
Tooth preparation for the crown.
Local anesthesia is administered if needed.
Old restorations are removed if compromised or decayed .
The tooth is prepped as a "core" to support the crown.
Minimally invasive tooth preparation is performed.
Impressions are taken for the crown material, occlusion, and shade.
These details are sent to the lab with a prescription.
A temporary crown is placed, lasting usually from 2 weeks up to 6 months if required.(after crown lengthening surgery)
Second Appointment:
Removal of the temporary crown
Checking the fit of the crown
Either cement or Bond the definitive crown depending on the material of choice.
With two appointments and careful planning, dental crowns can restore both function and aesthetics to your smile, ensuring you wear your crown with pride.
Does the Crown Preparation Hurt?
Patients often have concerns about the potential discomfort during dental treatments, especially for more invasive procedures like crown preparation. We want to assure you that your comfort is a priority. Before the crown preparation begins, your tooth will be fully anesthetized, so you should not experience pain during the procedure. In fact, the sensation should be similar to having a regular filling. While the treatment is ongoing, you might be aware of the sound, water, and the buzz of the dental drill, but you should not feel any pain.
Does the Local Anesthetic Hurt?
Local anesthesia is administered via injections, usually placed near the teeth being worked on. You might feel a sharp prick and some slight discomfort during the injection process. To minimize this sensation, we typically use a topical anesthetic gel and advanced injection techniques, so you'll hardly feel the needle. In rare cases, deeper injections may be necessary for fillings or tooth preparations, which might be less pleasant but are typically over in a matter of seconds.
How Long Does the Treatment Take?
The crown placement procedure is generally completed in two visits. During the first appointment, your dentist will prepare the tooth and take impressions for the dental laboratory. While you wait for the final crown to be fabricated, a temporary crown will be placed. On the second visit, we'll remove the temporary crown, which may involve some additional drilling. This step will also be conducted under local anesthesia to ensure your comfort. The new crown will be tried on and adjusted as needed, and then it will be cemented or bonded to your tooth according to your material choice.
Post-Treatment Pain and Discomfort?
It's normal to experience some pain or discomfort in the days following a crown preparation. Over-the-counter pain relievers such as Ibuprofen or Paracetamol are usually sufficient to manage any pain and swelling after treatment. It's also common for teeth to feel tender when biting for a few days, and this can last from a few weeks to a few months. Sometimes , if your teeth remain sensitive after the preparation, we may keep them in temporary restorations until the sensitivity subsides before proceeding with the definitive crown. Rest assured that your dentist will provide guidance and support to make the process as comfortable as possible.
What are the material options for a crown?
Metal Crowns
These crowns can be made from various metals, including non-precious metals (containing less than 33% gold) or semi-precious metals (containing up to 60% or more of gold).
All-metal crowns are known for their durability and longevity.
They are particularly suitable for posterior (back) teeth due to their strength.
They require minimal tooth preparation, preserving more of the natural tooth structure.
However, their metallic appearance makes them less ideal for visible front teeth.
Porcelain-Fused-to-Metal (PFM) Crowns/ Metal Ceramic crowns (MCC)
These crowns combine the strength of metal with the natural appearance of porcelain.
A metal substructure is covered with a layer of tooth-colored porcelain, creating a realistic look.
PFM crowns are suitable for both front and back teeth.
They offer a good balance between strength and aesthetics.
Over time, a dark line may develop near the gumline as the gum tissue recedes, revealing the metal beneath.
All-Ceramic or All-Porcelain Crowns
All-Ceramic Crowns (ACC) there are 2 most common type of porcelain crowns
1 .Zirconia Crowns:
Zirconia is known for its exceptional strength and durability, making it an ideal choice for posterior (back) teeth and dental bridges.
However, zirconia crowns may have a more opaque or "dull" appearance compared to natural teeth due to their high strength. This is why they are often used in areas where aesthetics are not a primary concern.
Zirconia is especially recommended for individuals who have a bruxism habit (grinding or clenching of teeth) because of its ability to withstand the forces generated by this condition.
This is also a preferable choice if the teeth under the crown is dark like after a Root canal treatment or after trauma.
2. Lithium Disilicate (E-max is the most commonly used trade name from Ivoclar) Crowns
Lithium Disilicate is a type of porcelain crown known for its exceptional aesthetic qualities.
It can be made to look very lifelike and natural, especially if the underlying teeth are not discolored, and there is sufficient enamel for bonding.
E-max crowns are a popular choice for visible front teeth where aesthetics are a priority.
They are less opaque and can closely mimic the appearance of natural teeth.
Both Zirconia and Lithium Disilicate crowns have their unique advantages, and the choice between them depends on factors such as the tooth's location, your aesthetic goals, and the specific requirements of your case.
Additionally, it's worth noting that both of these materials can be layered with feldspathic porcelain to enhance their aesthetics. This layering can create a more natural appearance, especially on zirconia crowns. However, it's important to be aware that porcelain layers may be more prone to chipping, which is a consideration when selecting the ideal crown material for your specific needs.
Composite Crowns
These crowns are made from tooth-colored composite resin material.
They are a more affordable option but may not be as durable as other crown materials.
Composite crowns can be color-matched to your teeth for a natural look.
They are often used for temporary or short-term solutions as they are not that strong
What are the possible complications?
Potential Complications of Dental Crowns:
Pain, Swelling, Numbness, or Tingling: These can occur, but efforts are made to minimize these effects through careful injection techniques.
Reaction to Injection: Rarely, some patients may experience jaw muscle soreness and stiffness after an injection.
Tooth Sensitivity: After preparation, the tooth may become sensitive, which can persist and may require additional treatment, such as a root canal.
Pulpitis: Trauma, deep decay, or extensive preparation can lead to tooth pulp inflammation. Root canal treatment may be needed in such cases.
Gum Soreness or Irritation: This may occur, particularly if a retraction cord is used to obtain accurate impressions.
Porcelain Fractures or Chips: Small fractures can be repaired, but larger ones may necessitate a new crown.
Dark Lines on Crowns: In some cases, dark lines may appear on the crown edge if the gum recedes. This issue can sometimes be corrected.
Recurrent Tooth Decay: Decay can develop beneath crowns; good oral hygiene and regular check-ups are essential for prevention.
Food Impaction: Food may become trapped between crowns, especially if the teeth are tilted or adjacent teeth are poorly formed.
Temporomandibular Joint Dysfunction: Changes in bite following a crown can occasionally lead to joint issues but can usually be corrected.
Aesthetic Concerns: Once cemented, major adjustments to the aesthetics of the crown may not be possible.
How long do crowns last?
The longevity of crowns varies depending on the type of material used,all have different survival rates over the years. In a nutshell
Metal Crown - 97% survival at 9 years and 94.9% at 25 yrs (Donovan.et.al 2004)
MCC- 97% survival rate in 10 years and 85% survival rate in 25 years. (Walton et al 2013)
MCC- 94.7% survival rate at 5 years - A Systematic Review (Sailer.et.al - 2015)
ACC - 95.6% survival rate at 5 years. - A Systematic Review (Sailer.et.al - 2015)
ACC (Emax) – survival rate 97.8 % in 5 years and 92.6 % in 10 years - A systematic Review (Peiger.et.al- 2014)
Root canal treated have a lesser survival rate of 82% in 25 years whereas the non-root canal treated vital teeth show 87% survival rate at 25 years. (Walton.et.al- 2013)
What are the Alternative Treatment Options?
Fillings: For minor issues, simple fillings with either composite or amalgam materials may be considered or sometimes as a temporary option for a shorter duration.
Inlays and Veneers: Inlays are suitable for back teeth, while veneers are an option for front teeth when appropriate .
Onlays and Overlays: Onlays are used when a single cusp is missing, and overlays protect teeth with all cusps involved.
It's important to note that while these alternative options exist, the choice of treatment depends on the specific condition of the tooth and your dentist's recommendations. Leaving dental issues untreated can lead to more severe problems, including personal injury, tooth loss, severe pain, localized infection, and swelling.
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