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Tooth Repair

What Are Crowns And Why Are They Used?

A crown (also called a 'cap') is a restoration that covers the visible portion of a tooth and is not removable. The most common reasons for requiring a crown on a tooth are:

  • to restore a tooth's strength and resistance to fracture when extensively filled or broken down
  • to alter a tooth's size, shape or color for cosmetic reasons
  • to establish an even bite to facilitate chewing, comfort and health of the jaw joint or muscles
  • to provide access for adequate cleaning and health of the surrounding gum and bone

A crown is most commonly made using an inner framework of alloyed gold (usually silver color) for strength and an outer layer of ceramic which is tooth colored. Crowns are sometimes made entirely of ceramic, without a metal framework when this will enhance a color match but this will result in a decrease in strength, which should be considered. Crowns can also be made entirely of gold in which case they are usually yellow in color. A tooth may first require a filling to eliminate defects created by previous decay or fractures. When a tooth is severely broken down, root canal treatment may be required in order to allow the use of a post inside the root to rigidly hold either a large foundation filling or a cast post and core, which would then provide a solid foundation and prevent the crown from falling off. Root canal treatment may also be required before or after a crown is placed if the root canal contents become abscessed.

Natural Tooth Crown on Tooth

How Is A Crown Placed?

Several steps are involved in placing a crown. The first step is to design and plan the crown to optimize its size and shape, your bite and access for cleaning. Your tooth is then carefully and meticulously shaped so that a precisely fitted and natural appearing crown can be made for you. During this same appointment, a temporary acrylic (plastic) crown is made for your tooth which will keep it comfortable, protect it and allow you to eat, speak and have a normal appearance. A well made temporary crown will function similarly to the final crown. Once the tooth and gums are healthy, a mold will be made of your tooth from which the crown will subsequently be made. The laboratory phase of making your crown occurs between appointments and is completed by specially trained laboratory technicians. The final steps involve completion of any adjustments to your crown prior to its attachment, after which your crown is not removable.

Crowns Can Be Designed For Attractiveness, Comfort and Chewing

Natural looking crowns need to be more than just 'white', they must approximate the complex color scheme of your other teeth or they will stick out like a 'sore thumb'. Color is approximately matched using standardized color tabs which are selected with your approval and is included in basic crown fees. If your crown is prominently visible, some degree of additional customization will usually be required to more closely match your other teeth. This customization process can proceed until the best possible match is obtained subject to the limitations of man-made materials and fees based on the length of time required for customization. When skillful clinical treatment is combined with artful laboratory technical work it is often difficult to detect the difference between a well made crown and your natural tooth. Natural teeth will tend to slowly darken with age. Teeth restored with crowns will remain the same original color.

Shape is extremely critical and is one of the most frequently overlooked aspects of many crowns. This can result in an otherwise attractive smile being ruined by crowns not matching the remaining teeth and appearing as if they stick out. Proper shape is also required to prevent food jamming between teeth and to permit fast and easy cleaning.

Red, blue or swollen gums and gum recession are ugly and can be caused by improperly made crowns. The gum around the crown should be pink, firm and not bleed during cleaning. Well made crowns completed using gentle techniques should have minimal effect on natural looking pink gums.

A well made crown should feel completely even with the other teeth on the very first day and does not require time to settle in. A crown that is slightly 'high' can result in great pain and inability to chew properly, whereas a crown that is slightly 'low' will result in tooth movement and bite instability which compromises the other teeth. A crown should also be made to feel comfortable when you slide your teeth from side to side or back to front as in chewing. A well made crown should actually help stabilize your bite and maximize that tooth's chewing ability.

If carefully planned and designed, crowns can be used to re-create an even bite and give the impression that crooked teeth are actually well aligned. This can ensure optimal chewing ability and help maintain bite stability over many years which is important if you are planning to keep your teeth for a lifetime.

A crown should feel comfortable and look natural. A tooth with a crown on it will maintain or restore your ability to eat and speak.

How Your Crown Can Have Lasting Results With Less Future Costs

Most crowns fail because of tooth decay under the edge of the crown or gum disease, both of which are frequently caused by a poor fitting crown and inadequate cleaning. An extremely well fitting crown is less likely to allow decay to get under the crown destroying the tooth underneath it. A crown that fits well is also easier and faster to clean saving you time everytime you clean your teeth and saving you money every time the dentist cleans your teeth. A crown that can be properly cleaned will last much longer, further reducing the financial cost of dental care throughout your lifetime but even more importantly, a crown that lasts longer will increase the likelihood that you will keep your teeth a lifetime.

The shape of the tooth under a crown is extremely critical. The greater the expertise in completing this treatment, the more likely the tooth and gum will not require additional expensive corrective treatment. If properly designed and shaped, crowns should not fall off. Expert treatment during the shaping of the tooth when the crown is first made can essentially eliminate the unnecessary future costs of re-cementing or remaking a crown that won't stay on.

It is important to have all of your teeth examined and cleaned regularly by your dentist especially when they have crowns on them. By using specialized knowledge, skill and experience in combination with careful planning and attention to detail, a crown can usually be made to last for many years if appropriately cleaned. A well made crown will minimize the need for future treatment and increase the likelihood you will keep your teeth for a lifetime. All these details will give you the best value for your time and financial investment.

How Do I Clean My Crown?

Cleaning teeth with crowns on them is very similar to cleaning non-restored natural teeth. You must thoroughly brush your teeth and clean between the teeth using either floss, super floss or a prox-a-brush every day.

Case Studies - Crowns

Ms. B.M. was referred to our office by her periodontist in 1999 when she was 56 years old because her main concern was her two front teeth, which had crowns on them, looked like they were blackening at the gum line, the left front tooth looked longer than the right one and the crowns no longer matched color of the other natural teeth. Two new crowns were made for the front teeth to create the desired smile.

Before After

Miss. L.B. was 22 years old in 1994 when she decided that she wanted straighter front teeth but she did not want to have orthodontic braces put on her teeth. We made models of her teeth and developed a model of how much straighter we could make her teeth with crowns. Once Miss L.B. saw this model she decided to proceed with the crowns even though three teeth would also require root canal treatment. Once treatment was completed, Miss. L.B. had the smile she wanted which was very close to the model we had completed in advance.

Before After

Miss. F.S. was 18 years old in 1995 when she was referred by her orthodontist to our office for esthetic improvement of her smile because of the poor appearance of her two front teeth. She had damaged the front teeth somehow a number of years prior and several previous attempts at bonding tooth colored fillings had been completed. We recommended some gum surgery be completed initially to remove some of the excess gum height and to allow both front teeth to have the same length because the area was extremely visible. Once this was completed two crowns were placed on the front teeth to finish the new smile.

Before After

Mr. D.L. was 44 years old in 2003 when he presented to our office with his crown in his hand as it had fallen off his front tooth. He had chipped this tooth playing hockey when he was a teenager and a crown had been made for it which had recently fallen off several times. He had noticed that this tooth and the gum around it appeared to have moved down more than the other front tooth over the past while. He wondered if it was possible to repair his tooth. We advised that while this tooth would always be somewhat weak because of the extent of damage done to it, none the less, the tooth could be repaired with a new crown. We also advised him that the height of the gum was different on this tooth due to recent tooth movement and this could be corrected if he felt the area was esthetically visible. Mr. D.L. decided that the gum did not show when he smiled and therefore decided not to have the length of the two front teeth exactly matched. We completed the foundation work and a new crown for this tooth.

Before After
Case Studies - Extensive Tooth Repair

Mr. G.S. came to our office in 1999 at the age of 42 years by referral of his general dentist because of the extreme wear on all of his teeth, cold sensitivity on some of his teeth and because Mr. G.S. wanted to have a better smile. Mr. G.S. had a history of lots of fillings that had often broken and thought he used to grind his teeth and that he still did a bit. A nightguard had been made 10 years previously which he had only worn for about 6 months. Following examination, it was obvious that the wear was very significant and had progressed through the entire enamel layer of the teeth and into the softer and more sensitive inner dentin layer. It was also very apparent to us that Mr. G.S. was still very much grinding his teeth and wearing them down even if he was not really aware of it, which is actually quite common. Mr. G.S. was eager to proceed and following some gum work, crowns were designed and built for virtually every tooth. By request of Mr. G.S., a space was left between his two upper front teeth as it had always been there (something like late night T.V. talk show host David Letterman) and his crowns were made to be quite white. Mr. G.S. still grinds his teeth, but now wears a very precisely made nightguard which is quite comfortable to wear and protects his teeth from wear and fracture. He doesn’t even think about his teeth anymore as the sensitivity has gone away and they function like normal teeth.

Before After

Ms. L.P. saw our name in the telephone book and decided she wanted to consult with us on improving her smile when she was 45 years old in 1994. She was very definite. She wanted whiter and longer teeth with less upper gum showing. She also noted some tooth ache. Ms. L.P. had many fairly large fillings, a reasonable degree of wear and back teeth that did not align normally. We discussed her desired smile and designed a device to show Ms. L.P. the general nature of the changes that were possible prior to starting treatment. It was evident that to reduce the amount of gum display that some ‘gum renovations’ were required allowing the use of crowns that would be longer toward the biting edge and longer toward the gum so less gum would be visible. Crowns were made for almost all of the teeth and veneers for the lower front teeth. The tooth ache went away as the teeth were repaired and the bite made more even in the process of treatment. Ms. L.P. was very happy with her new smile and makes use of it every chance she gets.

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Mr. H.G. was 83 years old in 2001 when his general dentist suggested he come to see us as he wanted to fix his teeth saying that his friends and relatives thought he should do something. Mr. H.G. had no difficulties eating or speaking and had no discomfort. Mr. H.G. definitely had a habit of grinding his teeth together both during sleep and during the day of which he was not aware, accounting for the vast majority of the wear. We explained that crowns could be designed that would make his teeth look and work more like unworn teeth and that he could pick whatever color he liked. Following some gum work on the upper teeth, some root canals and some foundation fillings, crowns were designed and precisely fitted for almost all of the teeth. A nightguard was also made to help protect the dental work and his supporting teeth from future wear and fractures. Mr. H.G. can eat, talk and use his teeth as if they had always been this way. Mr. H.G. is always in a good mood and very cheerful, but now you can see him smiling, which his friends and relatives feel is more appropriate. Mr. H.G. is also very appreciative.

Before After

Mr. D.L. was only 36 years old in 1996 when his dentist suggested he visit our office as Mr.D.L. was concerned about the gaps between his teeth as well as the wear and chips. He thought he had been grinding his teeth together for years. He was also in the process of a divorce and wanted a better looking smile. To ensure we had the kind of smile in mind that Mr. D.L wanted, we designed his smile on a model of his teeth and reviewed this with him prior to starting. After some required gum work on most of the upper teeth, crowns were made on most of the teeth to match the smile blueprint initially agreed on. The lower front four teeth had ceramic veneers made for them. Mr. D.L. picked the color he wanted his teeth to be. A nightguard was made for use every night to help protect his dental work. Mr. D.L. is very happy with his new smile and told us he is now primarily concerned about motorcycle riding.

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