When a tooth is too compromised to be restored with a filling, the treatment of choice is a dental crown. Dental crowns in the past were usually made of porcelain built on a metal base. These days it has become very popular to make crowns that are purely ceramic, as they give a better aesthetic result. This was possible with the technological advancement of modern ceramics (E-max, Zirconia). Dental crowns are made in dental laboratories while we have placed a high quality temporary crown over your tooth.
Why should I have a crown and not just a filling instead?
In order to have a filling safely and successfully placed, it is necessary to have adequate tooth left, both in size and shape, to accommodate that filling properly. Many times this is not possible, due to the following reasons:
- Extensive decay
- Large fracture
- Missing cusps
- Replacement of a huge amalgam filling
- Root canal treatment with difficult access
- Replacement of an existing crown or inlay
- Need for supreme aesthetics on anterior teeth
At our dental practice in Market Rasen the dentist will take a pre-op dental photo using our intramural camera, and also a radiograph and these will be displayed to you with explanations of why you need the proposed crown, if that is the suitable treatment for your tooth.
What are the possible adverse effects of having a crown?
- Temporary sensitivity, usually negated with common pain killers. It rarely lasts more than just a few day after the preparation.
- Temporary crown falling off. It is a common happening to lose a temporary crown as they are not as strong as the permanent restoration. Please contact the practice immediately and it will be replaced asap.
- Root canal permanent reaction. The nerve of the teeth that undergo crown preparation suffers a great stress and may never recover from it just after the treatment. It can also suffer long term slow alterations and eventually become necrotic and painful, even year after. In all these cases, a root canal therapy might be required. The need for root canal therapy is the most common serious adverse reaction of a crowned or bridged tooth. Research shows that 20-25% of the teeth that get crowned will need root canal therapy.
- The root canal treatment will require additional visits that were not expected or planed for and it will also have the extra cost required in order to save the tooth, as there will be no other choice to save the tooth and the crown. Of course it is alway possible to extract the tooth but that would mean losing the tooth and bearing the cost of the crown and the extraction as well.
- In summary, whenever a patient take the decision to have crown he should not do it, unless he is prepared that the unlikely adverse reaction of the nerve can become reality in some cases, and all described above would be required in that case.
- In our dental practice at You Smile dental care we take all necessary precautions (working with powerful loupes, supreme bonding technique, high quality drill burs)and manage to successfully keep a much lower percentage of adverse reactions.
- In our dental practice at You Smile dental care we take all necessary precautions (working with powerful loupes, supreme bonding technique, high quality drill burs)and manage to successfully keep a much lower percentage of adverse reactions.
What material should I choose for my crown?
The dentist will recommend a type of crown that is more suitable for your particular case. Choosing the material and type of crown is better to be left for the specialist. However, at You Smile dental care we will inform you of the proposed options and help you contribute to our choices and reach an informed consent.
In general:
- Metal/ceramic crowns: These are porcelain crowns made of porcelain layer on a metal skeleton. These are best when the underlying structure and shape of the tooth is not good enough to support holoceramic crowns, when gum health is poor, when aesthetics come second from functionality.
- Holoceramic crowns, metal free: These are a more modern type of restoration that is achieving great results the last years. Best when the remaining tooth is good enough to accommodate them, the periodontal tissues are healthy and the aesthetics of the essence.
What are the benefits of metal free ceramic crowns (e-max, zirconia), compared to porcelain/metal crowns.
- Superior aesthetics (More natural shades without metal reflections)
- Minimal invasion (Much less removal of healthy tooth tissue is required for the preparation!)
- Less likely to suffer a chip and easier to repair if needed. (Increased durability).
What are the cons of holoceramic crowns?
- They take longer to bond (compare to metal crown that can just be quickly cemented.
- They are not suitable for greatly compromised teeth and small teeth. (Need adequate tooth)
- They are not the best choice for bridges where a series of crowns is fused to replace completely missing teeth (e-max can break in long units, however zirconia is still very hard).
- The whole technique is sensitive and requires a highly skilled and experienced dentist working with enhanced vision (loupes, microscopes). At You Smile dental practice dr D. Alexakis is a fully cosmetic dentist that has made hundreds of very successful metal free ceramic crowns.
What are the prons and cons of zirconia crowns compared to e-max?
- Zirconia is extremely hard while highly aesthetic. It should be the material of choice where a combination of strength and high aesthetics is required, while the periodontal tissues are in good oral health. For example the smile teeth of a patient that grinds his/her teeth (bruxism).
- The same hardness that makes zirconia almost unbreakable and extremely durable becomes a negative in the unwanted scenario where the tooth nerve starts to hurt after the crown has been fired and requires root canal therapy. It will be a challenge to drill through the zirconia crown to perform root canal treatment without having to remove the crown.
