DENTAL CROWNS AND BRIDGES
A dental crown is a tooth-shaped “cap” that is placed over a tooth – to cover the tooth to restore its shape and size, strength, and improve its appearance.
The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.
A dental crown may be needed in the following situations:
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To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
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To restore an already broken tooth or a tooth that has been severely worn down
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To cover and support a tooth with a large filling when there isn’t a lot of tooth left
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To hold a dental bridge in place
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To cover misshapened or severely discolored teeth
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To cover a dental implant
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To make a cosmetic modification
Dental bridges literally bridge the gap created by one or more missing teeth.
A bridge is made up of two or more crowns for the teeth on either side of the gap — these two or more anchoring teeth are called abutment teeth — and a false tooth/teeth in between. These false teeth are called pontics. Dental bridges are supported by natural teeth or implants. A bridge helps to strengthen the prepared teeth and makes chewing and eating easier because they are fixed and can’t come out.
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Bridges can:
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Restore your smile
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Restore the ability to properly chew and speak
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Maintain the shape of your face
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Distribute the forces in your bite properly by replacing missing teeth
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Prevent remaining teeth from drifting out of position
Crowns and bridges can be made out of a gold alloy, some other metal alloy, stainless steel, all-porcelain/all-ceramic, composite resin, zirconia, or porcelain on the outside fused to metal or zirconia on the inside. There are advantages and disadvantages to all of the types of dental crowns. Gold dental crowns have traditionally been the most durable and require less of the tooth to be removed or shaved down. The primary advantage of porcelain crowns is their esthetics, while newer types of ceramic crowns have become increasingly more durable.
PFM crowns are relatively esthetic restorations that have been in use for more than 40 years. In one way, they combine the best of both worlds (metal and porcelain).
A crown made of “precious or noble” metal (gold or platinum)is very strong, fits precisely and is bonded/cemented to the tooth. This metal substructure (beneath the porcelain) imparts strength and makes up for the porcelain’s weakness and fracture potential The downside — The crown’s porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown’s porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede.
PFM crowns have an “esthetic” longevity of about 10 years but can lose the stains applied to make them look natural over time, particularly if the gum tissues also recede. They have a “functional” longevity of about 20 years. There are factors that can shorten the life of a crown. These include primarily the crown material, but also quality criteria such as the exact adaptation to your individual tooth shape and the harmonious integration into your individual bite. Good oral hygiene and adherence to routine check-ups in our practice continue to play a role.
These crowns can be a good choice for front or back teeth.
A compromise between gold and porcelain fused to metal crowns would be a cast gold crown with a porcelain “facing” on the side for esthetics if needed.
All porcelain crowns are better solution for front teeth. In terms of service and longevity they have been relatively unpredictable for posterior (back) teeth. During the past decades, numerous all-ceramic (porcelain) crowns for back teeth have come and gone because of frequent failure. Without getting too technical, all dental porcelains are ceramics; variations of glass, fired in an oven at high temperatures in which the components fuse together.
Their major advantage is aesthetics allowing incredible life-like appearance. Their major disadvantages — lack of strength, brittleness, and their potential to damage opposing teeth against which they bite. Like glass, there failure is “catastrophic” if they fracture making repair impossible. It is therefore difficult to predict their longevity, particularly because of the varied brands and materials used.
Zirconium is becoming one of the most chosen materials for dental crowns. Its many advantages include:
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Extraordinarily tough - Because they are extremely hard and stable, zirconia has a low risk of breakage compared to ceramic crowns made in earlier times. Because they can easily withstand the higher chewing load, zirconia crowns can therefore also be used in the area of ​​the molars. In this capacity, they are comparable or even superior to metals. These properties make it possible for zirconia crowns to be used as desired in contrast to the all-ceramic crowns.
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Transparent and translucent features that make crown perfectly similar to the original tooth or even better looking than original - The aesthetic effects alone of a zirconia crown should be the biggest advantage it can give. It is important that you have dental crowns that will look natural especially if it will be placed at the front teeth and will be visible beside the natural teeth.
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No metal fuse – which has aesthetic as well as health benefits. The aesthetics cannot be reduced due to exposed metal edges, especially after a longer wearing period. Also, it cannot come to the delivery of metal ions to the body tissue, which can lead to gingival irritation and discoloration.
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Biocompatible – The direct contact between the cap and tooth does not make any body reaction because this mineral material is totally metal-free and anti-allergenic therefore it is suitable for everyone.
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Less tooth removal – zirconia is thinner than ceramics, therefore less tooth grinding is required for its placement.
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Zirconia manufacturers are now producing and designing dental crowns custom milled from solid block of the material and baked at ultra-high temperatures to ensure that the finished crowns are almost indestructible.
It is a fact that gold crowns have been used by many people for so many years and it is well tolerated by the body. But it is still better to be able to show that natural effect when you smile. Add the fact that gold is metal and some people just do not like having metals in their internal parts.
Zirconium crowns are definitely more robust than porcelain crowns. They last longer too, compared to porcelain that chip and break. Porcelain crowns also need to be fused to a metal base and the metal is that black unsightly line above the gums of people with porcelain crowns.
Since Zirconium crowns are milled from a chunk of crystal, they are guaranteed to be at least 5 times stronger than porcelain and its metal fuse. Zirconium crowns also provide strength without that bulky appearance that porcelain is so known for.
Zirconia is very hard, which can cause significant wear on the opposing natural teeth. This can lead to increased dental issues over time. Also, They may negatively impact the root of the tooth covered by zirconia crown.
Crown prices greatly vary depending on the country you live in, the experience of the dentist and the dental technician providing the treatment, the size of the crown/tooth. However in general it is true that zirconium is the most expensive type of dental crown. Unfortunately the increased durability, the natural look and biocompatibility comes with a price tag. Prices in the United States are around $1000 per unit and around £600 per unit in the UK.
In Dr Kostic Dental & Implant centre, one should expect to pay anywhere between €140 to €260 for a crown or veneer depending on the material and number of crowns required.
At the first visit our dentist uses impression paste or putty to make an impression of the tooth which will be replaced by the crown. This impression helps the technician building realistic crown which will fit perfectly into your mouth. The dentist will also select the shade that most closely matches the color of the neighboring teeth. If the tooth has been fractured or had a root canal treatment, it will first need to have a buildup — a filling that restores enough of the tooth for the crown to hold onto
Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. Then our dentist will use impression paste again on the stump, because the zirconia cap will be fitted to it. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.
The dentist will then determine the shade of the patient’s teeth using a shade guide or take pictures of the teeth to help the lab technician make crowns that will match the rest of the patient’s teeth.
During this first office visit our dentist will make you a temporary crown to cover and protect the reshaped tooth while the crown is being made.
Afterward begins the work of technician who builds the crown/bridge using the impressions.
Usually a few days after a temporary crown, the patient returns for a second visit. During this visit, the temporary crown is removed and the tooth may or may not need to be numbed again. First the cap will be put in your mouth to make sure that the crown will perfectly fit to the stump. If everything is acceptable, and no further laboratory work is needed, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.
The tooth being restored is numbed so that it isn’t painful during the crown preparation. This requires a shot in the gums of the local anesthetic. After the procedure is over and the anesthesia has worn off, the patient may feel some sensitivity with the temporary crown or some soreness in the gums around the tooth. The pain is very minimal though and shouldn’t last long.
If it is possible, it is best to wait until after pregnancy for elective dental procedures to minimize stress on both the mother and baby. Getting crowns is often the result of a sudden fracture or other unavoidable situation though, and treatment may need to be immediate. The materials used for crowns/bridges are all safe during pregnancy, so when necessary, it is possible to get a dental crown/bridge during pregnancy.
Dental crowns/bridges should last on average from 10 to 20 years. Crowns/bridges are still subject to fracture and cavities, so it is important to take extra care in brushing and flossing around crowned teeth to prevent them from needing replacement too often. When all-ceramic crowns or veneers are present, it is often advisable to wear a mouth guard at sleep time to protect the porcelain from fracturing and prolong the life of the crowns.
Replacing missing teeth with a dental bridge should actually make eating easier. Until you become accustomed to the bridge, eat soft foods that have been cut into small pieces.
It can be difficult to speak clearly when teeth are missing. Wearing a dental bridge with the anterior teeth in their proper relationship will help you speak properly.
It is important to keep remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day, flossing and using an antiseptic mouthwash daily help prevent tooth decay and gum disease that can lead to tooth loss. Your dentist can demonstrate how to properly brush and floss teeth. Keeping a regular cleaning schedule will help diagnose problems at an early stage and treatment has a better prognosis. Selecting a balanced diet for proper nutrition is also important.