Definition & Overview

Tooth crowning is a standard dental procedure that involves covering a damaged tooth with a dental crown, a tooth-shaped cap that is placed over the natural tooth as a method of artificial restoration. It is designed to protect, strengthen, and improve the appearance of the affected tooth. It is used to cover the part of the tooth that is visible above the gum line, which is referred to as the crown.

Who Should Undergo & Expected Results

There are different reasons as to why a dental crown may be required. Tooth crowning is commonly used to:

  • Replace large fillings – Dental fillings are typically used to cover small holes in the teeth that are caused by decay or cavity. If about 50% of the tooth has been damaged, dentists typically remove large filling and replace them with a crown to provide adequate protection.

  • Restore a tooth after a root canal – A root canal therapy typically leaves the affected tooth prone to fracture and further damage. As such, dentists immediately place a dental crown after the procedure not just for protection but also to restore the tooth’s original appearance.

  • Treat broken cusps - Tooth crowning is also often done to repair the cusps, which are parts of the teeth that receive the highest amount of stress when a person chews. Due to this, it is common for the cusps to break off easily or to suffer from fractures, but covering them with a dental crown can keep damage at bay.

  • Improve the appearance of the teeth – Consistent stress and pressure can compromise the appearance of the teeth. One of the most common problems that cause unsightly teeth is the breaking down of the natural tooth enamel, leaving only a softer and more vulnerable tooth behind. Other common appearance problems include discoloration, misshapen teeth, and unnatural spacing between each tooth. All of these problems can be resolved with tooth crowning.

  • Replace missing teeth – Tooth crowning is widely used in combination with dental implants, which are artificial tooth roots that are made from biocompatible titanium materials. In this procedure, dental crowns are used as artificial teeth to replace the missing ones.

  • Restore teeth that have been damaged by wear and tear – Teeth’s appearance and shape can be damaged due to the long-term effects of continuous grinding, chewing, and acid erosion (especially in the case of patients suffering from acid reflux and bulimia). Dental crowns can hide any imperfection regardless of the causes.

  • Protect from cracked tooth syndrome - Tooth crowning is ideal for those who have fractured teeth or a condition called cracked tooth syndrome. People with this condition have teeth that are easily broken or fractured, so tooth crowning is necessary rather than optional. The crown can effectively hold each tooth together.

How Does the Procedure Work?

Dental crowns are made from different materials. The most popular are porcelain, porcelain bonded to precious metals, all-ceramic, glass, and gold. Most crowns are made of porcelain bonded to metal wherein the metal serves as the base, while the porcelain is applied as a layer over it. Some crowns are made only of porcelain, but these may not be as strong as those that are bonded to metal. However, porcelain has become quite popular because it offers a very natural-looking appearance. It is for this reason why it is the first option when restoring the front teeth or the teeth that are seen when the person talks or smiles. All-ceramic dental crowns, on the other hand, are ideal for any teeth regardless of their position inside the mouth. These have the strength of a bonded crown and the natural look of the porcelain crown. Another type of dental crown that can be used anywhere in the mouth is the glass crown, which also looks very natural. In the past, gold was also widely used as a material for dental crowns especially when it is bonded to other metal alloys that can increase its strength. Gold-alloy crowns are usually in gold or silver colour. Dentists decide on the materials to use based on the patient’s needs, preference, budget, and dental condition, such as whether the patient had fillings, fractures, or had undergone root canal therapy.

The process of getting a dental crown typically starts with a thorough consultation where the dentist assesses the affected tooth and the extent of the damage. It is at this point where it is decided if a dental crown is the best solution for the problem at hand. If it is, the dentist begins by administering local anaesthesia to numb the tooth. The decayed part of the tooth is then removed and if needed, the affected tooth will be filed down to make room for the dental crown. The remaining structure of the tooth will then be protected using a thin layer of dental filling.

Meanwhile, an impression of the prepared tooth is made using a putty substance, and while waiting for the permanent crown, a temporary crown will be used. This temporary crown is usually made of either resin or acrylic material, and will be placed on the tooth using temporary cement that is easy to take off once the permanent crown is ready. The dentist makes sure that the permanent crown is of the same colour with the rest of the teeth by using a shade guide and taking pictures of the teeth during the session when the temporary crown was placed.

During the second visit, local anaesthesia will again be used to numb the tooth. The temporary crown will then be removed, and the permanent crown will be installed in place. After it has been properly placed, the permanent dental crown will be cemented using dental glue.

Possible Risks & Complications

After the procedure, there is a risk that the patient will experience the following symptoms:

  • Discomfort or mild pain
  • Sensitivity to hot and cold food and drinks
  • Allergic reaction to metal

While discomfort and sensitivity may pass eventually, an allergic reaction should be reported to the dentist.

Over time, the crown may also become prone to damage. It may chipped, become loose, or fall off. A dark line near the gum may also appear if the crown used contains metal.

References:

  • Academy of General Dentistry. What Are Crowns? Available at: http://www.knowyourteeth.com/infobites/abc/article/?abc=C&iid=301&aid=1204. Accessed 10/29/14

  • American Dental Association. Crowns. Available at: http://www.mouthhealthy.org/en/az-topics/c/Crowns. Accessed 10/29/14

  • Amsterdam, AT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 70

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