Project Description

Crowns & Bridges

“We shall never know all the good a simple smile can do.” ~ Mother Teresa.

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What Are Crowns & Bridges?

A dental crown, also sometimes called a cap, is a type of restoration that is used to repair teeth that are damaged, cracked, broken, decayed or otherwise unattractive in some way. Unlike a dental implant, a crown does not replace a tooth but rather is used to cover the outer surface of the tooth, protecting the living inner part of the tooth from further damage.

ceramic dental crowns

Crowns can be made from a number of different materials, but in general they are made from either metal (sometimes gold, often other noble metals mixed together such as platinum, silver, etc) or they could be made from a ceramic or porcelain-like material, or they could be made from a combination of metal covered with a ceramic or porcelain-like material.

The part of your natural tooth that we see when we look in the mouth is called the “crown” of the tooth. As such, the replacements that are made from metal or ceramic or the combination are also called crowns. This portion of your tooth is an important part of it’s structure. The shape of the crowns of various teeth vary a bit, depending on their spefic job in the mouth. The crowns of your front teeth are designed to bite into things. The crowns of the back teeth are designed to grind and chew our food, and so they look quite different from the crowns of the front teeth. One of the most important jobs of our crowns is to protect the inside of the tooth. The crown of a natural tooth is made of a substance called enamelrowns are covered with enamel, a material that protects the inner tooth due to it’s strength and hardness, but that surface can still be attacked by cavities, and can become damaged and weakened.

When teeth become damaged to a point that a simple filling isn’t strong enough to protect the inner part of the tooth, a dental crown is needed. The replacement crowns are made to look, feel and act just like your natural teeth.

how a crown is prepared

A tooth must first be prepared to receive a crown.  This is done by using the dental hand-piece to reduce the outer dimensions of your natural tooth so that a crown can fit down over the prepared tooth once all the damaged areas have been removed.  The picture to the right illustrates how the crown fits over the prepared tooth.  More often than not, the underlying tooth will be damaged enough that in order to place a crown you will require what is called a “core”.  A core is made when the underlying tooth is built up by using materials so that there is more to “grab hold” of when putting the new crown on the tooth.  The crown will be cemented in place using a permanent cement, and is designed to stay on for good.

illustration of dental bridge

A bridge is merely two crowns that are attached with one or more teeth separating them, in order to fill a missing space in your jaw.  The “fake” teeth inbetween the two crowns are called pontics.  A bridge can have one or more pontics.  However, as the number of pontics increases, the strength, durability and possibilty of the crown decreases.  Sometimes there is just too much space to fabricate a bridge.  Today, the dental implant is replacing the dental bridge as the ideal treatment for missing teeth.  While bridges are a good option when implants are not possible, bridges sometimes require the intentional damaging of good teeth in order to replace a missing tooth. Dental implants on the other hand do not affect the adjacent teeth.

dental implant supported bridge

In modern dentistry, the more appropriate way to replace a long span of missing teeth is by use of an implant supported bridge. As you can see in the image here, two dental implants are acting like the roots of two normal teeth, and the dental bridge spans the area of missing teeth, replacing them as if they were never gone. Implant supported bridges are permanent, they do not come in and out of the mouth like a partial or complete denture. Once they are cemented into place, they are there for good.

A crown is sometimes required for a tooth that has received a root canal treatment.  A root canal may save you from loosing a tooth, but the process can also weaken the tooth over time.  When the pulp and blood supply is removed from the inside of a tooth during a root canal procedure, they are no longer living teeth, and so can become brittle and fracture over time.  Sometimes the root canal is performed because so much of the outer tooth structure is damaged that the remaining tooth would need the strength of a new crown to protect it going forward.  A crown will seal off the inside of the tooth, and reduce the risk of fracturing the tooth, as well as serving to have the appearance of a real tooth.

Some root canal treated teeth can be restored with just a filling in the access where the root canal was performed.  This is usually teeth that are located in the front of the mouth, and that had decay or damage that wasn’t extensive.  If they had large amounts of decay or a big fracture, these front teeth may require a crown as well.

ceramic crown lifelike

The crown or bridge that is made to go over your damaged tooth will be custom made for you, and will have the same characteristics as the teeth that you have in your mouth. The shape and color will be matched so that the crown or bridge is seamless in your smile. Once the final product is cemented in place, nobody will know that you were ever missing a tooth!

Frequently Asked Questions

Here are a few of the most frequently asked questions we have concerning dental crowns and bridges.

The Lifespan Of Crowns & Bridges

It is said that the average lifespan of a crown or bridge is between five and fifteen years.  Much of the lifespan of a crown or bridge depends on the level of home care the crown or bridge receives. Additionally, regular dental check-ups and professional care and cleaning is important. Teeth clenching is a factor. Likewise, teeth grinding shortens the lifespan. Ice crunching can damage crowns, as well as very hard foods. Crowns used for unintended purposes can see damage. That would include things like opening bottles or tearing open plastic packages. These activities shorten the duration of a crown or bridge life cycle.

If you ask Dr. Ranney how long will a crown last, he can tell you that it can be for a good amount of time. He has a crown that was placed during Ronald Reagan’s first term in office! So, they can last for several decades when cared for properly.

Why Crowns Need To Be Replaced

Crowns are stronger than ever. Materials today are much improved over those of the past. However, they still have forces acting against them. First, grinding your teeth damages crowns. Forces are great on the teeth when you grind and chew. These forces can wear down the teeth. Another force acting on crowns are bad habits.  Chewing ice is a bad idea. So is biting on your nails and opening packaging made of plastic. And, don’t get us started on the subject of opening bottles with your teeth! Avoiding these activities will help your crown last longer.

Another potential issue that affects crown longevity is decay. The crown is still attached to a real tooth. That tooth structure is still susceptible to decay. Great care should be taken to clean and maintain your crown. Failure to do so results in recurrent decay.

Crowns are metal, ceramic or metal-ceramic objects that are shaped like real teeth and are placed over natural teeth that have had too much damage or decay to be repaired by a simple filling. tooth-shaped “cap” that is placed over a tooth — covering the tooth to restore its shape and size, strength, and/or to improve its appearance.
Once cemented into place, crowns are permanent and are not removable from your mouth. They look, feel and act like real teeth in many ways.
Bridges are crowns that are attached to two healthy teeth that have a missing tooth or teeth in-between.  The two crowns are connected by one or more “fake” teeth, called pontics.  The teeth on either side of the missing tooth space are prepared to have the bridge slip down over the teeth, and it is cemented in place permanently.
In the case of implants, the bridge is attached on either end to an implant, with the pontics in-between the implants supported ends of the bridge.

dental bridge
implant bridge

The cost of a crown can vary depending on each individual’s circumstances.  Factors such as whether or not the tooth will need a core buildup, is the crown going to need an abutment to attach to a dental implant as well as other factors all influence the cost of a crown.  Make an appointment at The Smile Anchorage and we will help you determine what it will cost to restore your tooth with a dental crown.
The cost of a bridge can vary depending on each individuals circumstances.  Factors such as the length of the bridge, whether or not either anchor tooth will need a core buildup, as well as other factors all influence the cost of a bridge.  Make an appointment at The Smile Anchorage and we will help you determine what it will cost to restore your teeth with a dental bridge.
Crowns may be required for a number of reasons. Some of them include:
  • To protect a tooth that has been damaged due to trauma or decay
  • To cover and protect a tooth that has had a root canal
  • To replace a tooth that has an appearance that doesn’t fit in with the rest of your teeth
  • To finish the restoration of dental implants
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A bridge is used to fill in the space left by a missing tooth or multiple missing teeth.  Sometimes a bridge is required rather than a dental implant due to restrictions caused by the requirements to place an implant (bone quantity or bone quality, space restrictions).
Most of the time people will not notice that you have a crown or bridge.
When providing your dental treatment we must take many factors into account.  Some of those are functional; things must be the way they must be in order to work properly.  The others are aesthetic; things need to appear the best that they can in order to appear natural.  Sometime, there is a battle between the functional and the aesthetic.  We will balance these factors in the best way that we can, and take into consideration all the factors that will affect your dentistry.
One factor that may allow for crowns to appear as crowns and not natural teeth is material choice.  Obviously a metal crown is not going to appear natural in your mouth.  However, sometimes metal is the best choice for the situation.  fortunately, when metal is the best choice for treatment it is usually in the back of the mouth where it isn’t noticeable.
Other factors that would have an impact on the look of a crown or bridge is the length of time that a tooth has been damaged or missing.  The soft tissue around the tooth or teeth may have changed, and these changes can be more difficult to address, especially in the front of the mouth.
When a skilled professional is performing a crown or bridge procedure on you, it should be rather painless.
During the procedure to prepare the tooth or teeth, you will receive a local anesthetic to numb the area.  Once the anesthetic begins to work, the only sensation you should have is that of water spraying into the mouth.
Once your new crown or bridge is cemented in place, you may have an odd feeling initially.  This is because the crown or bridge is a new item in your mouth, and the sensation can be strange for a day or two until you get used to having it in place.
First, we must determine if the crown or bridge that has come off is an emergency problem or if it can wait.
If you are having pain or a lot of sensitivity from the crown or bridge being loose or coming off, call our office right away and we will see you as soon as we can to alleviate the discomfort.  If you are not in pain, you can still call us right away, but you can rest easy that you are not likely to do much damage if you follow a few guidelines until you can make it to our office.
Without a crown or bridge covering your tooth, the natural structure of the tooth is at risk for breaking or fracturing.  While the crown or bridge is loose or missing, avoid eating/chewing on the side of the mouth where the crown or bridge resides.
Do not keep the crown or bridge in your mouth if it has come off.  Putting it back in puts you at risk for swallowing it, or even worse is the risk that you could aspirate the crown or bridge (it could go into your lungs) causing the need for an emergency room visit.  Store it it some loose tissue paper inside a plastic bag (like a ziplock bag) and bring it with you to our office.  There is a good chance that it could only need to be re-cemented in place.
If the crown or bridge is loose but has not come off, do not take it off yourself. You could damage the underlying tooth structure or the surrounding teeth. Call our office right away and make an appointment to have us remove the loose object.
Do not use dental cements or adhesives that you find in the drugstore. You could put yourself at risk for damage to your tooth, the crow or your surrounding teeth.
In general, there is no special care required for a crown.  Crowns should be treated just like your natural teeth.  Twice a day brushing with a fluoride toothpaste and a soft or extra-soft toothbrush, and once a day flossing are all that is required.  We would also highly recommend the use of an anti-cavity fluoride rinse.
A bridge requires just a bit of extra care, in that it is more difficult to floss a bridge because there are no spaces between the crowns and pontics of the bridge.  In order to floss, you will need a floss threader, which is used to slip the floss beneath the bridge and allow the proper cleaning of the bridge.

Are Crowns Permanent

A crown or bridge is meant to be permanent in the sense that it isn’t temporary. Rather than calling them permanent, we should call them the “final” crown or bridge. They are cemented in place with a cement that is intended to be “permanent”, but only as long as the crown or bridge lasts. This is really more a question about longevity, than permanence. Final crowns and bridges are made to last for a very long time. But, they don’t last forever,
in most cases. So if the question is, “are crowns permanent?”, then the answer is no.

Temporary Crowns & Bridges

Some crowns are intended to be temporary. They are also called “provisional crowns” or “provisional bridges“. Because they are called “temporary” perhaps that is where confusion comes with regard to other crowns being “permanent”. Temporary crowns are worn while your final crowns are being made in the lab. They are more fragile than the final crowns. Due to this, they sometimes break or crack. Furthermore, they dislodge occasionally. The temporary cement isn’t super-strong. This is because the temporary crowns are designed to come off when your final crown or bridge is ready. When provisional crowns or bridges come off, crack or break, call our office so we can fabricate a new one.

dental bridge on cast model

Crown Materials

Bridge and crown materials fall into four basic categories. First, there are the CERAMIC materials. Secondly you have the PORCELAIN FUSED TO METAL bridges and crowns. Thirdly are the GOLD ALLOY type. Finally you have the BASE METAL materials. Additionally, you could consider RESIN materials as another category. More about this later.

Ceramic & Ceramic-Like Materials

Currently the majority of crowns we place are made of all ceramic materials or cermaic-like materials. Porcelain, ceramic and materials like Zirconia make the most aesthetic crowns. While there are technical differences in the materials, they are all similar in that they are the most life-like in appearance. These materials appear very life-like. In the past, these were used only in the front of the mouth. But, over time, the materials have become super strong, allowing these to be used in the back of the mouth. Strength is important there. This is due to the forces we create when chewing.

Gold Alloy Crowns & Bridges & Base Metal

Crowns and bridges made of alloys of gold, palladium, platinum, silver and other precious metals are quite good. There biggest drawback is the gold appearance. Many people do not like the look of the gold, and prefer a tooth colored material. These materials are not very reactive, meaning they have a low probability of corrosion. They are also very smooth, and not abrasive to the opposing teeth. This reduces tooth wear.
Base metal is similar, but made of cheaper metals.

Porcelain Fused To Metal

Here is some middle ground. The base of the crown or bridge is made of metal. It can be a “noble” metal (like gold) or a base metal. The metal is then covered with porcelain to give a better appearance. These are strong, but less life-like because the metal has no translucency. Crowns with more lucent interiors (like zirconia) tend to have a better appearance. They are very durable. There can be some porcelain chipped or broken if it is layered too thin.

Resin Materials

crowns made from resin have a tooth colored appearance, but are not nearly as good looking as the ceramic type crowns. Their greater disadvantage is that the material will wear faster. So, while they are less expensive, the likelihood they will need to be replaced is much higher.

Summary

Crowns can be made from a number of different materials. These include:

  • Metal – Gold alloys or other metal alloys including chromium, palladium or nickel. Metal crowns in general require less tooth structure to be removed. They are strong and long lasting. The primary drawback to metal crowns is their appearance.
  • Porcelain Fused To Metal (PFM) – These are metal underneath, but are covered in porcelain material giving the tooth a more realistic appearance. The primary drwabacks of PFM crowns is that the porcelain can chip or break, and there is more wear to opposing natural teeth than metal crowns.
  • Solid Ceramic or Solid Porcelain – These crowns have great esthetics, the appearance is very natural. However, they are not as strong as metal or PFM crowns.
  • Resin – A material that is not as good looking as porcelain or ceramic crowns, and have the ability to wear down over time as they are not as strong.

Dental Insurance Coverage

People often ask us if their dental insurance coverage will take care of the costs associated with any given procedure. This is a question that is difficult to answer through our website.

There are a tremendous number of insurance companies. Each of those companies may have several different policy options. There are also other considerations, such as co-pays and deductibles. Those can vary from person to person depending on their insurance policy.

Sometimes it occurs that you have dental insurance coverage, but there are time-frame restrictions to consider. For example, you may have insurance that pays for a dental cleaning every six months. That would mean your insurance would not cover your cleaning if you visited the office five and a half months after your last dental cleaning. You would have to wait two weeks before your benefits would be active.

Another situation that could occur would be exceeding a yearly maximum. For example, if you had coverage that pays for a crown, but you had a $1500 yearly insurance maximum. If you had already had some treatment that the insurance paid for in the amount of $1400 your remaining insurance is just $100. You would have just that $100 remaining that the insurance would pay, unless you wait until your insurance reset for a new year. That time reset could be on a calendar basis, or a policy basis.

Another factor that could weigh on payments made by insurance is that of pre-determination. For example, let’s assume you have coverage for a crown. You have a tooth where you dislike the appearance. We determine that a crown is the best way to solve the problem. Your insurance may consider the procedure to be cosmetic in nature, and your policy may have an exclusion for cosmetic work done to your teeth. In these situations, we can submit your claim to your insurance provider before the work is done in order to determine if the proposed work would be covered bu your policy.

All of these factors are person specific.

In conclusion, the answer to the question of whether or not your insurance covers a specific treatment is “maybe”. So , if you would like to know if your insurance covers a specific treatment, call our office at (502)243-9200. Or, take a short drive to our office in East Louisville and one of our insurance specialists will help you understand your policy coverage.

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