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Alan L. Stott, DDS

Crowns and Bridges

Crowns and Bridges

Dental Crowns

Dental crowns can be made of gold, all porcelain, or porcelain over a thin coping of metal. They are used to repair teeth when they become really decayed or fractured. They are fabricated by our dental lab and take about two weeks to make. During these two weeks the patient has a temporary crown placed on the tooth.

Dental Bridges

Bridges are made of the same material as the crowns. A bridge is used to replace missing teeth in the mouth. It “bridges” the gap from one tooth to the other. A bridge is like having three or more crowns hooked together with a false tooth placed in the space of the missing tooth. Other options for replacing missing teeth include partial dentures and dental implants. Give us a call to see what options are best for you.

……..You have questions about Dental Crowns and Dental Bridges and we the answers for them……. 

What is a dental crown?

A dental crown (often called a dental cap) is a lab fabricated restoration made in the shape of the tooth. It fits over the prepared surface of the tooth and is cemented in place.

What is a dental crown made of?

It is made of either porcelain, gold or other precious metals, or hardened plastic. Often dental crowns are made with a combination of metal inside for strength and porcelain on the outside to make it look like a natural tooth. This type of dental crown is called a PFM, meaning porcelain fused to metal.

Which type of dental crown is better?

It depends. If we want a really natural looking tooth, we would go with an all porcelain dental crown. The downside to an all porcelain dental crown is it is not as strong as a dental crown that has some metal inside it. If we want a fairly natural looking dental crown with some added strength, we would go with a PFM dental crown (porcelain fused to metal). If a patient is not concerned about esthetics and wants maximum strength, like on a back molar, a full metal dental crown is a good choice. This is usually a gold dental crown. In our office, we use all three types of dental crowns.

Are gold dental crowns all gold? If so, that would make them very expensive.

Gold dental crowns are not all gold. They are an alloy with 40-70% gold. They may also include platinum, palladium, silver, copper, and tin. They may cost a little more than a porcelain dental crown due to the price of precious metal.

Why do we need a dental crown instead of just filling the tooth? When is a dental crown necessary?

Fillings are great for when the space left after all the decay removal is small to moderate in size. When the decayed area is large or a large part of the tooth has fractured off, we need to go with a dental crown due to its superior strength and ability to hold the tooth together.  

What is the typical process of making a dental crown?

First, all the decay and broken areas are removed from the tooth. If there are big holes in the tooth, a build-up is used to replace the missing tooth structure. The tooth is next shaped (prepared) by removing about a millimeter of tooth structure all around the tooth. This allows space for the dental crown to slide on when completed. Once the tooth is shaped, an impression is taken using a tray and a silicone material. The dentist fills out a lab prescription where he tells the lab the color and details needed for the dental crown fabrication. The impression is sent to the dental lab where they pour it up in stone. This stone model gives the lab an exact replica of your teeth. They use this model to make a dental crown that fits the prepared tooth precisely and is the right size so as to contact the other teeth properly. The time needed for the lab to make a dental crown is about two weeks. During this time, a temporary plastic crown is placed on the tooth to protect it and keep it from drifting out of place. At the end of the two weeks, the patient comes back in for the seat appointment. The temporary crown is removed, the new dental crown is adjusted, and the dental crown is cemented in place.

What is a Cerec dental crown?

A Cerec dental crown is a dental crown that is fabricated with a milling machine in the dental office. It is advertised as a “dental crown in a day” because often the dental crown can be started and seated in the same day.

Which is better, a Cerec dental crown or a regular lab fabricated dental crown?

It depends. If one is in a big hurry, it is nice to have the dental crown prepared and seated in one day. In my opinion, the lab fabricated dental crown is better. I feel it looks better due to more natural looking porcelain. I think it is stronger due to a metal substructure inside. And I think it fits better. The milling machine used to make a Cerec dental crown is not as precise as the fabrication techniques used to make a lab dental crown. The other advantage of a lab fabricated dental crown is it can be used in many situations, like real deep decay under the gum line, the need for a stronger dental bridge or dental crown, or the need for a special design under a partial denture. There are dentists who believe Cerec dental crowns can be used successfully in any case. That is not what my experience has been.

Why do dental crowns cost so much?

Unlike a filling, for a dental crown it may take about an hour to prepare the tooth, take the impression, and place a temporary crown. There is the cost for the lab to fabricate the dental crown. Dental crowns often contain expensive metal like gold. When the patient comes back in two weeks to have the dental crown seated, that appointment may take 30 minutes. The dental crown fee is based on the time required, the cost of the materials and lab fee, and the skill of the dental team.

What is a dental bridge?

A dental bridge is used to “bridge” over a space in the mouth where there is a missing tooth or teeth. The dental bridge consists of dental crowns on the teeth on both sides of the space and false teeth (pontics) in the missing space. If there is only one tooth missing, it is a 3-unit bridge, consisting of the dental crowns on the two teeth on the sides of the space and the false tooth occupying the space. These three units are all hooked together. The way a dental bridge is made is similar to the way a single dental crown is made.

What are the options when we have a missing tooth? What are the pros and cons of the options?

There are four options:

1) You can leave the space alone. The pros are this is the simplest and least expensive option (basically no additional cost after the extraction). The cons are it may make it harder to chew food and the teeth on the sides and above the space may start drifting into the space.

2) You can have a bridge. The pros are the making of a dental bridge will take about two weeks and it is about in the middle as far as price. The cons are you may have to grind on the adjacent teeth that may not really need dental crowns. If these teeth are in need of dental crowns, the dental bridge option is an easier one to make. Approximate cost: about $3000-$6000, depending on the number of teeth replaced.

3) You can have a partial denture made. The pros are this is relatively inexpensive and is quick to make. The cons are a partial denture may feel bulky to the patient, may have metal clasps that show, and may trap food more than the bridge option. Approximate cost: about $1500-$2200.

4) You can place a dental implant. The pros are the dentist does not have to grind on the adjacent teeth like with a dental bridge and it will not feel bulky like a partial denture. The cons are it is the most expensive option per tooth and it may take about 8-9 months to complete due to the need for bone grafting, the need for the jaw bone to fuse to the implant, and the time needed to fabricate the final dental crown. Approximate cost for a single implant: about $4500-$5200.

Will the work to make a dental crown be painful?

During the dental crown procedure, the tooth is numbed well, so the patient is very comfortable. There is often some slight discomfort after the preparation and seating of a dental crown. After the preparation and seat appointments, the tooth may be slightly sore for a few days. The tooth has undergone trauma due to decay, fractures, and heavy biting. The crowned tooth may require some time to adjust.

Will I need a root canal (tooth nerve treatment) with my dental crown?

Due to deep decay close to or into the nerve of the tooth, deep fractures, or heavy biting forces, some teeth that have dental crowns may need root canal treatment before the crown is made or months or years after the crown is made. We can never predict how a weak traumatized tooth nerve will react to decay and fractures. On the average, I would say that 5% of all crowned teeth may need root canal treatment before or at some time after a dental crown is placed. The sooner we can take care of decay and fractures in a tooth, the less chance the tooth will need root canal treatment.

Why do dental crowns fall out or come loose?

There are several possible reasons. The dental crown may be real short requiring the dentist to go under the gum with his crown preparation to get better retention for the crown. The dental crown preparation may not be the right shape. There may be new decay under the dental crown causing the crown to become loose. The patient may chew on very sticky candy which can pull a dental crown off. A dental crown may come off because it has been in service for many years and is worn out.

How long should a dental crown last?

It depends. The average life of a dental crown is about 10 years. I have seen dental crowns last only 2 years due to the patient having teeth that decay fast or due to a heavy bite. I have seen dental crowns last 30 years due to great oral hygiene and regular check-ups. The better the patient’s oral hygiene, the longer a crown will last.

Can dental crowns break?

Yes. Just like most things, dental crowns can break and wear out with time. They cannot last forever.

When do dental crowns have to be replaced?

It depends on the biting forces of the patient, on how fast the patient’s teeth decay, and on how well the patient flosses and brushes.

Can dental crowns decay?

Dental crowns do not really decay. They can wear out or fracture. The tooth structure under the dental crown can decay requiring a new crown or other treatment. We can avoid that decay by good brushing and flossing and having regular dental cleanings and check-ups.

What does a dental crown cost?

A single dental crown may be $800 to $1200. It will cost more if the tooth is really broken down and needs a build-up, or the gums have to be prepared in a special way for the dental crown, or if root canal treatment is required. If you have a PPO dental insurance, you can save money by going to a dentist that is an in-network provider for your insurance company.

Are dental crowns covered by insurance?

It depends on your insurance plan. The plan may not cover any dental crown fees, or they may cover 50-75%, or they may cover 100%. In order for the insurance company to save money, some really poor insurance plans exclude the more expensive procedures like dental crowns, dental implants, and dentures.

If my insurance says they cover dental crowns, is it guaranteed that they will pay for all dental crowns done by my dentist?

No. They may say a dental crown is covered at a certain percent, but if their consultant determines the dental crown is not needed (his opinion from his office 2000 miles away), the insurance company may not pay anything. Insurance companies are well known for denying dental claims so they can increase their profits. It may be wise to send out for a pre-authorization from the insurance company to see if they will cover your dental crown. But, even with the pre-authorization, they may not pay for the dental crown after it is completed.

How can I save money on a dental crown?

If you have dental insurance, use an in-network provider for your insurance company. That will save you money compared to going to an out-of-network dentist. I would not suggest that you shop for the cheapest dental crown price. A dentist can make a dental crown cheaper by using inferior materials or by rushing the work on the dental crown and not doing the work properly. I have seen a lot of lousy dental crown work done from all parts of the U.S., but especially from foreign countries. This inferior dental work usually has to be redone, or worse, may cause the loss of the tooth.

Which is better or stronger, a dental crown or a dental porcelain veneer?

In some situations, a dental crown is stronger since it holds the tooth together and is less likely to break, de-bond, or chip. In other situations, a dental porcelain veneer is better since it does not require as much tooth structure to be removed. If there is a lot of loss of tooth structure due to decay or fracture, a dental crown may be the only option.

Can dental crowns be used to straighten my teeth?

Using the shape of the new dental crowns, dental crowns can be used to give the teeth a more straightened and even appearance. However, this is not the preferred way to straighten your teeth. Orthodontics with braces can straighten teeth better without having to have your teeth ground down.

Should I have a dental implant or a dental crown?

A dental crown is a dental restoration placed on a broken-down tooth due to decay or fractures. A dental crown is also placed on a dental implant. A dental implant consists of a titanium cylinder that is surgically placed in the jaw bone. Then a post is placed on this implant. Next, a dental crown is placed on the post. So, both a broken tooth and an implant require a dental crown as the final restoration.

Can dental crowns be whitened or bleached?

No. They cannot be whitened or bleached. However, they can pick up stains that will give them a darker appearance.

Can dental crowns cause bad breath?

Dental crowns cannot cause bad breath, but leakage and decay under the dental crowns can cause odors. It pays to brush and floss dental crowns well to avoid costly dental crown redo’s.  

What is a porcelain inlay or onlay?

They are like mini-dental crowns that fit in or on top of the tooth. They can be used when the damage to a tooth requires more than a filling but does not require a full dental crown.

Is it worth the time and cost to have a tooth crowned versus removing it?

Sure, it is cheaper to extract the tooth. But, then you have to do something with the space. If you plan to just leave the space, extracting the tooth is your best option. If you want to keep your teeth looking good and functioning well, dental crowns, dental bridges, and dental implants are better options.

Are all dental crowns of equal quality?

Just like any service, there is quality work and there is lousy work. In our office we have

reserved time so we can provide non-rushed precision treatment. And we use top quality dental labs for our dental crowns, dental bridges, dental implants, and dentures.

How do I find the best dentist to make a new dental crown for me?

You can ask friends and relatives who they recommend. You can ask dental offices if

they are in-network providers, which will save you a lot of money. You can ask for a free

consultation to see if you like the dentist and the office. You should look for a dentist that has a lot of experience. An experienced dentist uses that experience to better treat the patient’s dental problems.

My current dentist wants to do a lot of dental crown and bridge work. He wants to veneer several teeth. How can I know if this is reasonable treatment?

You are welcome to come visit our office for a no-charge second opinion. There can be several treatment plans that can work. Some will be more expensive than others. (For a more exact estimate, we would need to do a complete exam with x-rays at an additional fee.)

How can I find out more about dental crowns?

You are welcome to come into our office for a free consultation. We will present to you some options and costs. For a more exact estimate of what treatment is needed, we would need to do a complete exam with x-rays at an additional fee. We can save you money if you have a dental PPO plan because our office is an in-network provider for most dental PPO insurance companies. For those without insurance, we have an in-office dental savings plan which will reduce your costs about 20%. We look forward to meeting you and your family.


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