Facts you need to know before getting a Porcelain Crown!

Our teeth are precious as it is and we only realise its importance when it starts giving us trouble and causes pain and discomfort. Until then most of us take the care and importance of our teeth for granted and pay very little attention to it. Teeth are a tool or a weapon for most cannibals and just like animals, humans survive by making optimum usage of our teeth to chew and tear up food. Therefore, it is pivotal for our own survival to take good care of our teeth.

One such important dental procedure that helps most of the patients who suffer from teeth related issues is Dental Crowns. A Dental Crown, like the name suggests, sits on top of the original tooth and helps protect the original tooth beneath it and also performs all the tooth-related functionality that the original tooth performs. Dental Crowns are one of the most innovative solutions to modern day dental problems and covers a wide range of issues such as -

• Tooth Decay
• Broken or Fractured Tooth
• Misshapen Tooth
• Discoloured tooth
• Post Operative Tooth Replacement etc

These are some of the scenarios where dental crowns prove to be very useful and can help patients in overcoming tooth related issues. Dental crowns isa major topic and has a sea of information that one needs to know before getting a dental crown affixed at the dentist's office.

In this article, all the facts that one needs to prepare before getting a dental crown is covered - right from what dental crowns are, how many kinds of dental crowns are there, the most widely used dental crowns of all - Porcelain Crowns, the advantages of each kind and their drawbacks and the procedure of getting a Porcelain crown and it’s maintenance.

Dental Crowns

Dental Crowns are one of the most widely used dental procedures and are very helpful with a bunch of dental ailments that can plague men, women and children. Any kind of tooth ailment mostly requires the tooth to be redone by removing the dental issue such as cavity, infection or fractured tooth portion that requires fixing.

In this scenario, the dentist removes the infected part or the broken or fractured part of the tooth and files the tooth down to reduce its size. This original tooth is now free of any damage but cannot perform any of its dental function due to its reduced size and shape. This original tooth also needs protection from regular habits such as chewing, food contact, germs and bacterias that may infect the leftover tooth once again. The dentist now has to cover the original tooth with something that resembles a tooth but also functions just like a tooth. It can carry out its masticatory functions, protect the original tooth within and provide aesthetic appeal to the patient's mouth.

This is where a Dental Crown comes into picture. A dental crown acts just like a crown by sitting on top of the filed down, original teeth and helps in the following functionalities:

• Carry out masticatory function such as Chewing, tearing of food and ingestion of food
• Provide normal adjustment between the teeth and prevent any drifting of teeth that is adjacent to the damaged tooth
• Helps in normal speech and proper enunciation
• Helps the patient have a normal aesthetic appeal and prevent the lack of tooth appearance

Why does one require Dental Crowns?

A dental crown can help in managing several tooth ailments and fixing many of the issues that a patient may have. Some of the most common reasons why one would need a dental crown is mentioned below

• Replacement for the original tooth when the original tooth is filed down
• Keeps the original tooth protected from day to day activities
• Keeps the original tooth from breaking down further or chipped away
• It helps in restoration of a severely worn down tooth
• Sometimes, a patient may require a dental bridge and dental crowns can help with that
• Incase the tooth cannot be restored, a dental crown can cover up a dental implant laid
• Protects a tooth after it has undergone surgery such as root canal treatment
• Can be done on tooth where a large filling is done but very little original tooth remaining

These are some of the most common scenarios in which dental crown needs to be used on an existing tooth so that the patient can resume normal functionality of the mouth.

Types of Dental Crowns

There are many kinds of Dental crowns and they can be widely divided into many categories. These are based on either the material that they are made from, the position that they occupy in the patient's mouth, the type of covering the dental crown provides, the longevity of the usage of the crown by the patient etc. Below are some of these categories:

1.Based on Longevity of Crown Usage

This category is majorly to do with how long the crown is going to stay in the patient's mouth as there are primarily two scenarios - one crown is used right after the treatment procedure to hold fort while the other crown is the permanent solution that is strong enough to carry out the original teeths functionality. They are divided into two following types:

• Temporary Crown

A temporary crown is prepared and fitted by the dentist in the time that the patient undergoes treatment and is waiting to get the permanent crown that can carry out all the functions that the original teeth would have. This crown is only used to check whether the original crown of similar material will fit and suffice the requirements of the patients. They are usually made of pre-veneered material

• Permanent Crown

A permanent crown is the dental crown that helps in regaining all the functionality of the original teeth. The only requirement for a temporary crown is because a permanent crown can take a few to several weeks to be prepared and contoured to adjust into the patient's mouth.

2.Based on Position of the Crown inside the mouth

This category is based on where the dental crown is going to be placed in the mouth. This helps in deciding what kind of material and how sturdy or durable the crown selection should be. It is majorly divided into two types:

• Anterior Crown

An anterior crown is placed in the front teeth - which means that they are very visible when the patient smiles, talks or eats. This is why these crowns are preferred to look more aesthetically pleasing. They may have a compromisable strength and durability due to their limited masticatory functionality

• Posterior Crown

Posterior crowns are located in the back of the patient's mouth but have a major role in mastication and therefore need to be much more strong and durable. Some patients compromise on the aesthetic appeal when it comes to posterior crowns as they are not very visible when the patient smiles or talks.

3. Based on the coverage of the crown on the teeth

This category has to do with the size and coverage of the dental crown that is chosen by the patient or the dentist. This is decided by the kind of treatment that the patient has undergone and the reason for getting the dental crown affixed. It depends on how much of the original teeth are remaining and how strong the original tooth is. It is divided into following two types:

• Traditional Crown

A traditional crown covers most of the original tooth. This happens when the dentist has to remove most of the original tooth due to an infection or because of the lack of strength of the original tooth.

• Onlay or 3/4th Crown

An onlay or 3/4th crown only covers a portion of the original tooth and mostly sits on top of the original tooth like a cap. In this case, the dentist does not have to remove a major part of the original tooth and in most cases, the original tooth is sturdy enough and therefore does not require a traditional crown.

4.Based on the Age of Patient

This category is to do with the age of the patient as dental crowns can be required by children and adults irrespective of their age. Children can infect their teeth more commonly than adults due to poor oral health and the exposure to junk food. There are two types based on the age:

• Pediatric Crowns

Pediatric Crowns are made especially for children. They are mostly prefabricated and pre-veneered and are most commonly made in stainless steel as they are considered to be a temporary option. They come in a wide variety of shapes and sizes and can be adjusted to the patient's tooth size accordingly. However they also are made from other materials especially for anterior crowns such as Resins, Ceramic and Zirconia.

• Adult Dental Crowns

Adult dental crowns are the traditional crowns that are custom made by the dentist or in the lab based on the requirements of the patient after careful evaluation of the size and shape of the tooth. This kind of crown may take several days to get ready.

5.Based on the Material of the Crown

This is one of the most important and the most commonly used categories when we talk about the types of dental crowns. Dental crowns can be made from a variety of material and it completely depends on the requirements of the patient, the suggestion of the dentist and the other criterions mentioned above such as the position of the crown, the coverage requirement, the age of the patient and the duration of the crown to be used. Below are the most common types of crowns that is available in the market:

• Metal Crowns

Metal Crowns are the most common types of dental crowns but their popularity has been challenged by the new age crowns that have been invented of late. Metal crowns are the traditional form of dental crowns and have been in use and practice for a very long time. The metal crowns are made from a variety of materials and are purely made from metal - metal alloys. Alloys are more preferred than metals as such for crowns as they are resistant to damage and cause no allergies.

The most common type of metals that are used to make dental crowns are Gold, Nickel, Palladium and even stainless steel in some cases (such as for pediatric crowns and temporary crowns). Metal alloys are very adaptive and provide for the best kind of dental crown restoration, in fact they are the strongest and the most durable when it comes to metal crowns. Other advantages of metal crowns are that it requires very minimal removal of tooth while placement as they have a very thin exterior and can be easily contoured. They also have very less requirement to maintain and can last for a ling time.

Their only flaw is that they are very obvious and most people shy away from using metal for anterior crowns as they have a striking metal colour and therefore have very less aesthetic value. It can be used for posterior crown restorations but even then, the modern innovations have come up with so many different kinds of tooth-coloured options such as porcelain and zirconia, that patients now prefer these to the traditional metal crowns. Another con for metal crowns is that it cannot be used for some patients who are allergic to metals and in some cases, patients may develop certain allergies after usage of metal crowns. For such patients, metal crowns are not a good option.

• Porcelain Fused to Metal Crowns

Porcelain Fused to Metal crowns are made from a porcelain exterior but have a base of metal lining that runs through the crown. This is one of the perfect combinations of strength plus aesthetics and is therefore a very popular choice for both anterior and posterior teeth. The crown is made from porcelain material which is tooth coloured and therefore can easily look like teeth when it sits on top of the original tooth. The base of the crown is made from metal as a metal lining runs through the crown to support and provide sturdity to the crown.

This type of crown is very popular and is suggested to be the best for most kinds of restorations. The tooth coloured exterior blends well with the rest of the teeth and therefore helps in aesthetic presentation. On the other hand, the metal base lining helps in providing strength and sturdity to the crown to make it durable for a long period of time. It has more aesthetic value than metal crowns.

On the con side, the metal lining does show up below the teeth and can be seen from up close. This might be a flaw for people who are aesthetic conscious but can still be a viable option for anterior crowns. Another con is that the porcelain part of the crown may get damaged with excessive wear and tear and can be prone to chipping and fracture. This makes it less popular but is still one of the three most used types of crowns by dentists and patients alike.

• Porcelain Crowns

Porcelain Crowns are literally made from porcelain - yes the white ceramic things that occupy our kitchen cutlery shelf. This tooth coloured material is one of the fan favourites and is preferred by most patients due to its aesthetic presentation. It can blend extremely well with the rest of the teeth and can hardly ever be recognised unless closely inspected. The crown is also capable of withstanding significant chewing pressure and strength and therefore can be a perfect option for anterior crowns as it is capable of tearing up food, cutting into food and better aesthetic value.

It is also capable of handling high temperatures and therefore can be extremely useful to patients who have sensitivity to temperatures. Just like porcelain cutlery, porcelain crowns can take a lot of heat and take a while before sensitivity can hit the nerves. It is also a great option for those who have metal allergies and have limited options when it comes to getting permanent dental crowns.

The cons of porcelain tooth crowns would be its obvious lack of strength and durability, just like porcelain nature. The crown is tough for normal day to day activity, but for those who have teeth grinding issues and for those who do not take care of the crown very well, the porcelain crown may not last very long. It is prone to wear and tear and can easily be worn down especially if the patient has Bruxism. Porcelain crowns can also be susceptible to fractures and chipping if care is not taken by the patient. For those who are into sports and are more prone to facial injuries, porcelain crowns may not work out. It also needs considerable contouring and filing down by the dentist so as to make adjustments when the crown is placed. This means that most of the original tooth may be lost in the process of getting a porcelain crown.

Another important aspect is the porcelain crowns cost - porcelain crowns are quite expensive but there are many dental hospitals that now cover the cost of crowns and procedures in their dental and medical insurance claims. So it is safe to assume that although there are some cons to porcelain crowns, it is still the most favorite kind of dental crown preferred by both dentists and patients alike.

Advantages of Porcelain Crown against other Crowns

Porcelain dental crowns offer a sea of advantages when it comes to the dental crown subject - its natural colour, versatility, easy to work with attributes and its tendency to mimic human teeth are all pros for the use of porcelain crowns for dental crown procedures. Although there are some cons to porcelain crowns, modern dentists and researchers are constantly working on improving the quality of porcelain crowns and they are getting better with regards to durability and strength with each passing year.

Below are some comparison between some of the most common and traditional crown types against porcelain crowns to help patients understand how well these crowns fare against each other:

Porcelain Crown v/s Metal Crowns

Advantages: Metal crowns are one of the most widely popular crowns and have been in use for many generations. Although, porcelain is more recent and preferred by the younger crowd who place more importance on aesthetics over other things. The advantages of porcelain over metal crowns is that metal crowns may not suit everyone and those who have metal allergies cannot withstand the use of metal crowns in their mouth.

Also, metal crowns have a serious flaw - their striking visibility. They are strong metallic in colour which makes them extremely visible and this is one of the major reasons why most people do not entertain metallic crowns, despite its strength, durability and cost effectiveness. Most people in the younger age group are very conscious and therefore prefer to have tooth coloured restorations instead of metal crowns, even for the molars and premolars which are in the posterior section.

Metal crowns such as gold are still seen as a symbol of luxury and uniqueness and many celebrities prefer getting metallic crowns in gold and silver as a cosmetic restoration. For others, who do not pay much attention to aesthetics, may still prefer metal crowns for posterior restorations.

Disadvantages: Unlike Porcelain, metal is sturdy and strong and can last in the patient's mouth for as long as 20 years. They are extremely easy to work with and have thin, malleable walls which makes them easy to adjust and contour in the patient's mouth. It requires very less filing of the tooth to accommodate the size of the crown. Therefore, metal crowns take up less space and do not require filing away most of the original tooth.

Also, metal crowns are much cheaper when compared to porcelain crowns cost. Porcelain is a very valuable material and much work goes into making this crown and getting it adjusted to the patient’s requirements, therefore they cost higher and require some aftercare as well to ensure they do not get chipped or fractured post installation. Metal crowns require very little post placement care and are very easily attached to the original crown and cost much less to prepare as well.

Porcelain v/s Porcelain Fused to Metal Crowns

Although both use porcelain, the two types of crowns are quite different from each other in terms of many aspects.

Advantages: The Porcelain crown is more preferred for anterior restorations than PFM or Porcelain Fused metal crowns. The reason for this is the metal lining that covers the base of the porcelain fused metal crowns - these metal thimbles can show up at the base of the crown and give away the fact that the tooth is actually a crown. The metal lining can be aesthetically less pleasing and therefore less suited for anterior teeth such as incisors and canines.

Even though the Porcelain fused to metal crowns are believed to be stronger and more sturdy, they do pose a challenge in the fact that the porcelain covering the metal portion is susceptible to chipping and fracture due to the varying material of the crown. With the uneven sturdity and uneven pressure that might fall on the crown, the porcelain portion may chip or fracture if care is not taken to preserve it. Porcelain Fused to Metal crown cannot be used by those who have metallic allergies as well due to the metal inner core used in the crown.

Disadvantages: The Porcelain Fused to Metal crowns are still considered stronger and more durable than porcelain, thanks to the metallic inner core that supports the crown. It can withstand pressure and stay intact for much longer than porcelain crowns.

Another con for porcelain crown would be its obvious difference in cost. Since only a portion of the crown is made from porcelain, it costs less than all porcelain crowns cost. They are also easier to prepare in the labs and require less time to adjust and contour in the patient’s mouth. Porcelain Crowns are preferred for anterior restorations than porcelain fused to metal crowns by patients who are very keen on aesthetics as well, despite its porcelain based exterior.

Porcelain and Zirconia

Zirconia is a new age material with which a lot of research and study has been done and also has been used as a new age material to make crowns out of due to its natural colour and opaque white appearance. Zirconia is made from Zirconium Oxide which gives these crowns its characteristic strength and ability to withstand pressure. The material is also very biocompatible and therefore its is safe to be used by patients who have allergies to most metal and other materials as the composition of this material is very similar to human biological materials.

Zirconia has an opaque texture and is quite durable and also aesthetically pleasing, therefore makes it an excellent option for use in anterior restorations and for posterior restorations equally. The only flaw with comparison to porcelain crowns is that the texture, although white and tooth-like, does not look natural like porcelain. The material is also quite hard to work with and requires a lot of time to prepare and adjust or contour in the patient's mouth. It is also as expensive or even more expensive than all porcelain crowns cost. These are some reasons why most people still prefer Porcelain crowns over Zirconia crowns.

Procedure to get a Porcelain Crown Placement

Getting a Porcelain Crown is a fairly simple procedure. The procedure is also quite painless provided that the dentist is quite experienced in working with porcelain crowns. The entire procedure is split into 2 to 3 sessions which helps in providing necessary time between each and every stage of the crown placement. Below are the steps that is taken to get a porcelain crown placed for a patient:

1. In the first visit, the dentist would first examine the damaged or infected tooth and remove the portion that needs to be removed to make the teeth workable. The removal of the infected part is necessary as only then, the rest of the portion of the teeth can remain healthy.

2. The dentist may have to perform a root canal treatment or simply have to file down the teeth to a level that a crown can sit on top of the original teeth, incase of a fracture, misshapen or discoloured tooth.

3. Once the tooth is filed down, X-ray images are taken to help in determining whether the tooth has any more damage, infection, breakage or fracture within. This helps the dentist in understanding the state of the tooth and the nearby teeth before making a crown

4. A mould made of putty is placed between the two jaws to create an impression of the original tooth that requires the crown - the mould automatically creates measurements of the original tooth as well as the dimensions of all the adjacent teeth so that the bite area can all be well adjusted. Alternatively, digital pictures using a 3D wand are also done in some offices.

5. The measurements are then used to prepare the permanent crown of a material that is suggested and mutually agreed by the patient and the dentist. Meanwhile a temporary crown made of resin or stainless steel is placed so that the normal functionality can be continued.

6. Once the crown is ready, the temporary crown is removed and the permanent crown is checked for adjustment. The crown can be contoured and fit to perfection and positioned using a dental paste or cement to secure the crown.

7. The dentist then would ask the patient to bite down the crown so as to ensure the crown is secured in its position. Over the next few days, instructions are provided to care for the crown and to help the patient to recover post the procedure

8. The patient must visit for a post-procedure visit where any concerns can be discussed or adjustments, if any, can be made to the crown.

Post Procedural Care

Once the Porcelain crown is affixed, there are some recommendations that the dentist would advise to follow in the coming weeks for the best post operational care:

• It is best to stay away from extremely hot or extremely cold drinks and food so that the crown can adjust properly in the patient's mouth. Extreme temperatures can crack a crown
• Good oral hygiene must always be practiced by brushing twice and flossing once a day to remove any food remains from around the original tooth so as to protect the original tooth from further damage or infection
• Sticky, hard, too sweet, too salty and too greasy foods must be avoided at all times to maintain a good and healthy crown strength at all times
• Visit the dentist once every few months to ensure that the crown is doing well and to help adjust the crown if there are any discomfort
• If the porcelain crown chips, breaks or mislodges, call the dentist immediately and secure the crown. The dentist can help place the crown back and small portions of the chipped crown can be fixed by the dentist
• If large portions of the crown has been chipped and broken, the dentist may advise to go in for a new crown altogether, therefore is is necessary to take good care of your porcelain crown.

Conclusion

These are some of the most important facts that one must know before getting a porcelain crown affixed on the original tooth. Porcelain crowns are extremely natural and can behave just like human teeth. But care has to be taken so that the crowns can remain in good shape for a longer period of time.