Everything you need to know about Dental Crowns

Dental sciences have improved so much in the recent times. The evolution of medicine and dental sciences itself has been such an incredible journey and has been furthered by the innovation of new medicine, technologies and diagnostic measures that have been introduced in the field over the years. In all of these technologies and innovations, perhaps the first and foremost innovation that helped in containing and managing most of the dental problems was the invention of dental crowns.

Dental crowns are very versatile and come in many different options and can be chosen based on the kind of functionality and the appearance that is required. This is why they have become one of the most common types of dental procedures in the dental world. Choosing a dental crown can easily be done from an available set of options that can be listed out by your dentist. The patient can choose the kind of crown he or she wants based on appearance and the importance of aesthetics and maintenance for the said crown. In this article, we will be discussing in much detail about dental crowns, cases where dental crowns are required, benefits of dental crowns, types of crowns, materials from which dental crowns are prepared from and the care and maintenance of dental crowns.

What are Dental Crowns?

Dental Crowns are the most advanced and the most versatile option for replacing a damaged original tooth by an artificial tooth that can help in carrying out the same functions as of the original teeth without compromising on the integrity of the actual teeth.

A crown is literally a crown when it comes to its placement and performance. It sits right on top of the original teeth but does not replace the teeth as such. The kind of option that requires the complete removal of teeth is called an extraction and often requires a dental implant, which is a whole different topic in itself. A dental implant is set deep inside the jaw using a metal and places an artificial tooth of a chosen strength and appearance. The metal part is covered with an actual tooth-like mould that acts and functions like a tooth and can be made distinctly for the patient post getting his or her measurements for the missing tooth.

In most cases however, the dentists prefer to save the root of the teeth and remove only the part that has the infection or the damage. The root is better left untouched as the root of a natural tooth is very strong and is attached to many nerves making it one of the best options for the patient. Only if the root is infected or damaged and definitely cannot be left inside the mouth due to fear of infection is when a dentist would choose to go in for an extraction.

For all the other purposes, the root of the teeth is always left intact and only the portion which has the damage is removed. Post this the dentist usually takes the measurement of the missing tooth or teeth and forms a crown, which is meticulously placed on top of the left over tooth to regain the functionality of the tooth as such. This is called a dental crown and is one of the most preferred and opted methods of tooth restoration in the dental world today.

Dental crowns are extremely efficient, can last for an easy couple of years and range between 5 to 20 years based on the material chosen. It can be made from a variety of materials, each one having its own ups and downs, based on aesthetics, functionality and the position of the crown inside the mouth of the patient. Dental crowns are one of the most routine procedures in a dentist office and is usually done within a few seatings with your dentist. The crowns are made in labs by professional dental staff who can work with a range of materials to bring about the perfect crown for each kind of tooth. Sometimes a patient may require multiple crowns and in some cases these crowns are required for consecutive teeth, which is then referred to as a bridge. A Dental Bridge consists of crowns that are packed together and can be fixed as such by the dentist and would look like a natural set of teeth that sits consecutively next to each other. Bridges need to be made more carefully with multiple sets of measurements for the teeth.

Requirement of a Dental Crown

A dental crown can be a solution to many prevailing dental problems. But for which problems are they commonly used for may be a question for most patients. Dental Crowns are used as a post operative procedure or a method to cover up the original damaged tooth to restore the functions of the original tooth. Dental crowns are absolutely safe and by far the best dental option to cover up most problems with regards to a tooth.

Below are the most common scenarios where a dental crown is suggested as a solution:

• A crack or a fracture in the original tooth
• A misshapen tooth that poses an aesthetic challenge
• A discolored tooth that can pose an aesthetic challenge
• A decayed tooth - the most probable cause for crowns
• A post operative option after root canal treatment
• A severely worn tooth due to patient habits such as grinding
• A tooth with large cavities and requires major portion removal

These are some of the scenarios in which a dental crown is suggested as a post operative method to cover up and restore the functions of the original tooth.

Benefits of Dental Crowns

Dental Crowns are one of the most helpful methods and alternatives to restore the tooth function of those teeth that can no longer serve their purpose due to the damage caused in them. Some of the most important benefits of dental crowns are listed below:

1. To restore Mastication Functions

Teeth are most important to carry out the eating and chewing functions. Each tooth in the mouth has a set function and a role to play in the chewing process. For example the canines are used to tear up the food, the molars and pre molars help in proper chewing of the food, the incisors help in biting of the food etc. When one of the tooth gets damaged due to any reasons, it needs to be replaced as there is a certain role for each kind of teeth in the mouth

2. For Proper Speech and Enunciation

Teeth also help in speech and most of us may not realise that until and unless we lose a few of the important ones. Frontal teeth help us in enunciating the words much better and clearer and losing those teeth can make our speech slurred and unclear.

3. For Proper Teeth Alignment

Teeth alignment can be disturbed if one or few of the teeth gets damaged. The way we bite down and the way our jaw is aligned can be disturbed by the absence of a tooth and therefore to maintain proper teeth alignment, a damaged tooth needs to be restored with a dental crown

4. To Avoid Receding of Adjacent Teeth

If a dental crown is not affixed on a treated tooth, there can be gaps between the tooth that is created by the natural movement of the gums and the jaws. The way we bite down and the adjacent teeth near the infected teeth can move further apart causing more challenging issues for the patient

5. For Aesthetic Reasons

The absence of a proper tooth, especially if they are anterior teeth can be extremely difficult as it can look quite odd aesthetically speaking. It is impossible to leave a sawed down tooth as such especially if they are in the front unless the patient is quite old, but in which case the tooth would probably be extracted as it would no longer have the strength to stay in place. For every other scenario, a dental crown may be the only solution to fix the absence of a tooth caused by damage.

Apart from these reasons, placing a dental crown on top of the treated tooth also ensures that there are no further attacks on the tooth by bacteria and germs. When we eat food and the food particles tend to generally get trapped here and there, the treated tooth and the gums near it are left exposed and vulnerable to attack by the germs. But when the tooth is taken care of by placing a dental crown on top of it, it can save the rest of the original teeth in the mouth and also ensure that the food does not get trapped near the treated tooth with good maintenance.

These are some of the best benefits and advantages of having a dental crown replace the original tooth.

Types of Dental Crowns

There are many different kinds of dental crowns based on many different factors. Some of the classification on the basis of which dental crowns are prepared and chosen are mentioned below:

1. Based on Position of the Crown

This is one of the divisions under the type of crown which is based on the position of the crown inside the mouth of the patient. Whether the crown is used for the frontal teeth or the teeth in the back, decides what kind of crown needs to be used. There are 2 kinds of crowns based on position of the crown and is mentioned below:

• Anterior Crown

This is the kind of crown that is used for the front teeth which is more visible to others. This kind of crown is usually of lesser strength but the focus is mainly on the colour of the crown and how easily the crown blends with the rest of the teeth

• Posterior Crown

Posterior Crown is the kind of crown that goes in the back of the jaw. These kinds of crowns need to be more sturdy and strong as they carry out most of the biting and chewing functions. Colour matching these crowns with the rest of the teeth is usually given second preference and more focus is placed on the strength of the crown.

2. Based on Duration of Usage

Crowns can also be categorised based on the duration of its usage and its relevance inside the month of the patient. There are two kinds of crowns when divided by the time they spend inside the patient's mouth and therefore they are made accordingly.

• Temporary Crown

Temporary crowns are placed on top of treated teeth right after the procedure is over. They are usually prefabricated and come in various sizes and shapes and can simply be altered within the office to suit the requirement of the patient. The purpose of using a temporary crown is to guard the tooth that has been restored from developing any further problems or infections while the permanent crown is being prepared, as making a permanent crown can take long.

• Permanent Crown

Permanent crown is the final type of crown which is pre-selected by the patient based on his usage and convenience and is mostly prepared after much studying of the behaviour of the original tooth, how the temporary tooth has behaved whilst the permanent crown was being made and the proper fit and contour of the original tooth. This is why permanent crowns take longer to make and therefore requires temporary crowns to fill in for the time being

3. Based on the Age of the User

Another important classification of crowns is based on the age of the user - which is an important category as the crowns used for kids are made much differently than the ones used by adults. The difference lies in the duration of the usage of these crowns, material used and the cost factor as well

• Pediatric Crowns

Pediatric Crowns are the kind of crowns that are designed for children and babies who have their primary teeth. These kinds of crowns are usually pre fabricated and can be generally used as and when required. They help in carrying out the normal function of the missing tooth until the permanent teeth show up, therefore helping in chewing, alignment and other functions.

• Adult Crowns

All kinds of other crowns that we have discussed so far come under the Adult crowns category. They are usually made from various materials and each one has its own distinct character based on its position, strength and appearance.

4. Based on the Material Used

This is probably the most widely classified topic under different types of crowns. The kind of dental crown is most usually referred to by the material that is used to make such crowns. These can vary from a few thousand rupees to tens of thousands of rupees and can be characterised by their strength, durability, appearance and many such factors. This is discussed in much detail in the next section.

Materials Used to make a Dental Crown

Materials that are used to make dental crowns are one of the most researched and studied subjects when it comes to dental sciences. There are many kinds of materials and chemical compounds that are used to make dental crowns. Some of them are cost efficient, some of them are sturdy and durable and some of them have a fine balance between the two. The other most important factor when choosing material that makes dental crowns is appearance. There are many who prefer metal crowns for their functionality but they lack aesthetics as they are visibly outstanding and can be easily differentiated. Some materials can make what is colloquially termed as ‘White Crowns’ or crowns that are white in color and easily disguise themselves as a natural tooth. White dental crowns are nothing more than materials that are natural tooth coloured and can easily mimic an actual tooth. All of these differentiations are solely created by the material that is chosen to make the crown.

Some of the most popular types of Dental Crowns and the material they are made from are:

1. White Crowns

White Crowns are generally referred to all the kinds of crowns that appear white and are made from biocompatible material that can mimic the natural tooth color. White dental crowns are one of the most popular options when it comes to crowns for the anterior and in some cases, even the posterior teeth. When aesthetics and usability is given forefront and weightage, white crowns are one of the most popular choices for a crown in patients.

White crown tooth is made from many different kinds of material such as porcelain or ceramic, zirconium etc. White crowns for teeth is basically a non medical, colloquial term which refers to crown materials that have a tooth like colour and blend in with the rest of the teeth and do not appear to be like a crown, unlike metal or metal fused crowns per se.

White crowns for teeth cost much more than the average metal based crowns but they are very aesthetically pleasing and are apt for front or anterior crowns. For teeth that are restored in the frontal area, metal crowns can look quite jarring and therefore, white crown teeth are the only option for anterior crowns. The material that is used to make white tooth crowns are:

• Porcelain or Ceramic

Porcelain or Ceramic is the most popular kind of crown which is used for a long time now. This type of crown has been developed after a long study on the material that is most feasible to make crowns out of but with strength and durability along with color matching abilities. Porcelain or ceramic are one of the most top rated materials to use for crowns as they are metal free and completely biocompatible. For those patients who have metal based allergies, this can serve as a wonderful option.

The pros of porcelain crowns is that it can be completely colour matched with the patients teeth and will look as close to natural as possible. They are metal free and therefore do not cause any allergies in corresponding patients. They are made to fit and have a hard outer shell and therefore have a decent durability and strength factor.

The cons of this kind of white crown tooth is that it is quite expensive and requires some initial investment due to the unique nature of its material. Another factor is that due to its hard outer shell, much of the original tooth would need to be required so that this crown can be placed and contoured appropriately. Unlike metal crowns, they do not have incredible bite force or strength and therefore can be suited for anterior crowns only. They last for 10 years or more with good care and maintenance.

• Zirconium

Zirconium is another favourite kind of new age material to make white dental crowns out of. Zirconium comes in an easy to mould and easy to make kind of format and is one of the top rated materials to work with currently in the market. They are long lasting, tooth coloured and can be colour matched, have good durability as that of metal crowns and elegance as that of any white crown. This makes it perfect for a white tooth crown. They are also similarly priced to porcelain crowns and therefore make a good alternative to ceramic or porcelain crowns. However they seem to have better durability and strength than ceramic crowns as per studies.

2. Metal Crowns

Metal crowns are one of the most standard and basic crowns that are available in the market. They are the first ever kind of crowns that were first introduced and are known for their strength and durability. They can last as long as 20 years and even more with good maintenance and care, which of course they need very little of being that strong and durable. They can be easily contoured and fitted to the teeth based on requirement as they are extremely malleable. They also can be used exceptionally well as posterior crowns as they can handle very good bite force. The only downside to metal crowns are their distinct and apparent colour. They can be easily seen even being in the posterior part of the jawline and can cause some aesthetic issues for those who care.

Some examples of metal crowns are gold alloys, silver alloys, stainless steel crowns etc.

3. Metal Fused to Porcelain Crowns

Metal Fused to porcelain or ceramic is one of the best combinations of white crowns with metal crowns. White tooth crowns have a small downside when it comes to structural integrity but with some help from metal, they can easily become one of the best white dental crown options for both posterior and in some cases anterior crowns also. In this type of crown, the core is made of metal and is then fused with porcelain or ceramic all around to form a coating that looks like a tooth. It is then contoured and trimmed to meet the requirements of the patient.

The pros of this kind of crown is that they are a perfect combination of white crowns for teeth with metal crowns, with the added strength of one and the color matching ability of the other. But the downside is that it has a metal tinge to it, a lining inside that can peek through, making it not so invisible that it is metal fused with porcelain. Therefore they are still not so suited for anterior teeth and can be better suited for posterior teeth. One of the best parts about this type of crown is that they are one of the cheapest options for white crowns. They are only second to stainless steel crowns when it comes to cost wise comparison.

4. Resin Crowns

All resin crowns are also considered to be white crowns but unlike other white dental crowns, this type of crown can be less expensive and requires much more care and maintenance. It is not as strong as the other white tooth crowns and can get worn down faster than the rest. Many dentists prefer all resin crowns for temporary restorations as they can be easily replaced with permanent crowns and they are also colour matched and therefore one of the best options for anterior teeth as well. They can be easily moulded and trimmed as per the requirement of the patient thanks to easy to use format but can wear down as easily as well. They typically last longer than temporary crowns but may not be a great idea for an actual permanent crown option. They can also make great options for pediatric white crowns.

These are some of the most popular materials used to make dental crowns. Of all the crowns mentioned here, most of them align to white dental crowns or metal crowns and therefore these are generally the two most used types of materials when it comes to dental crowns.

Care and Maintenance of White Crown Tooth and Metal Crowns

When you first visit a dentist, he or she may initially take a look at your tooth issue and if a tooth restoration with dental crown is suggested, you would be asked to come a few more times before you are all set to go home with a good set of teeth. Once the treatment of the damaged or decayed tooth is completed, the dentist usually gives you a temporary crown that will stay in place for as long as the permanent crown is being made to specifically suit your requirements. Once the permanent crown is prepared and set in place, the dentist would advise on some key points and tips to follow to ensure that you take good care of your newly fixed crown.

Taking care of a dental crown is especially important as a missing, broken or damaged crown is considered to be a dental emergency in most cases. This is because once the crown falls off or is damaged, the original teeth below it and the gums around it are vulnerable and exposed to risk of infection. This is why one must take good care of their dental crowns and if there were something to happen to it, contact your dentist right away to get the issue sorted.

Below are some of the tips to ensure that your crown stays intact and healthy as long as possible:

1. Good Oral Care

One of the most important tips, with or without a dental crown is to ensure that you follow excellent oral hygiene at all times. Brush twice a day and follow up with flossing so that you can get all the bits and pieces of food out and avoid the risk of decay. Use a fluoride based toothpaste and maintain good oral hygiene by rinsing your mouth regularly after each meal. This helps in minimising the attack of germs in the mouth. Rinse after sugary or starchy food as well for better protection

2. Food Caution

Stick to food that is healthy for your teeth. Avoid too much sugar, too much acidic food, too much oil and grease, too much fat and too much starchy food. These kinds of foods tend to stick around much longer between the crevices of your teeth and if not cleansed thoroughly, can be a cause of cavity and decay. It is better to avoid such food when you have a crown in place as much as possible. Avoid eating hard toffees, chewy candies, hard bones and other hard items in the area where you have a crown to avoid the risk of a crown fracture or breakage.

3. Temperature Exposure

Try to not indulge in too hot or too cold food at a time as they can interfere with the integrity of the crown. Maintaining an average temperature of your food especially in the area with the crown can be quite helpful to lengthen the life of the crown in place

4. Flossing Precautions

Make sure you floss in a proper careful fashion as aggressive flossing can interfere with the placement of the crown and can dislodge the adhesive and the crown from its place. Floss back to front and side to side and avoid up and down motion around the crown area.

5. Regular Dental Visits

Make sure to visit your dentist frequently, atleast once in every 6 months to check on the status of your crown. If you encounter any issues with the crown in between such as crown seeming loose, crown falling off, crown being dislodged, crown fracture or breakage, report to your dentist immediately and fix an appointment as soon as possible. Try to secure the crown so that it can be replaced back.

These are some of the tips to take good care of your dental crowns.