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Dental Crowns in México
The Dental Crowns and Bridges is both material and time intensive, involves laboratory support and encompasses two broad categories. Please read more about the quality procedure we preform at Ocean Dental Cancun.
The either full or partial coverage fixed restorations designed with porcelain crowns, to improve strength, contour, function and aesthetics, crowns can be fabricated from a range of materials including high gold alloys, titanium, resin, ceramic or combinations thereof. Crowns can be either tooth or implant supported.
About a third of the Western population have at least one dental crown and as you get older the likelihood increases; half of adults over the age of 50 would probably have a crown.
Why would I need a Dental Crowns?
Porcelain Crowns might be needed and you might require a trip to Cancun in the following situations:
If a tooth has a very large amount of decay, then a crown or an inlay/onlay becomes a more dependable long-term solution compared to just having a tooth filling. There are limitations with any large filling packed into a tooth by the dentist. If the material is amalgam it will expand slightly as it sets and if it is composite it will shrink slightly.
The larger the filling the bigger this effect and the less likely the filling is to last long term. It is also more difficult to recreate the form and contacts of the tooth, when most of it has been destroyed.
A crown can help to protect the remaining weakened tooth structure underneath. A filling will need to be carried out anyway, if the tooth is to have a crown. It is this tooth/filling combination which will be filed down to form the core on which the crown sits.
An inlay/onlay is an alternative solution, which like the crown is made in the lab and is bonded in passively, i.e. made to measure so it puts no force on the remaining tooth.
Sometimes you may have had a large filling that has failed, or another piece of that tooth that breaks away.
It may be possible to repair the tooth or to replace the filling but it is likely that at some point it will fail again and you will have to proceed to a crown.
Sometimes it is more sensible and more economical to proceed to a crown sooner.
Every time you fill a tooth, you remove a little more tooth structure- if the filling is small this is not a problem, but if the filling is large then maintaining as much sound strong tooth, to act as part of the core, is important for a successful crown. Whilst you can generally always progress to a crown, there is a point at which it becomes the most sensible treatment option to keeping the tooth long term.
Sometimes the only way in which worn teeth can be built back up to a normal height with sufficient strength to last is by having crowns. When crowns are being placed for severely worn teeth, a number of crowns are often needed and in some circumstances it may be necessary to change the bite.
Sufficient wear to require a crown would not come from tooth brushing abrasion, but erosion (having too much acid in your diet or gastric reflux) ,or attrition (grinding/ bruxism) ,or as is most often the case, a combination of the two. Because wear often makes teeth shorter and crowns need a certain amount of tooth (at least 3mm in height) to be retentive (stay on well), the bite may need to be opened or crown lengthening done to make a placing crowns possible.
You may also need a crown for aesthetics reasons. Crowns (like veneers) can change the colour and shape of teeth. They can be placed on healthy teeth to improve their appearance, but as they are very destructive, wherever possible it is best to avoid crowns on virgin (untouched) teeth.
However, If you have fractured a large piece of a tooth, a crown can sometimes be a more appropriate choice, to give the tooth back its natural look and use, rather than having a filling or veneer.
The treatment decision depends on the a number of factors, including how much tooth has gone, how you bite your teeth together, the cost and your aesthetic requirements. The dentist will discuss the advantages and disadvantages of all these treatment options with you, to allow you to make a decision.
When you have a crown, from that point on, you are always going to need a one. So if a crown fails, another crown will be needed to replace it. It is important the dentist establishes the reason for failure and takes steps to try and prevent this from happening again.
Sometimes a crown can be placed to protect a cracked tooth. If you look in a bright light, teeth have all sorts of cracks and fracture lines running through them – these are generally not a problem. If a tooth however, has a functional crack often called cracked tooth syndrome , it can sometimes need a crown to hold the tooth together, ensuring an even pressure on the tooth to prevent the crack from extending further.
A crown is not always necessary- treatment depends on the location, the depth of the crack and what else is going on with the tooth. Sometimes, the result is that a piece of tooth fractures off that can simply be replaced by a new filling. Other times, it can be a lot more complicated involving the nerve and needing a root canal or extraction.
Teeth that have been root filled are much more brittle than living teeth which have a nerve and blood supply. They can fracture easily with uneven pressure, so it is the recommendation of both the American Dental Association and Australian Dental Associations that posterior (back teeth), which are subject to great force during chewing, are placed with full coverage restorations if they have been root filled. This is possible with an amalgam filling or composite filling, but the most reliable method is with a crown, which acts like a helmet, bracing the weaker tooth underneath.
Whilst a tooth can still potentially fracture, a crown makes this much more unlikely, so the sooner this is done following the root canal the better. Before the procedure is carried out, the tooth should have settled down and should not be painful.
A standard dental bridge involves a crown on teeth either side of the space, with a fake tooth attached in the middle. See Bridges, for more information.
An implant integrates with your jawbone and essentially replaces the root of the tooth. A crown is needed to make implants look like teeth again and fill spaces for aesthetics and chewing. If multiple spaces are present an implant may support a denture or a bridge instead.
How Long do Dental Crowns Last?
On average a dental crown can be expected to last 10-20 years. But it is not unusual for it to last considerably longer. I know that this is a huge range but reliable long-term data is always difficult to collect and few good studies are around for us to rely on. There are many factors that will influence how long your crown lasts. Here are the main ones:
- The tooth– The quality of the core, amount of tooth remaining and state of the nerve
- The dentist– Their experience, the quality of preparation, impression and cementation procedure
- The type of crown (material)- Full gold crowns when done correctly last the longest
- The technician (lab)- The quality and fit of the crown
- How well you look after it
- The forces you place on it.
What are the Signs and Symptoms that I might need a Dental Crown?
There are no symptoms. Perhaps that is why crowns are often met with a little resistance by patients (as well as the cost of a crown). You break a tooth and arrive at the dental surgery to hear the dentist emit those much-feared words, “You are going to need a crown if you want to save the tooth.” Now that’s not strictly true, there are few circumstances in which, should you not be able to afford a crown, some sort of filling can be placed instead.
It may not be great, it may not look too good or contact the teeth either side properly and function like a normal tooth but something can be done 99% of the time.
Having said that, any very broken down tooth or large failed filling is certainly a candidate for a crown (or an inlay/onlay) so keep this in mind if you notice this in your mouth. If you have a back tooth root filled, then, as we have said many times, it should in most circumstances, be crowned afterwards to protect it. So be aware and expect it.
Are there occasions when you don’t necessarily need a Crown
Some dentists can be a bit eager to crown teeth if you ask me (after all it pays quite well) and I would certainly prefer to have a dental filling on my own tooth my own where appropriate. Do not skip this stage completely and go for the crown straight away without good reason.
A crown on a healthy tooth is not such a good thing, as it puts the nerve inside under a lot of stress. But when the point comes, where the long-term success of the filling is debateable and the strength of the structure of the core, called into question- then, I would be opting for a crown… It is the best long-term solution for protecting your tooth.
If you can’t afford a crown for your root filled posterior (back) tooth or the dentist wishes to monitor the root canal situation prior to crown construction, then the dentist can reduce the height of the cusps of the tooth by a few mm and place a composite or amalgam filling across the whole of the biting surface. Dentist call this “full cuspal coverage restoration”. This can provide a good restoration for many years.
Porcelain fused to metal crowns.
The front and top part of the teeth require a similar amount of tooth filing to a porcelain crown to make way both the metal substructure and porcelain on top. The inside area of the tooth can have the margin left in metal and can be thin, thus preserving the strength of the core. They are great for use in bridges and incorporating features such as ‘rest seats’ if you wear a partial denture. The porcelain can sometimes fracture off, exposing the metal core. This is pretty rare and often only an aesthetic problem, but it can cause concern for some patients.
Zirconia is a very popular material currently, some crowns are made purely of zirconia making them very hard (even abrasive if not polished properly. The whole crown can be milled from a single block and in this case it is harder to get a really excellent shade match (as the block is a more uniform colour). The advantage here is that you don’t need to remove much tooth at all since the material is very strong in thin sections. Zirconia can also be used for the first part of the crown (that sits over the teeth) and standard porcelain built up on top to mimic the natural tooth more closely, not just in its looks but in its characteristics too. Because zirconia is so hard it is not possible to etch the porcelain and so, a good long lasting crown relies on the retention of the preparation and the cement. See successful crowns for more information.
The higher the percentage of gold the better (over 75%)- this is often mixed with other metals such as, silver or copper and palladium. As the price of gold sky rockets so obviously does the price of the gold crown. The larger the crown, the more gold will be needed and the more you will pay. Gold is the most durable, predictable and best tolerated of all the crown materials- it’s just the issue of the colour.
Before and After Dental Crown
State Of The Art Technology For Dental Crowns
Sometimes impressions may have been taken at the consultation appointment for study models. These are poured up in stone to give the dentist a replica of your teeth in order to assess them, your bite and the tooth for which the crown is planned. The model of the tooth can be used to help make the temporary crown that is worn whilst the final crown is being made. If these impressions have not been taken at the consultation- I normally do them whilst you are going numb to save time; they are generally an alginate impression or a putty mould of the tooth to be prepared.
The high-speed hand piece called the ‘air rotor’ to file the tooth down slightly in all dimensions to make space for the crown. How much they file the tooth down depends on the type of crown being made (and hence the material it is being made of).
X – Rays
These must be taken to help assess:
- The quality of the core; are there any deficiencies or dental caries?
- The quality of the support for the teeth (i.e. periodontal disease) and the amount of good quality bone available to hold the roots in position.
- If there are any signs of needing a root canal, or to assess the success/failure of previous root canal treatment
- Gum assessment (periodontal condition)
X-rays are a vital part of this assessment, but pocketing and bleeding must also be examined to give a complete picture of the state of the gums.
Any active gum disease must be controlled before considering the Crown.
For dental crowns in Cancun you would need 2 visits to the clinic and you should stay in Cancun for at least 3 days. On the first visit we would examine the tooth and prepare it, take an impression and send it to the lab. On the second visit Dr. Irma Gavaldon would remove the temporary crown and place the permanent dental Crown.
The first appointment is for the preparation and the second is for the cementation.
During the initial consultation, the dentist will assess the tooth or teeth being considered for crowns see (diagnosis and treatment planning) then go over a brief version of the information that we have discussed in the preceding articles:
- Why have a crown?
- When you should have it
- How much the crown will cost?
- Risks and potential complications of having a crown
- The types of crown available
- Alternative options to having a crown and the advantages and disadvantages of each
- How many visits etc will be needed and the procedure for having your crown
There are two parts to the crown; the ‘core’ which provides the foundation on which the crown will sit and the actual crown itself (made in the lab by the technician). The two are attached to each other via a cement. Sometimes an extra appointment will be needed to place or replace a core in a tooth ready for the crown, sometimes this will be done at the same visit as the preparation- it just depends.
The core must be as strong as possible or the resulting crown will be compromised. The core can be either just natural tooth, a combination of natural tooth and filling material or a post and core used to build up a very broken down tooth that has had a root canal treatment. If the tooth is having a crown for certain cosmetic reasonsi.e. to change the shape and colour of the tooth (not because it is has been heavily broken down) or because the tooth is cracked- then the core may simply be the tooth itself.
Once the foundation (core) for the crown has been done, you are ready to have the tooth prepared for the crown. The stages are as follows:
- Anaesthetic. First the area is made numb using anaesthetic.This is necessary most of the time but not always.
- Crown preparation.
Once the dentist is happy with the preparation of the tooth, it’s necessary to take an impression on which the lab will make the crown. This step is very crucial- the impression has to be very accurate to ensure a good fitting crown.
If the crown preparation is at or below the gum, then in order to make sure that the margins are accurately recorded then dentist may wish to push your gum back a little to expose them more clearly.
This allows the technician, once he has poured up the impressions in stone to create replicas of your top and bottom teeth, to put them on an articulator to mimic how your teeth interlock. They can then make a crown that fits with the way you currently bite.
The last thing the dentist needs to do before you leave is take the shade. There are a couple of different ways to do this. The most common method is to simply match the shade of the teeth either side using a shade guide. Vitapan and Are, are the two principle guides used. Some laboratories and probably some practices have digital shade taking devices for crucial areas.
The dentist will communicate the time frame, type of crown, shade and any special instructions, such as a rest seat for a partial denture on a lab sheet which they send off to the laboratory with your impressions and bite. The lab will pour up your teeth, place them on an articulator to mimic the way you bite together and make the crown which will fit your tooth.
Anaesthetic is required if the tooth is alive as it can be very sensitive once the temporary crown has been removed. This is probably not needed if the tooth has had root canal therapy but some dentists like to put some in anyway for peace of mind. The temporary crown will then be removed- sometimes it can be levered off and other times it may have to be cut off. The tooth underneath is then cleaned to remove all traces of temporary cement and the permanent crown tried in.
- The margins- is the crown sitting down fully on to the tooth preparation?
- Are the contacts points good?
- Is the shade correct?
- Is the bite correct?
A crown will allow you to eat, chew and smile as normal, pretty much straight away. If you are a bruxist and grind or clench your teeth you should be wearing a night splint anyway, but if you have had crown and bridge work it is even more important you get one made (and wear it!). The anaesthetic will take a few hours to wear off- just be careful during this period. Avoid hot things because you will not be able to tell temperature and chew slowly so as to not bite your lip if you really must eat. Ideally wait till it has worn off before having food.
You need to look after you crown or crowns just as you would any natural tooth with good brushing and flossing.
Lots of different things will influence the success of your dental crown and ultimately how long long it will last. We have been discussing such factors in detail throughout this series. A great outcome and successful crown comes down to a combination of the dentist, tooth, crown, technician and let us not forget the part that you yourself play!
Here’s a bit of a summary of the elements within each of those areas that will contribute to the success of your crown:
- The quality and strength of the core
- The amount of good solid natural tooth remaining
- The state of the nerve
- The quality of the root canal treatment; if the tooth has one or needs one
- The quality of the post ;if it has one or needs one
- The periodontal condition of the tooth (amount of good bone support)
- The bite- how your teeth come together… Do you have missing teeth which will mean the tooth takes extra pressure? Do you clench or grind your teeth?
- The type of crown (material)
- The cement used
- The quality of the temporary crown.
The Technician (lab)
- The communication with the dentist- shade, material specifications and design
- The experience of technician
- The quality of the materials used
- The fit of the crown- margins (where the crown meets the tooth) and contact points (where the crown contacts the tooth next door).
- Your oral hygiene
- Your diet
- Regularly seeing a dentist to check everything is OK
- Your age
- Your activities.
Dental Crowns Complications
A crown is the most long-term solution available for repairing an extensively damaged tooth. That said, there are risks that you should be aware of and problems that can arise.
- Dental caries (decay): It is even more important that you have good hygiene following a crown, as plaque can collect at the margin where the tooth and crown meet. Whilst the crown itself will not decay, the tooth still can, so it is important to make sure this doesn’t happen.
- Periodontal disease (gum disease): Plaque (the root of all evil) around the crown can also cause gingivitis and if left, eventually this may progress to periodontal disease and the loss of support for your tooth.
- The crown comes off: Your crown can come off for three main reasons:
- Chip or fracture: Porcelain itself is a brittle material and fracturing, whilst fairly rare, is one of the more common problems we see with crowns. The fracture can be part of the porcelain overlying the metal core in a porcelain fused to metal crown- often, the seal or functionality of the crown will not be affected- only the look. Depending where it is in the mouth, this may or may not be a problem. Porcelain crowns are more likely to fail completely, rather than chip (unless of course, you bang your tooth). In such circumstances the porcelain may have been weaker, (not enough thickness for strength or fired incorrectly in the lab) and therefore subject to very high stress such as grinding. If this happens the tooth underneath may need to be re-prepared to give more strength and a different crown material might be selected or not. Small chips can often be replaced with a composite fillingmaterial- this has varying results and can sometimes be prone to falling off!
- The colour or shape is not right: The dentist (particularly if the crown is in the front of your mouth) should sit you up and check you are happy before cementing the crown or crowns in. Have a look at both the shape and the colour. It is important that the contact points are good between the teeth on both sides, or food packing may become a problem. Crowns are often done to stop this problem which can occur with very large fillings but if they are over adjusted or made poorly, food can still get stuck. Some teeth that have lost bone support as a result of periodontal disease may drift and cause the contacts to change- unfortunately this is largely out of anybody’s control.
- A dark line at the gum: This, as we have mentioned is a problem with porcelain crowns that have a metal sub structure (VMK or PFM) when the gum has receded. Recession occurs naturally as we grow older, but may be accelerated with gum disease or toothbrush abrasion. The metal underneath that was once hidden becomes visible. This is often difficult to mask with white filling material and attempts still show some greyness. If it is a problem for you in the front of your mouth, the crown will need to be replaced.
- Nerve problems: Despite all precautions and investigations, certain teeth will play up and require a root canal treatment or re-root canal treatment through the crown. In general 1-15% of teeth that are crowned lose vitality and need a root canal. Root canal in this circumstance can be a little more difficult. To begin with, finding the nerve tends to harder and the visual access to the canals slightly more limited. The crown may not align with the roots as you may expect and this can end up with the dentist needing to take away more tooth, reducing the strength of the core.
- Wear of opposing teeth: Adjustment of the porcelain surface of your crown to get the bite correct, causes the porcelain to lose its glaze and if not properly polished by the dentist, it can feel quite abrasive against the natural teeth that it bites on to. As we have discussed some crown materials are more harsh and likely to cause more wear than others. Your bite will also be a factor in the amount of wear that is seen.
The main advantages of having a crown are:
- Looks (aesthetics).You can improve the colour and the shape of the tooth or teeth with crowns. Porcelain has a more natural appearance and is much more resistant to stains than white fillingmaterial (composite).
- Protection. They provide the best possible protection to a heavily broken down tooth.
- Long lasting. Studies have shown that crowns last longer than any other type of dental restoration including all types of filling and implants. That said, they aren’t as good as natural teeth and once prepared for a crown, a tooth will always need a crown- there’s no going back.
The main disadvantages of having a crown are:
- Destructive. If the tooth is completely natural, the preparation is quite damaging to the tooth as it involves grinding part of it away. Where the tooth has already been heavily damaged or has multiple or large fillings it can have actually have a protective role. Careful consideration of this is needed in treatment planning.
- Damaged Nerves. 1-15% loose vitality and will require root canal treatment. For a number of reasons it is difficult to be any more accurate than this.
- Expensive. It may be 5-10 times the cost of a filling. See ‘crown costs’.
- Long and multiple appointments.
Dental Crowns FAQ
There are circumstances in which a crown may not be possible or a sensible decision:
- Inadequate access. Preparing a tooth for a crown is a delicate/ fine procedure and even though a dental crown may seem to be the right treatment, if you cannot open more than two centimeters or the tooth is very far back or on an angle- it may not be possible to get the drill in to prepare the tooth.
- The tooth itself. It is very important that the dentist considers the biological effect on the tooth, not just how it will look and it is important that you understand this. It is well known that a number of teeth that have crowns lose vitality (the nerve dies)- see above.
- Maintenance and aftercare. It is important that you have good oral hygiene and are able to keep the crown margins clean.
- Plaque build-up around the crown
- can only ever shorten the life of it, and so it is important that you and your dentist take steps toward preventing decay and gum disease.It is the duty of the dentist to provide the best technical work they can and to make sure that you understand how to look after your mouth; keep good oral hygiene and convey what maintenance procedures are needed. The success of everything your dentist carries out, relies greatly on you doing your part, or things won’t last as long as they should.
- General medical conditions. If a patient is not physically or mentally able to understand and accept treatment or cannot remain still for extended periods then having a crown may not be appropriate.
- Poor prognosis- unrestorable tooth. If the tooth cannot be restored properly and predictably to health and function, for example, if the decay extends below the crest of the bone supporting the tooth, then an extraction may be a better choice.
- Poor periodontal support. If the tooth has very little bone holding it in place and has mobility that suggests that the prognosis is not good and it may be lost shortly anyway, then extraction should be considered. Given that the tooth may soon need to be removed, the cost of a crown may not be justified. Just for the record, mobile teeth do not necessarily need to be removed. In fact many people have mobile teeth in their mouths that allow them to chew without pain and discomfort for many years before they become troublesome. If the tooth has healthy periodontal tissues this is not an issue.
- Unopposed teeth. If the tooth doesn’t have another tooth opposite it to chew on and is of little functional use, i.e. it doesn’t support a partial denture or provide any value to the mouth, then extraction may be considered. If it is opposite a space that is in a useful position, it would be far better to keep the tooth and fill the space to provide extra surface for chewing, thus preventing the effects of missing teeth such as tilting and movement of other teeth.
Most long term data as we have mentioned exists for gold crowns and VMK’s which have proved very successful over many years. The newer materials obviously have less data to prove how long they will last and they tend to be heavily marketed by the dental laboratories and companies that develop them. The proof is always in the pudding as they say- how these new crowns perform ,only time will tell.
Not really- sometimes a bit of soreness from the gum or perhaps a bit of sensitivity if the tooth hasn’t had a root filling. Everything should be back to normal within a couple of days. If you have also had a root canal as part of the treatment then the tooth may take a bit longer to settle down.
Sometimes when you are numb, it is not always that easy to get you to bite in your natural position and so the crown’s bite may not be adjusted fully. If after the anaesthetic has worn off, it feels high, give it a few days to settle down, but if the feeling persists, return to your dentist who will make the necessary adjustments and polish it down to the correct level.
It is also possible the crown feels a little rough after cementation once the anaesthetic has worn off. Often this will smooth down naturally after a couple of days of normal eating and chewing. If the feeling persists, pop back to your dentist as there may be a little bit of excess cement remaining.
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