Crown & Bridge

CROWN AND BRIDGE 101

Crowns

Dental crowns, also called caps, fit over worn or damaged teeth. They can also serve a cosmetic purpose, restoring a discolored tooth to its former hue. Your dentist may fit you with a temporary crown to protect a damaged tooth while the permanent crown is being made. Depending on the material used to make them, the wear they get and the care they receive, permanent crowns last about 5 to 15 years.

Who Needs Dental Crowns?

Crowns serve many purposes in restorative and cosmetic dentistry. They are an integral part of providing support to weakened or broken teeth. Untreated dental problems can lead to jaw pain, headaches and bite anomalies that could do further damage to otherwise healthy teeth. The following purposes illustrate some of the conditions for which your dentist might recommend crowns.

  • Protecting soft or weakened teeth
  • Supporting extensively filled teeth
  • Anchoring bridgework
  • Restoring the appearance of misshapen, chipped or discolored teeth
  • Covering a dental implant
  • Rebuilding a tooth after a root canal
  • Creating a healthy bite

Types of Crowns

Dental crowns fall into three categories: full metal, porcelain fused to metal and porcelain. Your dentist will assess your dental health and discuss your options with you, but all three crown types have distinct advantages.

All-Metal Crowns

Precious metals have tremendous durability and are non-reactive. These characteristics make them a preferred material for dental crowns. Gold alloys are the most common metal for crowns, but some dentists also work in platinum or palladium alloys that have a silvery hue. Metal crowns offer outstanding longevity, but because they look nothing like natural tooth enamel, they are most often used for molars where they will not be as visible.

Metal and Porcelain Crowns

Porcelain fused to metal (PFM) conceals metallic surfaces under a ceramic layer that closely resembles natural tooth enamel. Because of their metal cores, these crowns reveal their underlying structure in strong light and lack the translucency of natural teeth. However, their color and texture make them well suited to capping front or back teeth. PFM crowns can cause more wear on opposing teeth.

All-Porcelain Crowns

Porcelain crowns have the most natural look and are generally indistinguishable from natural teeth. Due to advancement in ceramics they are every bit as strong as metal or PFM crowns. New CAD/CAM techniques allow dentists to create crowns in minutes, but the procedure is typically costly. Porcelain crowns made in this way wear at the same rate as natural teeth.

How Crowns Are Applied

Your dentist will give you a local anesthetic to numb the area before preparing teeth to receive crowns. Biting on carbon paper shows how your teeth meet, ensuring the crown will not interfere with your bite. After the bite impression, you will be fitted with a dental dam to protect the rest of your mouth from tooth dust and keep the restoration site dry. With a high-speed drill, the dentist will then reshape any teeth needing crowns. Reshaping may involve minor filing, or it could necessitate removal of more material to leave a peg-like anchor point for the crown. The amount of your natural tooth that must be removed depends on the type of crown you’re getting and the reason for the restoration.

After shaping the tooth to prepare it for the crown, your dentist will take another bite impression. This step is essential to making the cap fit the remaining tooth perfectly. If you are getting same-day porcelain crowns, you have only a 20-minute wait. Metal and PFM crowns take more time to prepare; you will get a temporary acrylic crown and return in a few weeks to get the permanent crown fitted. In either case, the dentist will apply cement to the crown and press it into place.

If you get temporary crowns, ask your dentist about specific care requirements until the permanent crowns are ready. Some common precautions to take with temporary crowns include:

  • Chewing on the other side of your mouth
  • Avoiding caramel, toffee and other sticky foods that could loosen the dental work
  • Sliding floss from between the crowned teeth instead of lifting it free

Caring for Dental Crowns

Your new crowns look, feel and behave like your natural teeth, and they need the same care. Follow the brushing and flossing schedule your dentist recommends. Metal-based crowns may feel more sensitive to heat and cold initially but should adjust quickly. Contact your dentist if you notice the following concerns after receiving crowns.

  • Difficulty or pain when chewing
  • Pain in your head or jaw
  • Loosening or wiggling of the crown
  • Rough or jagged spots that could indicate a chipped porcelain crown

Bridges

A dental bridge spans the gap where a missing tooth once was, filling the space with a synthetic tooth. Like a bridge over a river, most dental bridges need support at either end, although cantilever bridges are an exception. Fitting a bridge requires reshaping the abutment teeth and capping them with crowns to hold the bridge securely.

Who Needs Dental Bridges?

Anyone who has missing or damaged teeth may be a candidate for dental bridges. Without something to occupy gaps, remaining teeth can shift position and alter your bite. These changes can lead to jaw pain, headaches and an increased risk of periodontal disease. Bridgework is more than a cosmetic procedure; it is essential to dental health. Bridges serve a number of purposes:

  • Restoring a healthy bite to facilitate chewing
  • Maintaining the contours of the face
  • Improving your smile
  • Reducing damage to remaining teeth from a misaligned bite
  • Restoring self-confidence after an accident or injury

Materials for Dental Bridges

Creating dental bridges is both a science and an art. The bridgework must feel functional and natural, and it must also match your natural teeth. To mimic the look of natural enamel, dentists may use porcelain by itself or bonded to a metal base. Some bridges use a composite resin that mimics the translucence of natural teeth.

Types of Bridges

Dental bridges are available as fixed or removable appliances. Your age, the health of your remaining teeth and your preferences determine which bridge type a dentist may fit. Both bridge types have their advantages, and both contribute to a healthier bite profile. Whether they are fixed or removable, bridges look indistinguishable from your natural teeth.

FIXED BRIDGES

A fixed bridge consists of a replacement tooth that fits a gap in your dentition and permanent crowns capping the abutment teeth on either side of the space. Fixed bridges feel and function much like your natural teeth; after a short while, most patients report that they rarely notice their bridgework except during cleaning. This bridge type offers great stability and strength. Because the bridge is fixed, it cannot be removed for easier cleaning and requires a specialized brush or flossing tool to maintain it.

Expect a fixed bridge to last about 10 to 20 years. When it is time to replace it, your dentist can remove a fixed bridge and craft a new dental appliance.

REMOVABLE BRIDGES

Also known as partial dentures, removable bridges are not permanently affixed to neighboring teeth, instead fastening to them with clasps. They are easy to keep clean and typically cost less than fixed bridges. Your dentist may recommend a removable bridge if the teeth on either side of the gap are soft or if you are missing a number of teeth. For teeth that may require more reconstruction in the near future, a removable bridge might be the right choice.

Getting a Dental Bridge

On the first visit for getting your dental bridge, the abutment teeth are prepared. Preparation involves re-contouring these teeth by removing a portion of enamel to allow room for a crown to be placed over them. You will then get a temporary bridge and crowns to protect the abutment teeth while your permanent bridge is being made. During your subsequent dental appointment, you will have your permanent bridge fitted and shaped. If it is a fixed bridge, the dentist will attach it to the abutment teeth. For removable bridges, metal or plastic clasps are affixed to the abutment teeth to hold the appliance.

Caring For Dental Bridges

Bridgework must be cleaned diligently, and that requires adding a few new tools to your oral hygiene regimen. A dental floss threader lets you sweep under your bridgework to keep the area clean. Small, flexible brushes can also be handy. Water jet devices blast trapped food particles from beneath bridgework. Your dentist can recommend oral care products to care for your porcelain or resin bridge.

Removable bridges require gentle handling. Porcelain is a brittle substance and can chip if treated roughly. Set your bridge down carefully instead of dropping it onto hard surfaces. Removable bridgework should be cleaned as often as you clean your other teeth and can be brushed with the same toothpaste or with cleansers designed for dentures.

Follow any specific instructions for the care of your bridgework and tell your dentist if you note any of the following concerns that could indicate a bridge that no longer fits:

  • Difficulty biting or chewing your food
  • Headaches or jaw pain
  • Loosening of removable bridgework
  • Rough or raw spots on the soft tissues surrounding the bridge
  • Difficulty speaking clearly

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