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Crown & Bridge
One or more missing teeth can adversely affect the appearance and functionality of your smile. Missing teeth can cause a change in occlusion (bite), shifting of the teeth, temporomandibular joint disorder (TMJ), speech impediments, an increased risk for periodontal disease and a greater chance of tooth decay.
Dental bridges, like implants and partial dentures, are used to replace missing teeth. There are several types of fixed dental bridges (cannot be removed), including conventional fixed, cantilever and resin-bonded.
Typically, conventional and cantilever bridges require shaping of the teeth surrounding a missing tooth. Crowns are then placed on the shaped teeth and attached to an artificial tooth (called a pontic).
A resin-bonded bridge requires less preparation of adjacent teeth. It is often used to replace front teeth, provided that the gums are healthy and the surrounding teeth do not have extensive dental fillings.
To learn more about dental bridges, check out this brief introductory video, or continue reading below for information about consultation and treatment planning, candidacy, recovery and the cost of dental bridges.
Consultation and Treatment Planning
Once you and your dentist determine that a bridge is the best replacement for your missing tooth or teeth, you will be advised of different materials that the dental laboratory can use to make your restoration. Material availability will depend upon where in the mouth the bridge will be placed, whether or not you grind or clench your teeth (bruxism), your dental insurance coverage, and other factors outlined by your dentist. Today’s bridges can be fabricated from a combination of porcelain and metal, porcelain and gold, or exclusively with high-strength metal-free materials such as zirconia or alumina.
Your dentist will take X-rays and impressions of the treatment area, as well as preoperative photographs, for use in planning the ideal restoration for you. Depending upon the number of consecutive teeth you are missing, your bridge could be three or more units; two crowns that are cemented to the teeth on either side of the space (called abutments), plus one or more false teeth (called pontics) to fill the space. Additional impressions will be taken after your dentist prepares the abutment teeth.
Candidacy & Procedure Details
During the first visit, your dentist examines the health of your gums and other teeth to evaluate if you are a candidate. Candidates are given a local anesthetic so your dentist can prepare the teeth required to support the bridge. If the support teeth are decayed or badly broken down, your dentist may have to build them back up before they can be used as support teeth.
Next, your dentist takes an impression of the prepared teeth with a putty-like material that is used to create a model of your teeth. Your bridge is fabricated based on this model by a skilled lab technician so that it precisely fits the prepared teeth. It is important that your restoration fit perfectly to avoid additional oral health problems such as tooth decay.
While your restoration is being fabricated, your dentist fits you with a temporary so the teeth and gums can be protected from damage until your permanent bridge is ready.
To complete the procedure, you must return to the dental office for a second visit to have the bridge fitted and cemented.
Recovery and Post-procedure Care
After your bridge has been cemented into place, your dentist will provide you with hygiene information to maintain the performance and longevity of your restoration, along with the health of your teeth and gums. A special floss threader will allow you to properly and thoroughly floss the areas surrounding your bridge and between the pontic and underlying gum tissue. It should be used daily to prevent the build-up of plaque and bacteria. Proper brushing with fluoride toothpaste should be performed at least twice each day.
How Much Does a Dental Bridge Cost?
The cost of dental bridges depends on several factors, including:
- The potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth.
- The artistic technique of the dentist and lab technician.
- The location of the dentist.
- The coverage provided by your dental insurance.
- The type of material used in the bridge.
- The preparation of teeth involved in the procedure.
Bridges can range in price from $700 to $1,500 per tooth based on the aforementioned factors (Compare with the per-tooth cost of dental implants). Keep in mind that this cost is for each artificial tooth replacement. You may only be replacing a single missing tooth, but your bridge might have three pontics, meaning you’re paying for three artificial teeth. In the case of this example, the cost would range from $2,100 to $4,500.
If you exercise proper dental hygiene and visit your dentist for regular checkups, your bridge can last for many years. If treatment is not covered by your dental insurance policy, or if you don’t have insurance, you may be able to enlist the services of a third-party financing company like CareCredit or Capital One. Qualified candidates can work with a financing company to develop a monthly payment plan that best fits their budget.
There are a number of variables that can affect bridge longevity, though it is not uncommon for them to last for 10 to 20 years.
Dental crowns, also known as “caps,” preserve the functionality of damaged teeth. This common dental restoration may be used to protect a cracked tooth, restore functionality of a tooth with excessive decay or replace a pre-existing crown. It encases a needy tooth with a custom-designed material. Dentists today have a variety of conservative treatment options through which to restore teeth. If possible, these options should be explored and discussed before selecting the full coverage crown.
Consultation and Treatment Planning
If tooth decay or damage is so extensive that veneers, direct composite bonding or other conservative treatments aren’t viable treatment options — or if you have undergone root canal therapy — your dentist will consult with you about dental crowns. Whether used to restore a damaged tooth or to create a lifelike tooth replacement for an implant, crowns can be fabricated in dental laboratories or in your dentist’s office, depending on the material.
Part of your consultation may involve taking impressions of your existing tooth (or teeth) as a basis for creating the shape and size of your restoration(s). If crowns will be used as part of a smile makeover, these impressions are used to make models for designing the new length, shape and alignment of your teeth, so that you can preview your new smile before committing to treatment.
Your dentist also will describe the tooth preparation process, as well as your options with regard to local anesthesia (to numb your teeth and surrounding areas) and sedation dentistry, if necessary. If your treatment involves placement of a temporary crown, your dentist will advise you of how long you will need to have the temporary in place and what hygiene steps to take to ensure functionality.
The Dental Crown Procedure – How it Works
To perform the crown procedure, your dentist prepares the tooth and makes a molded impression of the teeth to send to a dental laboratory. A fitted, temporary crown is created during this visit to temporarily protect the tooth while the final restoration is being made in the dental laboratory. Once completed, the crown can be cemented or adhesively bonded at a later visit.
A recent technology, CAD/CAM technology (computer-aided design/manufacturing technology) has evolved to display a 3-D picture of the teeth. A restoration is then created through milling of a ceramic block. If this technology is located in the dental office (chair-side CAD/CAM), there will be no need for a temporary or return visit for the final cementation.
Recovery and Aftercare
After your permanent crown has been placed, your dentist will provide you with information about caring for your new restoration. In general, maintain proper oral hygiene habits by brushing twice daily and flossing with dental floss or interdental cleaners (specially designed brushes and sticks) once a day. These practices will help to remove plaque from the area where the crown meets the gum, and help prevent dental decay and gum disease.
Avoid chewing hard foods, ice or other hard objects, since this could damage your crown. It also is important to avoid biting your fingernails and grinding your teeth, which could significantly shorten its life-span. If you habitually clench or grind your teeth, your dentist may recommend wearing a night-time mouth guard to offer protection while sleeping.
Prolonging the Life of Your Crown
The longevity of the full coverage crown is determined by the precision of its fit to the underlying tooth. The fit can vary tremendously and requires attention to detail by the providing dentist. An ill-fitted crown can house bacteria that may build into more serious tooth decay in years to come.
It is also important that the tooth be in a healthy state to ensure its longevity. In all cases, your dentist will evaluate the gums and supporting bone structure to ensure these supporting tissues are healthy. This protects the tooth and minimizes the potential for eventual gum recession that exposes the crown margin.
How Much Do Crowns Cost?
The cost of a dental crown depends on several factors, including the technical demands of the treatment, the training, expertise and location of the dentist, and the training and expertise of the dental technologist.
Crowns can range in price from $1,000 to $3,500 and last between 10 and 15 years or longer, though results vary depending upon your unique considerations. In aesthetically demanding situations, it can be helpful to ask the treating dentist for clinical photographs of treatment they have provided in the past to visualize the expertise and skill of the dental team being selected.
If treatment is not covered by your insurance policy, or if you don’t have insurance, you may be able to enlist the services of a third-party financing company like CareCredit or Capital One. Qualified candidates can work with a financing company to develop a monthly payment plan that best fits their budget.
Gold, Ceramic and Porcelain Crowns
The three predominant choices of restorative materials for the full coverage crowns are:
- All-ceramic (all-porcelain)
The material selected is determined by the clinical demands at hand; aesthetic demands, strength requirements, material durability and restorative space available.
Porcelain-fused-to-metal crowns provide for a strong, durable and aesthetic treatment option. One of the key factors for the aesthetic and functional success of this type of crown is ensuring the preparation of the underlying tooth structure provides adequate space for the appropriate thickness of the material selected. Additionally, the artistic skill of the laboratory technologist creating the restoration will determine its esthetic appeal.
One consideration with the porcelain-fused-to-metal option is that they may tend to show the underlying metal or gold margin at the gum line as gums recede over time. Some patients opt for this type, but replace it at a later date in order to maintain a higher aesthetic benefit. Porcelain-fused-to-metal crowns with an all porcelain collar can eliminate this vulnerability.
The predominant material choices for all-ceramic crowns is zirconia or aluminous. They provide a metal-free esthetic option with a number of benefits.
By eliminating the need for the supportive metal core, an esthetic all-ceramic crown can be created with a reduced thickness of material. This makes it a more favorable treatment choice in areas with limited space. Additionally, the elimination of the metal core allows for light transmission through the porcelain for better optical, life-like properties and a higher level of aesthetics.
All-ceramic materials continue to evolve in strength and durability, but caution should still be exercised for areas of the mouth requiring heavy function. Continuing research is exploring the significant vulnerabilities of the porcelain systems in such areas.
Although not as popular a treatment choice for aesthetic reasons, gold is still indicated in some instances. For example, patients with strong bites and those with parafunctional habits (such as grinding or clenching) might be better served with a gold crown. The traditional restorative material can provide stronger support to the remaining healthy tooth structure. Gold offers a level of durability that is appropriate for teeth located in the back of the mouth (such as the molars), where they will not be highly visible. Gold crowns tend to offer greater longevity and require less preparation than porcelain and porcelain-fused-to-metal alternatives. When chewing, gold tends to be less abrasive to the opposing tooth than porcelain. This helps to prevent wearing of the teeth.
Selecting the Right Dentist
Both the dentist and the laboratory technologist play a role in the design and treatment outcome of a crown. Art and science are important factors in designing the proper anatomical features to provide the best possible fit in the mouth.
Some of the technologies and material choices for today’s crowns are fairly new, making it important to know how much experience the dentist has with the equipment used in the procedure. General dentists, family dentists, cosmetic dentists and prosthodontists may perform all treatment options; however, the level of expertise varies among dentists. For example, prosthodontists receive an additional two- to three-years of training focused on understanding complex tooth and bone structures, which may be applicable to your case.
Frequently Asked Questions
Crowns, veneers and bridges can be made of various metals, high strength ceramics or a combination of both. Different types are suitable for different people and in different areas of the mouth, and different aesthetic demands. Dr. Anika can advise what would be the best solutions for your needs. The quality and appearance of your crown is not dependent on what its made of, its dependent of the skill and artistry of how its made.
On average fixed restorations lasts 7-15 years. This time can be reduced if you do not clean the teeth properly and allow gum disease or dental decay to affect the teeth. Also trauma can damage restorations in the same way it damages natural teeth.
No, teeth often receive crowns without a root canal.
Are implants better than bridges?
Not necessarily. If the teeth either side of a gap require crowns is may be more sensible and economical to have a bridge.
No, good crowns look highly realistic and can match to you existing teeth very well. If however you want a Hollywood smile you can have that also.
This will depend on your situation and clinical needs. A good quality restoration will take several weeks to be manufactured meaning that you will need at least two appointments several weeks apart. You have a temporary crown or bridge in the mean time. Quality work cannot be done in short spaces of time.
No, only the best quality crowns, bridges and veneers are used for all patients. We use different labs for different cases because some labs can recreated teeth for younger people, older people, or bleached teeth better than others. Under no circumstance do we use inferior medical devices even if they are cheaper.
Today’s crowns and bridges are made of natural-looking composite materials that make them virtually indistinguishable from your natural teeth.
Both dental crowns and bridges will last a good long while, though how long depends on a few factors.
Good oral health requires you to brush and floss on a regular basis because oral hygiene should be your number one priority if you want the procedures to last and be effective in the long run.
You also need to avoid eating unhealthy foods that have a hard surface because it might damage the crown or bridge. Avoid sticky foods to prevent decay and your crown or bridge should last from five to fifteen years.
Crown placement is typically completed in two visits. First, we will remove a thin layer of enamel coating and shape the tooth to provide room for the crown. This process allows the crown to be placed without crowding neighboring teeth or creating an uneven bite. Then we make an impression of the teeth, which is sent to an on-site lab where the crowns will be made from the most advanced materials for long-lasting durability.
The dentist will fit a temporary crown, which is crafted from resin, to protect your tooth while the permanent crown is being made. At the second visit, the temporary crown will be removed and the tooth will be carefully cleaned before the permanent crown is applied using a strong adhesive.
The newer all porcelain crowns are an esthetic improvement over older, porcelain fused to metal crowns as if the gumline would recede, the older crowns often showed a metal edge to the crown that originally was hidden from view. Since all porcelain crowns have no metal, no markings are evident if the gum line recedes.
There are three types of dental bridges:
-Traditional Fixed Bridge
-Resin Bonded Bridges
Because temporary crowns are made from acrylic, which is less strong than the metal, ceramic or porcelain material of a permanent crown, you must take extra precautions. Limit the amount of chewing you do on the side of your mouth where your temporary crown is located. Avoid chewing on hard candies, nuts and very crunchy fresh vegetables such as carrots on the same side of the mouth as your temporary crown. Until your permanent crown is in place, don’t eat sticky desserts or candy, including caramels, licorice, jelly beans, taffy, toffee and gummy bears, as they could pull the temporary crown off your tooth. Avoid chewing gum for the same reason.
Hot foods: Some individuals experience a mild-to-severe sensitivity in and around a crowned tooth when eating hot foods, particularly if they are affected by gum recession. If the problem persists, consult your dentist as the crown’s fit may require adjustment.
Cold foods: Although they do not harm your crown, such foods can trigger sensitivity similar to that caused by hot foods if any part of your gum recedes enough to expose the root above a crowned tooth. Your dentist may suggest that you use a toothpaste made especially for sensitive teeth; such toothpaste work by blocking the sensation traveling from the tooth to the nerves.
Sugary foods: Avoid constant exposure to sugary drinks, candy or gum, keep snacking to a minimum, and brush or rinse your teeth after eating chewy or sticky foods such as dried fruit.
It is important to maintain excellent oral hygiene, making sure to brush and floss twice a day. Avoid biting on hard foods like nuts and candy that can potentially fracture the restoration.
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