The right crown is not only a matter of technology, but also of a great sense of color and shape. The crown placed must belong to you and look like your own tooth. A beautiful crown is made of porcelain or porcelain with a metal interior. We do not consider the golden crown in this post, it is a great restoration, but not beautiful.
Your dentist has said that you need a crown, or you have asked for a crown yourself.
Reasons to put a crown on a tooth or molar are:
- The element has broken down to such an extent that there is no longer any support for other restorations;
- The element has become brittle because it is no longer alive;
- The element needs a large color or position change that cannot be made easier in another way;
- Due to old filling material or caries, the element has been weakened to such an extent that it can no longer be repaired in any other way.
What are the preparations for treatment?
Usually a photo is made in advance to see if the roots of the element to be treated are in order.
Is the treatment painful?
If the tooth or molar to be treated is dead, grinding is of course not painful. The edge of a crown often ends a little under the gums. The element to be treated is therefore partly ground under the gums, this can be painful. Moreover, the gums can bleed and obstruct good vision. To prevent this, anesthesia is usually used. The anesthetic not only helps against the pain, but also squeezes the blood vessels around the element.
How often do I have to come to the practice?
A crown is an indirect project, so at least two agreements are needed.
What inconveniences can I expect during treatment?
The same inconveniences as when making a composite filling.
After the anesthetic, the tooth or molar is ground to the correct shape. All the old filling material and inaccuracies are removed, leaving a nice and cool part on which the crown can be placed later. If the tooth shape is completely correct, prints are made and a wash bite. To make the prints sometimes a pre-treatment is necessary, if the edge of the crown comes to lie on or just below the gums. The crown edge of the definitive workpiece must fit perfectly on the element. The print of the edge must therefore be very sharp. For this it is often necessary to temporarily push the edge of the gums aside, so that the boundary of the cut is clearly visible. The gums are pushed aside by a thick, impregnated cotton thread that is placed around the element. The impregnating agent dries out the area around the element temporarily and the gums are pushed aside by the thread. The wire is removed shortly before printing, the cut edge is now clearly visible and a sharp print can be made. The wire is called retraction wire.
At the beginning or end of treatment, the dentist decides which color the crown will get. The color determination is done with porcelain samples in a color range or with a special device that measures the color of one of your cool teeth.
The restoration never gets one color, that would give a very unnatural result. A drawing is made of the desired color distribution.
When the prints and the wash bite have been made, the ground element must be protected during the period that the technician is going to make the crown. For this, an emergency crown with a temporary glue is glued to the tooth or molar.
Which additional objections can I expect?
After the first treatment you walk with an emergency crown. An emergency crown has a moderate fit and often a thicker, less well-fitting edge than a real crown. You notice this in use. You will have to keep the edge very clean by brushing extra well (and gently!). The gums can be damaged and bleed during brushing, this will heal automatically within three days. Cold water can be sensitive around the emergency crown, brushing with a toothpaste for sensitive teeth helps. And last but not least, the ground element can hurt, especially the first day. If your dentist expects you to have pain afterwards, a protective layer is usually applied to the element before the emergency crown is applied.
The emergency crown can come loose. Emergency cement, the glue with which the emergency crown is stuck, is not as strong as the glue with which a definitive crown is stuck. That is also not possible, the emergency crown must be easy to remove during the second session. Loosening occurs mainly by eating chewing gum, toffee or other very sticky foods. Continue by nail biting and firm flossing. Flossing along an emergency crown requires a special skill: you pull the floss thread down through the contact point of the emergency crown with its neighbor element and remove the thread by pulling it sideways between the elements.
The crown is placed after the second treatment. This is usually much nicer than the emergency crown, porcelain feels very smooth. The element can still be sensitive for a while, this "wears out" by itself.
Both a fired porcelain crown and a whole porcelain crown look deceptively real, indistinguishable from your own choosing, provided the color is chosen properly. You maintain a crown in exactly the same way as your own teeth.
A crown can be put on both a living and a dead element. The advantage of a living element is that it is more elastic and therefore stronger. It is sometimes thought that a root canal treatment must always be done to make a crown, so this is not the case. Your dentist will usually choose not to kill the element to be treated (devitalize).
As a complication after making a crown, it can happen that the element starts to play up and a root canal treatment still needs to be done. This depends on many factors, including the construction of your teeth and their sensitivity. The crown just made was not made for nothing. Only a small hole is made in the top of the molar in question, or in the back if it is a tooth, to reach the root canals. It is also possible that the crown is tapped off the element and replaced again later. Then the tooth looks or choose as a cool copy and as such you can also use and clean it.
The making of a porcelain inlay or onlay is done in much the same way.