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People often mistake dental implants for dental crowns, perhaps too often. The fact of the matter is that you can tell what a crown is just by looking. A dental implant is a screw or a framework hidden within the jawbone and gum tissue. A dental crown, on the other hand, is what specialists call the upper part – the tooth cap – the part that actually looks like a tooth.
At times, there is a chance that a dental crown is, in fact, a pontic (the middle false tooth in a dental bridge without any support in the jaw), or a partial crown built on a crooked or cracked tooth.
This should help you remember that a dental crown always needs either a natural tooth platform or a dental implant holding it in place. Only then a tooth, or an implant, can be crowned. In everyday speech, you may also hear dental crowns called ‘caps’.
The main quality of a dental crown is its tooth-like shape and hardness of the material from which it’s made. Its secondary characteristic is the color, which should be the same shade as your other teeth, or vice versa – your teeth should match the shade of the new crown. Dental crowns are used mainly to restore the aesthetic and pragmatic functions of:
A proper dental crown doesn’t have to be mounted on an implant but does have to imitate a real tooth with regard to its size, strength, and purpose—that is, restoring the patient’s ability to speak and eat properly.
In some cases, dental crowns are also used in baby teeth restoration, especially when the natural primary tooth cannot support a filling, or in order to protect it from tooth decay.
A proper dental crown doesn’t have to be mounted on an implant but does have to imitate a real tooth with regard to its size, strength and purpose—that is, restoring the patient’s ability to speak and eat properly.
The difference between dental crowns and tooth caps
The terms are interchangeable and thus mean the same thing. A dental crown is a tooth cap, but never an implant.
Dental crowns, Onlays and 3/4 crowns
In some cases when a tooth is damaged in a particular manner – not requiring a complete crown – its shape can be repaired with a partial crown or an onlay, i.e. a filling that fits the cavity, or irregular shape of the tooth. Inlays cover the middle of the tooth, between the cusps, whereas an onlay covers one or more cusps of a tooth. If the filling covers the whole surface of the tooth crown then we call it a dental crown.
Dental Onlays are recommended for back and molar teeth because they are not as durable as dental crowns.
Onlays and 3/4 crowns require less tooth to be removed, thus are a less invasive and aggressive method of indirect restoration of a tooth.
Have you had the bad luck of losing a part of your tooth, leaving a chipped tooth as a result of a bad accident? Or have you suffered from tooth decay that causes your teeth to crack or discoloration of teeth due to coffee drinking or smoking habits? Or even unevenly set teeth, and require a dental crown in order to fill in the visible gaps between the teeth? If so, dental crowns are a safe and sound answer to your problems.
Some patients wonder if a dental onlay, a filling, can also do the trick, but unfortunately, fillings are less durable and not strong enough to withstand the pressure produced by the human jaw while chewing or biting. The most reasonable answer to any chipped or cracked tooth is a dental crown.
When it comes to the possible types of dental crowns, we differentiate them by the materials used to create them, as is true with dental implants, fillings, or veneers. Some of the materials used are more suitable for patients with tooth decay issues, some for front teeth solely, some for back, and some are used only at the patient’s whim.
We’re going to focus on the permanent dental crowns, there are few types of them, depending on what the tooth crown is made of, and these are: prefabricated all resin metals like stainless steel, or all-metal (gold crowns), porcelain-fused-to-metal, and all-ceramic.
A lot of people mistake the all-resin crowns with ceramic crowns, having no idea what resin material actually is. They are also referred to as composite resin crowns because of a combination of plastics matching the natural teeth color that they’re made of – composite resin materials, like silicon dioxide, Polymethyl Methacrylate, or acrylic polymer. Thus, sometimes they’re called also acrylic resin crowns.
Acrylic resin crowns are a type of temporary crown used until the proper crown comes from the laboratory. As such, it’s prone to fractures and much weaker than the proper crowns, causing them to wear down quickly. They should be treated therefore with caution when eating solid foods. Their main advantages are the price and many colors they come in and hence fit the color of natural teeth easily.
In case the patient wishes to install them as a permanent option, then a larger than usual part of the natural tooth requires removal in order for the resin crown to be stable and fixed. They’re also used as an alternative to straight fillings.
For people with metal allergies, the most frequently recommended solution is a dental ceramic crown, made mostly of porcelain (glass with additional elements), which offers a more natural color match with teeth, because of their translucent quality. This means in turn that they can be coloured and shaped appropriately with no problems. This is why currently these are the most popular of all dental crowns. Porcelain dental crowns may wear down adjacent teeth and offer more durability than the all-resin crowns, but less than the PFM (porcelain-fused-to-metal crowns). The four most frequent ceramic compositions currently in use are:
Porcelain dental crowns can be used for the front or back teeth. The price of all-porcelain crowns will exceed these of all-metal non-noble or all-resin crowns, but they are still the most affordable in their quality-to-price ratio, being cheaper than the gold alloy or zirconia dental crowns, thus their popularity.
These are the most popular ceramic systems used in dentistry:
The newest solution on the dental market is the zirconium crown, sometimes called also zirconia crown, owing to the main materials used – zirconium oxide or zirconia. These are characterized by their similarities with natural teeth, namely – their durability and resistance to cracks. Zirconium crowns are less prone to chipping or damage because they’re very long-lasting and have a strong inner structure. Zirconia is a titanium-family metal commonly mined, hence its strength and longevity. In comparison to the PFM or all-metal crowns, the probability of an allergic reaction to metal components, especially nickel, is reduced almost to zero, because zirconia is the most biocompatible of all crown materials currently in use.
On the other hand, this has its drawbacks in price, due to the fact that solid zirconia crowns are very difficult and time-consuming to adjust if there is a need and thus may cause natural teeth damages as a result of biting or chewing. Zirconium is very popular among patients who have allergies, thus the growing demand for them in dentistry. Generally speaking, zirconium is the clear choice when it comes to durability, strength, and invulnerability to cracks – it’s so hard that it may pose difficulties during formation and adjusting by the dentist. The newest technology involved in fabricating zirconium crowns is the CAD-CAM, i.e. Computer-assisted designing – Computer-assisted milling.
A variation of zirconium crowns is the so-called LAVA crown which can be made of porcelain or zirconium dioxide material. They’ve been under 100 clinic examinations so far and they’ve been clinically tested for 10 years. Special properties possessed by crowns made of LAVA zirconia include translucent natural-looking tooth enamel and excellent strength. Whereas the all-ceramic crowns are preferred for their aesthetics, PFMs for their durability and strength, zirconia LAVA crowns can be chosen for both of these qualities. Their main disadvantage, of course, is the high price, because they may cost up to 1800 USD in the US, and around 600 GBP in the UK per single crown. Lava crowns in comparison to other crowns offer good aesthetics but are a little more lifeless owing to their opaqueness.
Last but not least, there are the so-called CEREC crowns, which are products of CAD-CAM, i.e. Computer-assisted designing – Computer-assisted manufacturing on the spot, and allow for an instantaneous fitting and cementing of the crowns. Read more about the CEREC one-visit crowns below.
Usually, installing regular crowns may take a few visits and thus some time and effort. It may even take up to three weeks’ time in some cases, thus the idea to quicken this process, just like in the case of one-day implants. However, with the already mentioned new technology of CAD / CAM (Computer-Aided-Design / Computer-Aided Manufacturing) dentists all over the world have received a new method of instantaneous fabrication of certain types of dental crowns. This, in turn, allows for an immediate fitting and cementing the crown onto the tooth root. The new crowns produced in this way are called CEREC crowns and the process is known as same-day crowns or CEREC one-visit crowns.
The first thing your dentist will do is take a 3-Dimensional (3D) digital impression of mouth to calculate space for crowns. No standard mould impressions are therefore necessary anymore, all this is performed with the use of medical mini-cameras. In the following step, the full potential of CAD / CAM (Computer-Aided-Design / Computer-Aided Manufacturing) is used in order to design and produce on the spot fitting ‘monolithic’ crowns. Colour matching then follows. Meanwhile, the patient waits for his crowns to be finished and properly shaded.
The biggest, most obvious advantage of such a state-of-the-art tech system, CEREC, is that the entire process only takes 2 hours. The life span of CEREC crowns is from 10 to 15 years. There is, therefore, no need for temporary crowns, impressions, or multiple visits to the dentist in comparison to regular dental crowns. The price of CEREC crowns is within the price range of regular porcelain or zirconia crowns.
The porcelain bonded crowns, or caps, represent a hybrid dental crown kind in which porcelain constitutes the top part and is fixed to the metal bottom. The underlying two-alloy metal base is well-fit to the trimmed beforehand tooth and shows strength typical of metals, despite the fact that it’s thin.
The main advantage of the porcelain-fused-to-metal crowns is the strength they offer while biting and chewing in comparison to all-ceramic crowns. The main disadvantage is clear gum lines visible in due time of gum recession with age giving the teeth an unnatural look. The methods of producing porcelain bonded crowns (PCB) consist of pressing the Porcelain Over Metal, the so-called POM method, and pressing the Porcelain To the Metal, the so-called PTM method.
Known better as PFM, porcelain fused to metal crowns are mostly in use in the British NHS, however, they’re becoming a less and less commonly used type of crowns due to unwanted results they may cause. This is despite the fact that porcelain fused to metal crowns are more affordable than all-ceramic crowns currently.
Whereas porcelain and gold have been the gold standard of materials used for crowns, it’s the new zirconium ceramic that supersedes them, despite the fact that still new variations of porcelain are fabricated like IPS e.max crowns.
Summing it all up, today, the best price-to-quality on the market are the Emax crowns – they last the longest for their price. However, bear in mind that gum recession disease, allergies, or simply your budget may exclude you from getting your chosen dental crown. Individual factors, as such, should be consulted with a specialist beforehand. The price of the newer dental restoration methods and products may still be high, depending on the part of the world where the dental practice that you choose is located.
Depending on the chosen type of dental crowns, the whole process of installing them by a specialist may take up to 2 or 3 visits at your dentist practice. Some materials used for crowns require more time for preparation in an outside laboratory, whereas some offer a quick on-the-spot possibility to fabricate them with the use of the latest technology like CAD-CAM, i.e. Computer-assisted designing-Computer assisted milling. However, all of the techniques require a diagnostic consultation visit at the dentist in order to prepare a treatment plan and digitally design a patient’s new smile. This requires at first:
Currently, more and more specialists make use of digital technology designing in cooperation with the patient at the consultations for enhanced and more accurate results.
Only after such a practical examination, a specialist may know how many crowns will be necessary in order to achieve the target result – the new smile, and how much it’ll cost. If the patient decides on the proposed treatment plan then the process can begin. This may take another visit or can be done just after the consultations.
Either after the consultations or on another visit most of the necessary work is done. In order to be able to cement or press dental crowns to teeth, it will be necessary to drill the natural tooth into a base form which serves as the fixture point for dental crowns. Of course, this procedure is done after tooth numbing or under local anaesthesia.
During the drilling, A root canal treatment might be required – this may prolong the process and make another visit if there is an infection. No tooth extraction is performed during preparatory work.
The most important step that follows is taking the impressions, either by means of moulds or digitally. Dental impressions must be taken accurately or else the treatment may be unsuccessful – the crowns may not fit the rest of the teeth. A colour matching procedure ensures that your new crowns will fit natural teeth, or just the opposite – that natural teeth will match the colour of new crowns. This is why some patients decide on teeth whitening during this phase of the procedure, which prolongs the process but is recommended if natural teeth are visibly discoloured.
In the case of standard all-ceramic crowns, a prosthetic laboratory needs to process the impressions and fabricate fitting prosthetic crowns. This may take some time.
On the other hand, a CAD-CAM, i.e. Computer-assisted designing – Computer-assisted milling can be used in order to fabricate a milled block of zirconium or Emax crowns on the spot in some cases. If so, then there’s no need for any additional fitting visits, because the ready to use crowns can be cemented or pressed immediately to the teeth. This also means that there’s no need to cement temporary crowns, fitted for the time being usually, as they are unnecessary and hence the patient may save on them.
However, in most cases, provisional crowns are installed during the process of preparation for permanent dental crowns.
When the tooth or teeth are already prepared for a dental crown, but the crown itself is not ready, dentists usually recommend installing temporary crowns, made on the spot at the dentist’s office from acrylic-based materials or as was already mentioned stainless steel.
Their main function is restorative and protective – not cosmetic. They stop teeth from shifting, secure the drilled teeth, help the gum tissue to form appropriately, should prevent hypersensitivity, block bacteria from spreading, and maintain the tooth’s purpose.
The patient should be wary that provisional dental crowns are as the name suggests – only for a temporary amount of time. This refers as well to their quality, shape, and strength. If your temporary crown fell off you shouldn’t try to put it on by yourself – only a specialist can do it properly.
The patient may also suffer at times from temporary crown pain – sometimes the unfitting shape of a provisional crown may cause such pain due to the physical presence of other teeth in too close proximity, or while eating. In such cases, if your permanent dental crowns won’t be ready in a few days’ time, you should ask your dentist for trimming or exchange of the unfitting crown.
How long does a provisional crown last depends on the awareness of the user – provisional crowns may fracture, break, crack, fall out, or even fall off and be swallowed, which is an utmost unfortunate scenario. Nowadays, the patient is made aware of what will follow if he uses his temporary caps too recklessly, trying to eat hard food for example.
Overall, temporary crowns usually serve their purpose well and are quickly exchanged for permanent ones, when they arrive from the laboratory.
Usually, it’s necessary to visit your specialist at least one last time. During this appointment, the dentist takes off the temporary crowns and fits, presses or cements the permanent crown. The dentist checks them, making sure the colour matches and that they are stable. You may also be asked to return for a checkup sometime later, but typically there’s no need for that. Your specialist will give you precautions for the next few days of using your new crowns, but the process is finally completed and you can enjoy your new shining smile.
Usually, dental crowns last from 5 up to even 15 years in the case of the more expensive and advanced types of crowns and materials used. This also depends on your eating, drinking and smoking habits. The more you use them, the more they are subject to daily wear and tear, or to damage from habits you have, like for example clenching your teeth during sleep. The more you practice these habits, the shorter their lifespan. Of course, proper oral hygiene is of utmost importance too.
The most obvious signs that your crowns need to be replaced are the following:
Costs of dental crowns vary from country to country and city to city. Typically, it’s because of the diverse costs of living and renting a place for a dental centre in particular regions. In city agglomerations like London, Paris, Berlin it’s more expensive to live than in smaller cities on the outskirts of the EU, thus dentists from big cities try to make it up through the charges for their services. In countries like Hungary, Poland or the Czech Republic the costs of living are lower than in the UK, US or Germany, dental crowns’ costs, therefore, are lower too. Newer products on the dental market, such as zirconia dental crowns cost more too.
Throughout Wales, Scotland and England porcelain dental crowns cost on average between 700 GBP, to 750 GBP per single crown to be fixed. These costs, of course, do not take into consideration the additional fees charged for consultations, examinations, CBCT scans, digital designing smile, temporary crowns, or root canal treatment – which in the UK can cost around 200 GBP. A recent press release discloses that one in 5 dental patients has been overcharged by their dentist recently in the UK.
Due to the “widespread obfuscation by dentists about their charges”, and despite the attempt to straighten things out by the consumer lobby group and its “Clean Up Dental Costs” campaign, some of the costs can be given only in imprecise numbers, and price ranges:
All ceramic (porcelain)
550 -1180 GBP
PFM / PCB
300 - 850 GBP
300 - 700 GBP
250 GBP **
CEREC (crowns in a day)
start form 400 GBP
* The price depends on the alloy. Nobel golden alloy crowns cost 100-200 GBP more.
** This is the most frequently quoted price for dental crowns on the internet, however, with no further details to which kind of crowns it refers.
Dental crowns cost on average 760 GBP, usually the price starting between 600 GBP up to 1500 GBPin the United States of America. PFMs dental crowns average a little less, starting from 670 GBP to 1000 GBP per tooth. Depending on the alloy used, all-metal crowns cost from 635 GBP to 1760 GBP for the noble golden crowns. Most expensive, however, are the all-porcelain dental crowns which cost up to 2300 GBP per tooth. Same-day dental crowns (CEREC) in the United States don’t cost much more than regular ones, because they go from 610 GBP to 1150 GBP.
Dental crowns’ prices in Poland and in Hungary are the most cost-effective among the EU zone countries. In turn, dental crowns in Turkey and India cost the least. This is why the best medical travel destinations for American citizens are Mexico and India. The latter offers the best deal for Australians. For citizens of the European Union and nearby, like the countries of the Middle East, the best medical travel destinations comprise of Eastern European countries like Poland, Hungary or the Czech Republic – these countries offer the best quality within the lowest price in the region.
The English NHS, encompassing England, Wales, Scotland and Northern Ireland, funds dental crowns within its paid package of medical services, Band 3, which costs 269.30 GBP. Thus, one can see that the NHS dental charges may cover the most basic of dental crowns. All treatments deemed medically essential by your dentist for the protection and preservation of a patient’s oral health may be covered on the NHS. Initial consultations and examinations for first-time patients are an additional cost. The crowns offered on the NHS are clinical and simple, serving a practical rather than cosmetic purpose: they are offered in order to restore the functionality of the patient’s mouth and dentition – i.e. eating, chewing and biting functions. For instance, an all-metal crown would be advised in the back of the jaw from a functional perspective by an NHS dentist. However, this depends on the particular case of a patient, the treatment plan developed by their dentist will be rudimentary in order to receive NHS treatment. For cosmetic effects, thae patient is recommended to go to a private dental practice. Some of these offices offer payment in installments and discounts in case of multiple crowns/implants queries.
Dental crowns, though made of quite resistant materials wear down over time, as do all things, due to bad eating and drinking habits. Attempting to perform tasks not meant for crowns may result in quick chipping or complete breaking of a crown. Biting, grinding your teeth, clenching them, and biting your fingernails may also result in the same scenario. From among the most frequent problems with dental crowns are the following ones:
Good oral hygiene is recommended for a dental crown’s good condition, just the same as in the case of your natural teeth – in order to decrease the possibility of gum tissue disease or teeth decay. A dental crown doesn’t require any special additional care or procedures besides regular care for your teeth and oral cavity by brushing your teeth twice a day, flossing daily and rinsing once a day.
Dental crowns are made especially for those who don’t wish to lose their natural teeth but regain a pearly smile with durability and strength. They offer a cheaper option than dental implants and can change your life and give you back your self-confidence so you can smile without holding back.
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