DENTAL
PROCEDURES Dental
Crowns
The
purpose of a dental
crown is to encase
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.
The Clinical Procedure
During
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 is 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 crown or
return visit for the
final cementation.
Fixed Partial Dentures, Dental Implants and Crowns
Fixed
partial dentures (aka
dental bridges) are
an extension of the
dental crown treatment
for replacement of missing
teeth. Crowns are placed
on the teeth adjacent
to the missing tooth
or teeth and connected
to a missing tooth-like
replica. Although fixed
partial dentures may
serve
as a functional and
esthetic restoration,
today’s treatment-of-choice
for a missing tooth
or teeth
is with dental implants.
A dental implant replaces
missing teeth with a
titanium root replica.
A crown is then placed
on the implant above
the gumline. Dental
implants are a very
predictable treatment
choice, returning support
to the bite and preventing
the need for the unnecessary
crowning of adjacent
teeth.
Crown Materials: Gold, Ceramic and Porcelain Crowns
The
three predominant choices
of restorative materials
for the full coverage
crowns are:
. Porcelain-fused-to-metal
. All-ceramic
(all-porcelain)
. Gold
The material selected
is determined by the
clinical demands at
hand; esthetic demands,
strength requirements,
material durability
and restorative space
available.
Porcelain-Fused-to-Metal
Crowns
Porcelain-fused-to-metal
crowns provide for a
strong, durable, and
esthetic treatment option.
One of the key factors
for the esthetic 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 crown will
determine its esthetic
appeal.
One
consideration in the
porcelain-fused-to-metal
crown is that these
crowns 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 of
crown, but replace the
crown at a later date
in order to maintain
a higher esthetic benefit.
Porcelain-fused-to-metal
crowns with an all porcelain
collar can eliminate
this vulnerability.
All-Ceramic Crowns
The predominant material choice for all-ceramic crowns today is either zirconia, or aluminous materials. 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
them 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 esthetics.
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.
Gold Crowns
Although not as popular a treatment choice for esthetic reasons, gold crowns are 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 crowns offer 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 crowns. When chewing, gold tends to be less abrasive to the opposing tooth than porcelain. This helps to prevent wearing of the teeth.
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