Dental crown

introduction

A Dental crown represents the possibility in prosthetic dentistry to treat a tooth that has been severely damaged by caries. In cases in which so much natural tooth substance has been lost due to the carious defect that the tooth threatens to break under stress, a tooth crown is often the last possibility of tooth preservation.

The artificial tooth crown is placed like a kind of cap on the damaged tooth and glued there, so it can help the tooth to regain its stability and prevent tooth loss.

gold, titanium, various Plastics and Ceramics are among the most frequently used materials for a dental crown in Germany.

A clear disadvantage of this type of prosthetic dentistry is the fact that an enormous amount of tooth substance has to be removed during preparation (up to 60%) and in many cases only a small tooth stump remains.

Many dentists recommend one due to the high preparation effort and the associated trauma to the tooth Root canal treatment before inserting the tooth crown.

This is a reasonable consideration because if that is the case Pulp In the nerve fibers embedded in it inflame after the tooth crown has been inserted, the entire tooth crown must be milled open and then replaced.

Types of dental crowns

There are different types of Dental crownswhich can be selected depending on the initial condition and the extent of the carious defect.

If the extent of caries is relatively small, it is often sufficient to make a so-called partial crown, while large defects must be treated with a full crown.

In addition, the individual crowns differ based on the materials used.

Usually find:

  • Full cast crowns
  • Veneer crowns
  • All-ceramic, electroplated and
  • Pen crowns frequently used

They have to be made from a dental impression in the dental laboratory and then inserted into the mouth.

In contrast to the more expensive variants, full cast crowns are cast from a single piece of metal and are therefore extremely durable.

They count to the standard services and are compared to higher quality Dental crowns relatively inexpensive.

The materials used include:

  • gold
  • titanium
  • Pallidum and
  • nickel

As it is often used in patients with crowns containing nickel allergy (Nickel allergy) came, they have hardly been manufactured for some time.

The choice of tooth crowns based on nickel is also not recommended for health reasons.

Dental crowns made from gold or platinum are best tolerated, as they neither trigger allergies nor have any other negative impact on the organism.

A rule of thumb: The more noble the metal in the alloy, the easier it can be processed in the dental laboratory.

This also results in a reduction in the risk that the Dental crown and discolor the surrounding tissue. However, crowns made from high-quality metals are much more expensive in comparison.

Since full crowns are only used in the posterior region, if at all, due to the lack of aesthetics, so-called veneer crowns are used for the prosthetic restoration of the anterior teeth.
In contrast to the full crowns, a plastic or ceramic coating is layered over the metal part of the veneer crowns.

Both the plastic and the ceramic can be adapted to the natural tooth color and are therefore much less noticeable.
Veneer crowns have a similarly long shelf life as solid cast crowns, but are less hazardous to health.
A disadvantage, however, is that the plastic or ceramic coating can flake off under load and then has to be replaced. Ceramic is generally a little more robust than plastic.

In addition, it can quickly lead to unsightly discoloration.
The most durable, but also the most expensive variant is the all-ceramic crown, which is made entirely of porcelain.

They are mainly used in the area of ​​the incisors and / or canines and look very similar to natural teeth.

Electroplated crowns are made from pure gold and porcelain. The production is extremely complex and expensive, but the durability cannot be surpassed by any other type of crown.

Duration of treatment

Prosthetic dental treatment takes time because several things have to be clarified in advance and the crown has to be manufactured in the dental laboratory.

The attending dentist will take an X-ray before the crown is made (Dental film) of the tooth and examine the condition of the roots.

In some cases, it is advisable to perform a root canal treatment, as the inflammation of the dental nerves can make it necessary to remove the tooth crown afterwards.

The tooth is then ground so that the later crown can be attached without any problems.

Only then can the necessary dental impressions be made and forwarded to the dental laboratory. The production of the tooth crown can take about one to two weeks, the tooth is provided with a temporary crown for this period.
Find out more at: Dental impression

After the laboratory has finished its work, the dentist takes the temporary restoration off again and removes residues of the adhesive cement. Immediately afterwards, the new crown can be inserted and glued.

durability

The durability of a Dental crown depends on the one hand on the selected material and on the other hand on the dental (or crown) care of the patient.

The gum line in particular should be carefully and carefully cleaned and cared for.

Fully cast and electroplated crowns can remain in the oral cavity for between 15 and 25 years under ideal conditions.

In most cases, all-ceramic tooth crowns last up to 15 years on the treated tooth.

Plastic crowns, on the other hand, are extremely susceptible to dirt and have a shelf life of only five to seven years.

costs

Supplying one carious tooth With a crown, the statutory health insurance companies do not usually fully cover them, they just pay a fixed allowance.

This fixed allowance can be increased, for example, through regular inspection visits and keeping a bonus booklet.

The remaining costs have to be paid by the patient in question out of their own pocket; the exact amount due depends on the material used.

Full cast crowns cost on average between 90 and 130 Euros per tooth.

Veneer crowns are available at a cost of 230 to 350 Euro per tooth a little more expensive.

If the patient chooses the restoration with an all-ceramic crown, between 280 and 450 Euros per tooth.

Inflammation under a crown

Grinding a tooth for dentures always carries the risk of the nerve tissue within the Dental pulp, of the pulp, ignited. When grinding, the entire upper Enamel layer, which protects the tooth thermally and mechanically, is removed and the pulp is only removed from the underlying layer, the dentin (Dentine), surround. The dentin has many small channels that have access to the pulp, so that the pulp is more in contact with the oral cavity than before.

This means that bacteria can now reach the pulp more easily and then inflame it. The inflammation of the pulp causes the nerve tissue to die and the bacteria metabolize these nerves. This creates Gasesthat become an uncomfortable Feeling of pressure leads, the so-called acute pulpitis, inflammation of the tooth pulp. The pain can become so severe that the tooth chamber has to be opened to remove the inflamed nerve tissue and relieve the pressure. The crowned tooth must then be treated in the root canal.

As a rule, the crown can be removed for this purpose without damaging it, so that it can be reattached after the end of the root canal treatment. If it is not possible to loosen the crown after the final insertion, a hole can alternatively be drilled through the crown, which is then closed again with plastic without any gaps. In both cases, the crown is not obsolete and can be worn.

Toothache under the crown

Toothache under a crown can have multiple causes. If the cement has washed out from under the crown, the tooth can hurt because the crown no longer seals tightly and protects the tooth. In this case, the crown and the stump are cleaned and permanently fixed with new cement and the symptoms disappear.

It can also be found under the crown Caries which leads to discomfort. The dentist has to take the crown down and treat the tooth decay, but it is possible that the old crown no longer fits after restoration. If the tooth under the crown has not been treated with a root canal, it is very likely that the nerve inside the nerve chamber will become inflamed, which can lead to severe discomfort. Either the crown is taken down and the nerve is removed or, if the crown cannot be loosened, a hole is drilled through the crown, which can be completely covered with plastic after the end of the root canal treatment.

In addition, another cause of pain can be a fractured tooth. In this case, the tooth is no longer worth preserving and must be surgically removed (tooth extraction).

Pain on pressure under the crown when chewing

If a crown is firmly inserted, it may be possible that it creates pressure pain when you get used to it. In most cases, this pressure pain disappears completely after a few days. The ground tooth needs a certain wearing phase, as the tooth crown only settles after the cementation. If the pain persists after about one and a half weeks, the occlusion should be checked by the treating dentist, as previous contact may be the cause. The tooth would then be subjected to too much stress when chewing and would therefore cause discomfort. After grinding in, this pain usually disappears quickly.

Crown after a root canal treatment

After the end of the root canal treatment, the affected teeth become brittle because they are devitalized and no longer supplied with nutrients. This brittleness ensures that the teeth are in danger of breaking even with low stress. This is the reason why they should be crowned shortly after the root canal treatment.

If the root canal breaks off, it often breaks off so deeply that it is no longer worth preserving and has to be extracted. The crown, on the other hand, protects the tooth, which is weakened in this case, from the outside and creates renewed stability that is comparable to that of a vital tooth. In the majority of cases, a pen set, which protects against pulling (extrudive) forces and also ensures more hold of the crown and stability.

Post and crown are planned and manufactured as soon as the tooth is symptom-free after optimal root canal filling (usually after 2 - 4 weeks). In general, the tooth should not be exposed to such great chewing loads during this time and something can take off from the occlusion be ground so that it has less contact than the rest of the teeth when biting. The other teeth then briefly take on the chewing load of the treated tooth, which they can compensate for a certain time frame.

Crown for an incisor

If the defect in an incisor is too large, it must be restored with a crown. A crown can also be indicated after trauma from a fall, provided the root is still completely intact and has not been damaged by a fracture. The highly aesthetic ceramic crowns can be used to create a crown in the anterior region that is visually similar to your own teeth. In order to create an absolutely perfect result, the dental technician takes photos of the teeth in order to optimally adapt the modeling and layering of the crown to your own teeth.

The provision of veneers for the other anterior teeth can also be discussed, provided there are defects and the provision is thus indicated.

What to do if the crown is loose

In any case, if the tooth crown is loosened, the treating dentist should be consulted to find out the cause. If a crown loosens and threatens to loosen, it may be that only the cement has washed itself out, so that it is cleaned and reattached at a dentist and is consequently stuck again. A loosening of the crown can also be caused by a Fracture of the stump or a Break through the root be. In this case, the affected patient feels severe pain and the tooth is no longer worth preserving, so that it has to be removed by the dentist.

If the tooth root canal is treated and anchored with a pin and the crown, it is difficult to reattach the pin-crown. In this case, the loosening of the crown may be due to the fact that the stump is damaged by caries and that the prepared fit, into which the post-crown structure originally fits perfectly, is soft and deformed by the caries. As a result, the structure can no longer be fixed in the fit.

The caries must then be removed and possibly a new post-crown structure made. However, if the caries has already penetrated very deeply, the tooth must be extracted because it is no longer worth preserving.

What to do if you swallow the crown

If a crown was accidentally swallowed, the person concerned should wait until he has a bowel movement and catch it. The crown does not pose any risk of injury to internal organs, as it is so small that it does not damage any structures. After the crown has been cleaned and disinfected, it can easily be reinserted. In most cases, no Provisional (temporary supply), since bowel movements can be expected after about 8 hours. During this time, the other side should be chewed to protect the stump.

What materials are used for the tooth crown?

A crown can be made using different materials. Gold crowns, which were considered the standard solution 20 years ago, are less popular today. Nevertheless, gold is very suitable as a crown material, as it has good biocompatibility. Biocompatibility describes the extent to which the body tolerates the material. Furthermore, there are almost no gold allergies.

The gold crown has been almost completely replaced today by the development of non-precious metal. The alloy chromium-cobalt-molybdenum has proven to be very suitable in terms of mechanics, resistance and biocompatibility and can be produced at a much cheaper amount than gold. Furthermore, only a small percentage of allergies are known.

Metal crowns and veneer crowns with a metal framework are usually used with phosphate cement.

Read on below: Phosphate cement

This base metal crown can also be veneered with ceramic so that it appears tooth-colored. The ceramic crown made of zirconium oxide, however, offers an aesthetically more beautiful solution, as it does not have any metal-colored edges like the non-precious metal crown and is therefore the best restoration, especially for the optically visible area.
The ceramic supply is slightly more expensive than a base metal supply and must be used with special materials. The well-tried phosphate cement is not suitable for this.

Ceramic crown

Ceramic crowns are a highly aesthetic option that results from the special modeling process. The ceramic crown, which is made of zirconium oxide, is modeled from countless small layers that are applied to one another and vary in color. This creates the translucence and color brilliance of the crown, which appears to be confusingly similar to one's own teeth and is indistinguishable for a layperson. The biocompatibility, the tolerance of the body to a foreign material, is to be assessed as very positive with zirconium oxide and is therefore very popular with metal allergy sufferers.

Crown or implant?

The question of whether a crown or an implant is suitable as a supply option for a gap does not arise, since a crown is always placed on an implant as a superstructure. The implant replaces the tooth root, is drilled into the bone and grows together with it. A so-called abutment, a structure that replaces the prepared tooth, is screwed onto this implant, and finally a crown is attached to this structure.

The crown acts as a superstructure to integrate the implant into the row of teeth. Furthermore, a bridge or one prosthesis if there is a larger gap.

What to do if a crown has broken off?

If the entire crown has broken off and the stump is in it, the dental practice should be visited immediately. The dentist must then decide whether he can still restore the tooth with a filler. In the worst case, it is so deeply fractured that it can no longer be preserved.

It is also possible that the tooth can be filled with a build-up, but the crown no longer fits and a new crown has to be created. If the tooth has to be extracted, the planning of the supply of the gap with an implant, a bridge or a prosthesis applies.

What to do if the crown is too high

After inserting a new crown, it is entirely possible that it is too high. The dentist checks the even occlusion and the crown for pre-contacts and grinds them in. If, after insertion, the patient has the feeling that he is the first to come up with the crown, he should visit the dentist so that he can check the occlusion again and, if necessary, grind it in until all teeth come together equally.

Crown smells bad

It is not uncommon for those affected to complain that they perceive an unpleasant odor on a crown. In many cases, this crowned tooth has become attached to the surrounding one Gums a bag formed in which tooth remnants get caught and bacteria multiply, which metabolize these residues. If these food residues are not removed, a very unpleasant odor can occur as soon as the tooth is chewed, as it presses into the pocket, whereupon the putrefactive smell escapes from the pocket.

Therapeutically, the pocket should be cleaned and rinsed with chlorhexidine digluconate, and an ointment containing cortisone can be applied to the gingival pocket to reduce the inflammation. The condition should improve a lot after a few days.

Can I get an MRI with a crown?

The MRI can impair the function of magnetizable and electronic objects. In the dental field, however, the MRI has no influence on fixed tooth crowns. It does not matter whether the crown is made of non-precious metal or zircon. Metallic fillings such as the amalgam or larger bridge structures are also completely harmless.