Crowns - are tooth-shaped caps placed over teeth to restore their shape, size, strength, and to improve their appearance. Crowns are utilized when decay and/or damage to a tooth is so extensive it cannot be properly restored with fillings or inlays/onlays.
They are necessary for a number of reasons:
1. To protect weak teeth from breaking or holding together parts of cracked teeth.
2. Restoring already broken teeth or teeth that have been severely worn down.
3. To hold a dental bridge in place.
4. To cover misshapen or severely discolored teeth.
5. To cover dental implants.
Crowns are fabricated from a number of materials: metal (gold alloy, palladium, base alloys such as nickel or chromium),porcelain fused to metal, all ceramic or porcelain, all resin, and acrylic. Each material has advantages and disadvantages.
It takes two appointments to fabricate a crown. In the first appointment all decay is removed from the tooth and the tooth is prepared for the crown. Impressions of the tooth are then taken. At the second visit, the crown is delivered and cemented.
Are also known as fixed partial dentures. They serve to bridge the gap created by one or more missing teeth. For example, if a patient presented to our clinic with an upper first molar missing, a bridge could be created from the second molar to the second premolar thereby filling in the gap created by the missing first molar.
A bridge is composed of two crowns placed on the teeth on either side of the gap and false tooth/teeth (also a crown) in between. The two teeth on either side of the gap are the anchors (or abutments) of the bridge. Thus, how long a bridge lasts largely depends on the health of the abutment teeth.
Bridges have a number of advantages:
1. They can help restore your smile and ability to properly chew and speak.
2. Distribute the forces in your bite properly by replacing missing teeth,
3. Prevents remaining teeth from drifting out of position.
4. The bridge is much more esthetic and is cemented into your mouth.
5. has significantly better retention and comfort without the hassle of constant removal and insertion.
Bridges are fabricated from the same materials that crowns are: metal, porcelain fused to metal, all ceramic or porcelain, all resin, and acrylic.
Fabrication and delivery of a bridge generally takes two, possibly three, appointments. In the first appointment, the abutment teeth are prepared and impressions are taken. A temporary bridge is also created and cemented into the patient’s mouth until they receive the permanent bridge. At the second visit, the temporary bridge is removed and the final bridge is placed. If the patient likes the outcome and the dentist is satisfied with the function and esthetics the bridge is cemented.
Prosthetic devices used to replace missing teeth and are supported by soft and hard tissues of the mouth. They are removable.
For people who are missing all their teeth dentures have a number of advantages:
1. They can give patients a smile again.
2. Patients who previously were missing teeth can now chew their food.
3. They allow patients to speak properly, and enhance esthetics.
A disadvantage of conventional dentures is that since they are removable they rely on a patient’s hard and soft tissues for retention. In certain situations retention is not as strong as a person would prefer which could lead to some discomfort. However, our clinic also fabricates implant-retained overdentures.
Essentially, a number of dental implants are surgically placed in a patient’s mouth (either by an oral surgeon or periodontist), a certain period of time is given to heal, mostly probably 6-8 weeks and custom dentures are then fitted onto the implants for significantly increased retention. These dentures can still be removed. Denture fabrication typically takes 3-4 appointments.
The first appointment is used to determine whether dentures would be suitable, and impressions and a bite registration are taken. At the second visit a preliminary denture model is tried in the patient’s mouth to ensure proper function, speech, esthetics, and bite. Once everything is adjusted to the patient’s and dentist’s satisfaction, the dentures are sent to a dental laboratory. Final dentures are typically delivered by the third visit. Our clinic also fabricates a number of variations of the conventional denture.
These are an alternative form of treatment for people that cannot have a bridge for any number of reasons. They serve the same purpose a bridge does: to replace missing teeth for functional and esthetic reasons. However, they are removable and are not cemented in the mouth. As such, they do not produce the same level of retention, comfort, and natural feel that bridges, or fixed partial dentures, provide. For retention partial dentures rely on soft and hard tissue support in the mouth as well as metal clasps that are anchored around specific teeth in the mouth.
At the first appointment, the teeth (to which the partial denture clasps will anchor) are prepared and impressions are taken. The next visit is generally a try-in visit to ensure proper function, speech, bite, and esthetics. At the third appointment the partial denture is delivered to the patient.
Dental Implant Restorations
Implants are another method through which missing teeth can be replaced. They are natural-looking replacements for missing teeth that provide the same function as a natural tooth root. Essentially, implants are titanium posts (they come in different sizes and lengths) that are surgically implanted in the upper and/or lower jaw bone.
Implants are constructed from titanium because of the metal’s durability, strength, and biocompatibility with human tissue. Depending on where implants have been surgically placed in the jaw it is recommended that the patient wait a minimum of 4-6 months before placing the final crown/restoration on the implant.
The reason for this is that within those 4-6 months, sometimes longer, the titanium of the implant and the bone within the jaw actually physically integrate with one another. If the implant is restored too soon, forces generated by a patient’s bite will prevent osseointegration from ever occurring which will result in implant failure.
So what are the advantages and disadvantages of this treatment? The advantages significantly outweigh the disadvantages.
1. If a patient opts for implants to replace missing teeth versus a bridge not only will it produce a better esthetic outcome, the implant will physically feel more like a natural tooth than a bridge.
2. In addition, since implants integrate with bone they help preserve bone and prevent bone loss, as opposed to a bridge.
3. This significantly increases the esthetic outcome.
4. Implants have also proven, through numerous studies, to have very high success rates even over periods of 10-20 years.
5. They also provide better stability and help distribute biting forces more evenly throughout the mouth.
In a bridge all biting forces generated on the artificial tooth are transferred to the abutment tooth which reduces their long term prognosis. Remember that to fabricate a bridge, the abutment teeth must also be prepared for crowns. This holds true even if they are free of decay.
In contrast, no other teeth need to be prepared when replacing a missing tooth with an implant. Implants can also help to significantly increase stability and retention of both upper and lower dentures.
However, implants do have downside/disadvantages as well.
1. They can be quite costly.
2. In addition, it takes a longer period of time to replace the missing tooth/teeth since the dentist must wait a minimum of 4-6 months after surgery to restore the implant with a crown or place a denture over the implants.
If a patient is diagnosed to have implants, the patient is referred first to an oral surgeon or periodontist. One of these specialists surgically places the implant in the patient’s jaw. Once enough time has passed for healing and osseointegration, the patient comes to our office to have the implant restored with a crown, bridge, or overdenture. For further information please feel free to contact our clinic.
Sample Pictures of Implant and Implant Crowns
A veneer is a thin layer of restorative material placed over a tooth surface either to improve esthetics or protect a damaged tooth surface.
Two main types of material are used to fabricate veneers: composite and porcelain.
Composite veneers can be either be directly placed (built in the mouth such as white fillings), or indirectly created by a dental technician in a laboratory and later bonded to the tooth with a resin cement.
Porcelain veneers, however, are only indirectly fabricated. If a patient prefers the placement of a direct composite veneer, it only takes one appointment. With indirectly fabricated veneers however, it will require a minimum of two appointments.
Impressions of the mouth will be taken in the first appointment, and the final finished veneers will be placed in the second appointment. Veneers typically require a very minimal amount of tooth reduction and preparation to enhance retention.
Lumineers are indirectly fabricated veneers that have two major advantages over normal veneers: they are significantly thinner and they don’t require any tooth preparation.
Veneers/Lumineers can close spaces between teeth, lengthen teeth that have been shortened by wear, provide a uniform color, shape and symmetry to a smile, and can make crooked teeth appear straight.
Inlays and onlays can sometimes be used as alternatives to typical dental fillings. They are made from either porcelain, gold, and/or composite or ceramic resin. Inlays and onlays are indirectly fabricated restorations and thus typically are not completed in one appointment; they require two appointments.
In the first appointment, as with fillings, decay and/or old fillings are removed, the tooth is prepared for an inlay/onlay, and an impression is taken which is sent to the dental technician at the laboratory. The inlay/onlay will be cemented in the patient’s mouth at the second visit; in the interim a temporary sealant is placed on the prepared tooth or teeth.
So what are the advantages to choose an inlay/onlay instead of a regular filling?
1. They are highly esthetic, no metal shows.
2. they are very strong once bonded to the tooth, the seal is very good (thus significantly lower chances of marginal leakage compared to regular fillings),
3. they will not stain, insulate the teeth well, well suited for large cavities (more conservative than entire crowns/caps),
4. Long lasting.
However, they do have a few disadvantages:
1. More expensive than regular fillings.
2. can fracture
3. They take two appointments.
The two images on the top illustrate regular amalgam (silver) fillings. The bottom two images show how the patient’s teeth look following placement of inlays/onlays.