A: A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth. Crowns are necessary when a tooth is generally broken down and fillings won't solve the problem. If a tooth is cracked a crown holds the tooth together to seal the cracks so the damage doesn't get worse. Crowns are also used to support a large filling when there isn't enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth, or cover badly shaped or discolored teeth.

2. How does a cosmetic dentist place a crown?

A: To prepare the tooth for a crown, it is reduced so the crown can fit over it. An impression of the teeth and gums are made and sent off to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown in made. On the next visit, the cosmetic dentist removes the temporary crown and cements the permanent crown onto the tooth.

3. I have seen people with crowns that look "fake" or that have a dark line at the gum line of the crowns. What causes that?

A: This is usually caused by the metal margin of a porcelain fused to metal (or PFM) crown. In the "old days," many dentists used PFM crown, but now in most cases, cosmetic dentists use all porcelain crowns, which provide virtually the same strength but are highly superior in their aesthetic result.

4. Why would someone want an all-porcelain crown?

A: Some restorations are designed with a metal lining, covered with porcelain (porcelain- fused-to-metal or PFM). At one point in time, most restorations were made this way. When placed, they usually look opaque or "flat" because they do not let light pass through like a natural tooth. There is often a tell-tail dark line next to the gum-line that is undesirable (often the darkness invades the adjacent gum tissue as an adverse reaction).

All-porcelain restorations are what we chose to use unless there is a compelling reason otherwise. Again, when properly seated, they are as strong or stronger than their metal predecessor. And the appearance can be identical to a natural tooth, allowing light to pass through (referred to as translucency).

5. Why would the cosmetic dentist recommend crowns instead of veneers?

A: Crowns require more tooth structure removal; hence, they cover more of the tooth than veneers. Crowns are stationary and are customarily indicated for teeth that have sustained significant loss of structure, or to replace missing teeth. Crowns may be placed on natural teeth or dental implants.

6. What can be done to replace a missing tooth?

A: Cosmetic dentistry now offers options beyond having a partial denture. One option is to have an implant and crown placed. An implant is a titanium cylinder that is placed in the bone (under the tissue) and functions to replace what was once the root of the tooth. After a period of 5-6 months a stress or load can be placed into this implant and then the crown is placed over the abutment. This tooth is now cared for like all the other teeth in your mouth. Another option is a bridge. A bridge is like a crown that is bonded to the teeth on either side of the missing tooth. Some people prefer to not go through the surgical procedure of having the implant placed. Others prefer to have a quick fix and to not go through the waiting period of 5-6 months before a crown can be placed on the implant.

7. What can I expect on my first visit for the crown procedure?

A: As soon as you are seated, we will numb the area to be worked on using a local anesthetic. Depending upon the type of local anesthetic used, you can expect to feel numb for one to four hours. If your anesthesia should last longer, do not be concerned. Individuals react differently to anesthesia. While the area is numb, please be careful not to bite your lip or tongue. You may want to consider a soft diet or no meal at all while until your sensation returns in the affected area. Once the appropriate area is numb, one of our cosmetic dentists will prepare the tooth to maximize the function, retention and aesthetics of your new crown. After the tooth is fully prepared, we proceed to the impression stage where we create a model of your prepared tooth for our in-house lab to custom-fabricate your crown.

Should you experience any discomfort you can take a mild analgesic (Tylenol, Advil, or aspirin, etc.) as long as there is no medical contraindication based upon your medical history. Typically, you can take anything you would normally take for a headache. If the discomfort persists, please call our office.

8. How should I care for my crowns?

A: To prevent damaging or fracturing the crowns, avoid chewing hard foods, ice or other hard objects - just like you should avoid for your natural teeth. You also want to avoid teeth grinding. Besides visiting our office, and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.

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