Dental crowns, implants and dentures

A dental crown is a tooth-shaped "cap" that is placed over a tooth -- to cover the tooth to restore
its shape and size, strength, and improve its appearance.
The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at
and above the gum line.
A dental crown may be needed in the following situations:

1. To protect a weak tooth (for instance, from decay) from breaking or to hold together parts
of a cracked tooth
2. To restore an already broken tooth or a tooth that has been severely worn down
3. To cover and support a tooth with a large filling when there isn't a lot of tooth left
4. To hold a dental bridge in place
5. To cover misshapened or severely discolored teeth
6. To cover a dental implant
7. To make a cosmetic modification

For children, a crown may be used on primary (baby) teeth in order to:

Save a tooth that has been so damaged by decay that it can't support a filling.
Protect the teeth of a child at high risk for tooth decay, especially when a child has
difficulty keeping up with daily oral hygiene.
Decrease the frequency of general anesthesia for children unable because of age,
behavior, or medical history to fully cooperate with the requirements of proper dental
care.

In such cases, a pediatric dentist is likely to recommend a stainless steel crown.

Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy),
porcelain-fused-to-metal, all resin, or all ceramic.

Stainless steel crowns are prefabricated crowns that are used on permanent teeth
primarily as a temporary measure. The crown protects the tooth or filling while a
permanent crown is made from another material. For children, a stainless steel crown
is commonly used to fit over a primary tooth that's been prepared to fit it. The crown
covers the entire tooth and protects it from further decay. When the primary tooth
comes out to make room for the permanent tooth, the crown comes out naturally with
it. In general, stainless steel crowns are used for children's teeth because they don't
require multiple dental visits to put in place and so are more cost- effective than
custom-made crowns and prophylactic dental care needed to protect a tooth without a
crown.
Metals used in crowns include gold alloy, other alloys (for example, palladium), or a
base-metal alloy (for example, nickel or chromium). Metal crowns withstand biting
and chewing forces well and probably last the longest in terms of wear down. Also,
metal crowns rarely chip or break. The metallic color is the main drawback. Metal
crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth
(unlike the metallic crowns). However, more wearing to the opposing teeth occurs
with this crown type compared with metal or resin crowns. The crown's porcelain
 portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-
metal crowns look most like normal teeth. However, sometimes the metal underlying
the crown's porcelain can show through as a dark line, especially at the gum line and
even more so if your gums recede. These crowns can be a good choice for front or
back teeth as well as long bridges where the metal is needed for strength.
All-resin dental crowns are less expensive than other crown types. However, they
wear down over time and are more prone to fractures than porcelain-fused-to-metal
crowns. They are usually only used for temporary crowns.
All-ceramic or all-porcelain dental crowns provide better natural color match than
any other crown type and may be more suitable for people with metal allergies. All-
ceramic crowns are a good choice for front teeth.
Temporary versus permanent. Temporary crowns can be made in your dentist's
office, whereas most permanent crowns are made in a dental laboratory. Temporary
crowns are made of acrylic or stainless steel and can be used as a temporary
restoration until a permanent crown is constructed by a lab.
Zirconia or milled crown which are digitally constructed either in an office that has
the software and hardware to produce them or in a dental lab. Dental offices that have
the software and hardware have the ability to produce a crown in one visit with no
need for a temporary.

Preparing a tooth for a crown usually requires two visits to the dentist -- the first step involves
examining and preparing the tooth, the second visit involves placement of the permanent crown.
First Visit: Examining and preparing the tooth.
At the first visit in preparation for a crown, your dentist may take a few X-rays to check the roots
of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there
is a risk of infection or injury to the tooth's pulp, a root canal treatment may first be performed.
Before the process of making a crown begins, your dentist will anesthetize (numb) the tooth and
the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the
chewing surface and sides to make room for the crown. The amount removed depends on the type
of crown used. If, on the other hand, a large area of the tooth is missing (due to decay or damage),
your dentist will use filling material to "build up" the tooth to support the crown.

After reshaping the tooth, your dentist typically will use a paste or putty to make an impression of
the tooth to receive the crown. Sometimes, though, impressions are made with a digital scanner.
Impressions of the teeth above and below the tooth to receive the dental crown will also be made
to make sure that the crown will not affect your bite.
The impressions or scans are sent to a dental lab where the crown will be manufactured. The
crown is usually returned to your dentist's office in two to three weeks. If the crown is made of
porcelain, your dentist will also select the shade that most closely matches the color of the
neighboring teeth. During this first office visit your dentist will make a temporary crown to cover
and protect the prepared tooth while the crown is being made. Temporary crowns usually are
made of acrylic and are held in place using a temporary cement.
Second Visit: Receiving the permanent dental crown.
At the second visit, your dentist will remove the temporary crown and check the fit and color of
the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth
and the new crown is permanently cemented in place.
Because temporary dental crowns are just that -- a temporary fix until a permanent crown is ready
-- most dentists suggest that a few precautions. These include:

Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the
potential of grabbing and pulling off the crown.
Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your
chewing to the other side of the mouth.
Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the
crown.
Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the
floss out, as you normally would, might pull off the temporary crown.

Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after
the procedure as the anesthesia begins to wear off. If the tooth that has been crowned still
has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may
recommend that you brush teeth with toothpaste designed for sensitive teeth. Pain or
sensitivity that occurs when you bite down usually means that the crown is too high on the
tooth. If this is the case, call your dentist. He or she can easily fix the problem.
Chipped crown. Crowns made of all porcelain or porcelain fused to metal can sometimes
chip. If the chip is small, a composite resin can be used to repair the chip with the crown
remaining in your mouth. This is usually just a temporary fix. If the chipping is extensive,
the crown may need to be replaced.
Loose crown. Sometimes the cement washes out from under the crown. Not only does
this allow the crown to become loose, it allows bacteria to leak in and cause decay to the
tooth that remains. If a crown feels loose, contact your dentist's office.
Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit, a lack
of cement, or a very small amount of tooth structure remaining that the crown can hold on
to. If this happens, clean the crown and the front of the tooth. You can replace the crown
temporarily using dental adhesive or temporary tooth cement that is sold in stores for this
purpose. Contact your dentist's office immediately. He or she will give you specific
instructions on how to care for the tooth and crown for the day or so until you can be seen
for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new
crown will need to be made.
Allergic reaction . Because the metals used to make crowns are usually a mixture of
metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is
extremely rare.
Dark line on crowned tooth next to the gum line. A dark line next to the gum line of
your crowned tooth is normal, particularly if you have a porcelain-fused-to-metal crown.
This dark line is simply the metal of the crown showing through. While not a problem in
itself, the dark line is cosmetically unacceptable and your dentist may have to replace the
crown with an all porcelain or ceramic one.
Onlays and 3/4 crowns are variations on the technique of dental crowns. The difference between
these crowns and the crowns discussed previously is their coverage of the underlying tooth. The
"traditional" crown covers the entire tooth; onlays and 3/4 crowns cover the underlying tooth to a
lesser extent.
On average, dental crowns last between five and 15 years. The life span of a crown depends on
the amount of "wear and tear" the crown is exposed to, how well you follow good oral hygiene
practices, and your personal mouth-related habits (you should avoid such habits as grinding or
clenching your teeth, chewing ice, biting fingernails, and using your teeth to open packaging).
While a crowned tooth does not require any special care, remember that simply because a tooth is
crowned does not mean the tooth is protected from decay or gum disease. Therefore, continue to
follow good oral hygiene practices, including brushing your teeth at least twice a day, flossing
daily -- especially around the crown area where the gum meets the tooth -- and rinsing with an
antibacterial mouthwash at least once a day.
Costs of crowns vary depending on what part of the country you live in and on the type of crown
selected (for example, porcelain crowns are typically more expensive than gold crowns, which are
typically more expensive than porcelain-fused-to-metal crowns). Generally, crowns can range in
cost from $800 to $1700 or more per crown. A portion of the cost of crowns is generally covered
by insurance. To be certain, check with your dental insurance company.

A denture is a removable replacement for missing teeth and surrounding tissues. Two types of
dentures are available -- complete and partial dentures. Complete dentures are used when all
the teeth are missing, while partial dentures are used when some natural teeth remain.
Complete dentures can be either "conventional" or "immediate." Made after the teeth have been
removed and the gum tissue has begun to heal, a conventional denture is ready for placement in
the mouth about eight to 12 weeks after the teeth have been removed.

Unlike conventional dentures, immediate dentures are made in advance and can be positioned
as soon as the teeth are removed. As a result, the wearer does not have to be without teeth
during the healing period. However, bones and gums shrink over time, especially during the
healing period following tooth removal. Therefore a disadvantage of immediate dentures
compared with conventional dentures is that they require more adjustments to fit properly
during the healing process and generally should only be considered a temporary solution until
conventional dentures can be made.
A removable partial denture or bridge usually consists of replacement teeth attached to a pink
or gum-colored plastic base, which is sometimes connected by metal framework that holds the
denture in place in the mouth. Partial dentures are used when one or more natural teeth remain
in the upper or lower jaw. A fixed bridge replaces one or more teeth by placing crowns on the
teeth on either side of the space and attaching artificial teeth to them. This "bridge" is then
cemented into place. Not only does a partial denture fill in the spaces created by missing
teeth, it prevents other teeth from changing position. A precision partial denture is removable
and has internal attachments rather than clasps that attach to the adjacent crowns. This is a
more natural-looking appliance.
Yes, dental implants can be used to support cemented bridges, eliminating the need for a
denture. The cost is usually greater, but the implants and bridges more closely resemble the
feel of real teeth. Dental implants are becoming the alternative to dentures but not everyone is
a candidate for implants. Consult your dentist for advice.

Does Insurance Cover the Cost of Dentures?

Most dental insurance providers cover some or all of the cost of dentures. However, contact your
company to find out the specifics of what they will cover.
The denture development process takes a few weeks and several appointments. Once your dentist
or prosthodontist (a dentist who specializes in the restoration and replacement of teeth) determines
what type of appliance is best for you, the general steps are to:

1.
Make a series of impressions of your jaw and take measurements of how your jaws relate
to one another and how much space is between them.
2. Create models, wax forms, and/or plastic patterns in the exact shape and position of the
denture to be made. You will "try in" this model several times and the denture will be
assessed for color, shape, and fit before the final denture is cast.
3. Cast a final denture
4. Adjustments will be made as necessary

New dentures may feel a little odd or loose for a few weeks until the muscles of the cheeks
and tongue learn to keep them in place and you get comfortable inserting and removing them.
Also, it is not unusual for minor irritation or soreness to occur and for saliva flow to increase
when you first start wearing dentures, but these problems will diminish as the mouth adjusts.
Dentures are made to closely resemble your natural teeth so there should be only a small
noticeable change in appearance. In fact, dentures may even improve your smile and fill out your
facial appearance.
Eating with new dentures will take a little practice and may be uncomfortable for some wearers
for a few weeks. To get used to the new denture, start with soft foods cut into small pieces. Chew
slowly using both sides of your mouth. As you get used to new dentures, add other foods until you
return to a normal diet. Be cautious with hot or hard foods and sharp-edged bones or shells. And,
avoid foods that are extremely sticky or hard. You should also avoid chewing gum while you
wear the denture. Also, don't use toothpicks while wearing dentures.
After getting dentures, you may have difficulty pronouncing certain words. If so, practice by
saying the difficult words out loud. With practice and with time you will become accustomed to
speaking properly with dentures.
If dentures "click" while you're talking, contact your dentist. Dentures may occasionally slip when
you laugh, cough, or smile. Reposition the dentures by gently biting down and swallowing. If any
speaking problem persists, consult your dentist or prosthodontist.
Your dentist or prosthodontist will instruct you as to how long to wear dentures and when to
remove them. During the first several days after receiving your denture, you may be asked to wear
it all the time, including while you sleep. Although this may be temporarily uncomfortable, it is
the quickest way to identify the areas on the denture that may need adjustment. Once adjustments
are made, you should remove dentures before going to bed. This allows gum tissues to rest and
allows normal stimulation and cleansing by the tongue and saliva. The denture can be put back in
the mouth in the morning.
A denture adhesive may be considered under the following circumstances:
1. To enhance satisfaction with a properly constructed denture. Adhesives enhance retention,
stability, bite force, and an individual's sense of security.
 2. To assist individuals with dry mouth conditions that lessen denture adherence, such as
individuals taking cold medications, those with neurologic disabilities including strokes,
and the elderly.
3. To provide added stability and security for those who place unusual demands on facial
muscles, such as public speakers or musicians.

There are situations when denture adhesives should not be used. Those cases include:

1. When it is used as a "fix" for ill-fitting or poorly constructed dentures. If dentures begin to
feel loose, cause discomfort or cause sores to develop, contact your dentist as soon as
possible.
2. When a dentist has not evaluated dentures for a long time. Dentures rest on gum tissue and
the jawbone, which shrink and deteriorate, respectively, over time. Therefore, the real
problem might be a need for a denture adjustment or new dentures.
3. When oral hygiene practices cannot be sustained.
4. When adhesives have been used for a long time, especially when visits to the dentist are
infrequent, and when the frequency and volume of the adhesive use increases. These
developments may indicate the need for a denture adjustment or new dentures.
5. When any known allergy exists to the adhesive's ingredients.

Here are some tips to consider when applying denture adhesives:

1. Use the minimum amount necessary to provide the maximum benefit. Apply less than you
think you need, and then gradually increase the amount until you feel comfortable.
2. Distribute the adhesive evenly on the tissue bearing surface of the denture.
3. Apply or reapply when necessary to provide the desired effect.
4. Always apply the adhesive to a thoroughly clean denture.
5. Remember adhesives work best with a well-fitting denture.

1. Paste application. Apply this denture adhesive to a dry or preferably wet denture. Avoid
placing adhesive close to the denture borders. If the adhesive oozes, use less of the
product. For dentures on the upper jaw, apply three short strips of adhesive -- or a series of
small dots -- along the ridge area and one down the center. For dentures on the lower jaw,
apply three short strips of adhesive -- or a series of small dots -- in the center of the ridge
area.
2. Powder application. Sprinkle a thin, uniform layer throughout the tissue-bearing surface
of the denture. Shake off excess powder and press the denture into place. Powders may be
preferred over pastes because they are easier to clean off the denture and tissue. In
addition, they don't have the same tendency as pastes do to "shim" (keep the denture away
from the tissue).

Dental adhesives are safe as long as they are used as directed. If the denture is well-fitting and the
adhesive is only used to give added stability, there should be no ill effects. If adhesives are used
excessively to fill voids for an ill-fitting denture, they can be harmful to the underlying soft and
hard tissues. Occasionally, in these cases, inflammation of the soft tissues can result. In addition,
because of its movement on the soft tissue and underlying bone, an ill-fitting denture can
cause bone loss.
Despite improvements in dental care, millions of Americans suffer tooth loss -- mostly due
to tooth decay, periodontal disease, or injury. For many years, the only treatment options available
for people with missing teeth were bridges and dentures. But, today, dental implants are available.
Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed
(permanent) or removable replacement teeth that are made to match your natural teeth.
There are many advantages to dental implants, including:

Improved appearance. Dental implants look and feel like your own teeth. And because
they are designed to fuse with bone, they become permanent.
Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing
you to mumble or slur your words. Dental implants allow you to speak without the worry
that teeth might slip.
Improved comfort. Because they become part of you, implants eliminate the discomfort
of removable dentures.
Easier eating. Sliding dentures can make chewing difficult. Dental implants function like
your own teeth, allowing you to eat your favorite foods with confidence and without pain.
Improved self-esteem. Dental implants can give you back your smile and help you feel
better about yourself.
Improved oral health. Dental implants don't require reducing other teeth, as a tooth-
supported bridge does. Because nearby teeth are not altered to support the implant, more
of your own teeth are left intact, improving long-term oral health. Individual implants also
allow easier access between teeth, improving oral hygiene.
Durability. Implants are very durable and will last many years. With good care, many
implants last a lifetime.
Convenience. Removable dentures are just that; removable. Dental implants eliminate the
embarrassing inconvenience of removing dentures, as well as the need for messy
adhesives to keep them in place.

Success rates of dental implants vary, depending on where in the jaw the implants are placed but,
in general, dental implants have a success rate of up to 98%. With proper care (see below),
implants can last a lifetime.
In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be
considered for a dental implant. Patients should have healthy gums and enough bone to hold the
implant. They also must be committed to good oral hygiene and regular dental visits. Heavy
smokers, people suffering from uncontrolled chronic disorders -- such as diabetes or heart
disease -- or patients who have had radiation therapy to the head/neck area need to be evaluated
on an individual basis. If you are considering implants, talk to your dentist to see if they are right
for you.
In general, dental implants are not covered by dental insurance at this time. Coverage under your
medical plan may be possible, depending on the insurance plan and/or cause of tooth loss.
Detailed questions about your individual needs and how they relate to insurance should be
discussed with your dentist and insurance provider.

The first step in the dental implant process is the development of an individualized treatment plan.
The plan addresses your specific needs and is prepared by a team of professionals who are
specially trained and experienced in oral surgery and restorative dentistry. This team approach
provides coordinated care based on the implant option that is best for you.
Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket
of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it
securely in the jaw. The healing process can take from six to 12 weeks.
Once the implant has bonded to the jawbone, a small connector post -- called an abutment -- is
attached to the post to securely hold the new tooth. To make the new tooth or teeth, your dentist
makes impressions of your teeth, and creates a model of your bite (which captures all of your
teeth, their type, and arrangement). The new tooth or teeth is based on this model. A replacement
tooth, called a crown, is then attached to the abutment.
Instead of one or more individual crowns, some patients may have attachments placed on the
implant that retain and support a removable denture.
Your dentist also will match the color of the new teeth to your natural teeth. Because the implant
is secured within the jawbone, the replacement teeth look, feel, and function just like your own
natural teeth.
Most people who have received dental implants say that there is very little discomfort involved in
the procedure. Local anesthesia can be used during the procedure, and most patients report that
implants involve less pain than a tooth extraction.
After the dental implant, mild soreness can be treated with over-the-counter pain medications,
such as Tylenol or Motrin.
Dental implants require the same care as real teeth, including brushing, flossing, rinsing with an
antibacterial mouthwash, and regular dental check-ups.