Crowns

A cemented, extracoronal restoration that covers or veneers the outer surface of the clinical crown.

Indications

- Badly broken-down teeth.( lost dentine is replaced by a suitable core of restorative material)
- Primary trauma. A large fragment of the tooth may have broken off.
- Tooth wear (erosion, attrition, abrasion)
- Hypoplastic conditions
- Unsatisfactory size or shape or inclination of teeth (eg. Diastemas closed by oversized crowns)
- Unsatisfactory occlusion to improve function
- As part of another restoration. Crowns may support bridges and may act as components of fixed
splints. Crowns are also made to alter teeth alignment for guide planes of partial dentures.

Anterior complete crowns for vital teeth

1. Porcelain Jacket Crowns (PJC) [Note: porcelain is a type of ceramic]

- Consist of an even layer of porcelain (1-2 mm) covering the entire tooth.
- Traditional feldspathic PJC:
it has an alumina core that is opaque which needs to be covered by a more translucent
porcelain that contains less alumina.
- Crowns w/ strengthened porcelain systems:
further layers of conventional feldspathic porcelain + extra strong core of
ceramic material
- Adv : - appearance (due to translucency),
- stability (in dimension, color, and oral fluids),
- cost,
- resist plaque accumulation
- Disadv : - marginal fit (may be less satisfactory compared to cast metal restorations),
- brittleness(PJC is likely to fracture under trauma rather than the root of tooth),
- removal of more sound tooth (adequate thickness of the material is needed to
compensate for the brittleness of porcelain)

2. Metal-Ceramic Crowns
- Porcelain bonded to metal alloys
(metal alloy w/proportion of platinum and gold, palladium and silver, nickel and chromium)
- Adv : - strength,
- less sound tooth tissue removed from palatal/lingual surfaces,
- adaptability (can be adapted to any tooth shape preparation whereas PJC requires a
smooth and uniform prep),
- soldered (can be attached to other crowns or artificial teeth for bridges or splints)
- Disadv : - appearance (more difficult to match natural tooth),
 - more sound tooth tissue is removed from the buccal surface,thus endangers pulp (if
tooth reduction is not enough, crown will be bulky or too opaque),
- cost
3. Others: Cast Metal Crowns w/ cemented porcelain or acrylic/composite facings,
Acrylic-Jacket Crowns

Anterior crowns for endo treated teeth

1. Glass ionomer cement or composite core + crown
- When sufficient dentine remains, missing dentine can be replaced with GIC or composite
2. Post and cores and separate crowns
- Crown can be a PJC or metal-ceramic crown.
3. One-piece post crown
- Crown made of metal-ceramic with the post cast as part of the crown (eg. In short clinical
crowns or lower incisors where there is insufficient space within the crown of the tooth to make
a retentive core and a separate crown)

Posterior Complete Crowns

1. Cast-Metal Crowns
- Uses noble metals (gold, palladium, platinum) in the alloy
- Adv: - min reduction of tooth tissue,
- occlusal surface is readily adjusted and polished,
- uncomplicated margins
- Disadv: - appearance
2. Metal-Ceramic Crowns
- Porcelain can be used to cover commonly seen surfaces
- Adv: appearance
- Disadv: more tooth tissue is removed
3. Ceramic crowns
- PJC may be used eg. In a premolar for better appearance

Posterior Partial Crowns

1. Three-quarter crowns (made by Cast Metal)
- Crowns cover 4/5 of the tooths surface (mesial, distal, occlusal, lingual, or palatal)
- Retained by grooves on the various surfaces
- Used when buccal surface is intact and reducing the tooth for a complete crown prep is
unsightly or reducing the buccal cusp tip will weaken the prep.
- Adv: - more conservative,
- margin does not approach buccal gingiva,
- vitality testing possible,
- appearance
2. Others: seven-eighths crown (covers all but mesial buccal cusp of an upper molar), half crown
(covers mesial surface and occlusal surface of a lower posterior tooth), etc.

Ref
Smith, Bernard GN. Planning and Making Crowns and Bridges. 3rd Ed. Pg. 3