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Gold crowns: 

Gold remains, mechanically, a very good material to restore teeth with. It is very strong so minimal tooth needs to be taken away to accommodate the metal it.  Gold crowns may be particularly recommended where there is little space in the bite or in patients with a ‘difficult bite’. Its major drawback is it, of course, it does not look like tooth!

Dentine bonded and all ceramic crowns: 

Made entirely of porcelain, without underlying metal, these crowns offer excellent cosmetics for teeth that show in the smile. New ‘all white’ materials mean that we can offer strong metal free crowns for back teeth also. The choice for patients who want their teeth to look their best.

Porcelain bonded to metal crown: 

Porcelain is built up on a metal substructure. Although not as conservative of tooth tissue as a full metal crown, these were traditionally used where we want a white crown.

Your dentist will discuss all your options, pros, cons and costs with you to help you decide which is most suitable for you.

Our dentists are very experienced in providing these treatments and in the vast majority of cases the treatment is very successful.  There are however some possible risks and side effects from the treatment and steps you must take to increase the success rate of your treatment.

Crowning a tooth involves taking away some tooth around the circumference and surface to make space for the crown. We would prefer to avoid this sacrifice of tooth tissue where ever possible and our dentists would much prefer less invasive treatment with white filling where possible. If, it is not possible to build your tooth back up, for instance, to ensure tight tooth contacts so food does not get trapped, or if the tooth is at risk of fracture, we may advise a crown. Rest assured, we are not quick to turn to this option and it is only suggested in circumstances when we truly believe is needed. 

As it is only already broken down and compromised teeth that crowns are advised for, there is a risk that the nerve can die if the tooth to be crowned is still alive. The tooth may then need root canal treatment or extraction.

Often the tooth is already root filled. We will advise you on the condition and make as best a judgement as we can on the quality and reliability of this and these are the foundations the new crown relies on. If a root filling under a crown fails, it may prove tricky to re-root fill, extraction may be required.

Occasionally when we ‘dismantle’ old fillings in preparation for a crown or onlay, we find there is insufficient healthy tooth underneath to provide a solid foundation for a new restoration. In these rare cases the only option may be to extract the tooth.

Treatment of the teeth can cause inflammation. This may result in the tooth feeling sensitive to heat, cold or pressure. The sensitivity is often transient and settles quickly. There is a risk however of more severe problem, particularly if the tooth was previously very broken down.  If you experience more persistent of severe discomfort, you may require additional treatment including endodontic or root canal treatment, or infrequently, extraction. Thus although every reasonable effort will be made to ensure the success of my treatment, there is a risk that the procedure will not save the tooth.

The vast majority of our patients however experience minimal problems during and after treatment so if complications arise, please let your dentist know.

The colour and shape of the dental crown is created by the dental technician. Different types of dental crowns are more aesthetically pleasing than others. The join between the onlay and crown and the tooth may be visible. If this join is visible in your smile, your dentist will do their upmost to disguise it, however this may mean taking away more tooth or taking the edge of the restoration under the gum, which is not ideal. Over time, the gum may receed from the edge of the crown and become more obvious. Some people are more prone to this than others. Brushing carefully with a soft brush and flossing can help prolong the optimal appearance and health of your crowns and onlays.

First appointment

1. The tooth is numbed and we check you are comfortable.
2. Initial quick setting impressions are taken of both upper and lower teeth. You may also be asked to bite into a material used to record how your teeth meet.
3. If you want a white crown or onlay you can participate in selecting a colour to blend in with your other teeth. This can be quite challenging and in some cases you may be asked to attend the laboratory where the crown is made so the technician who is making your crown can see the characteristics and colour of your teeth.
4. Your dentist will shape the tooth to accommodate the new crown or onlay . This means reducing the shape of the tooth in 3 dimensions and is a similar experience to having a filling removed with a drill.
5. In some cases you will need to have the underlying filling in the tooth rebuilt in filling material so that it forms a reliable foundation for the crown (termed a ‘core build up’).
6. A thin cord called retraction cord may be pressed around the gumline of the prepared tooth to gently hold the gum back from the tooth whilst we take a mould of the tooth.
7. The dentist syringes some impression material around the tooth and takes another impression (mould).
8. A temporary crown or onlay  is custom made for your tooth and cemented with temporary cement.

Second appointment

The crown or onlay is fitted at a second appointment.

1. You will be offered an anaesthetic.
2. The temporary restoration may usually be simply flicked off.
3. The new crown is carefully checked to ensure its fit, bite, contact with adjacent teeth and of course appearance.
4. Once you and the dentist are happy, it is cemented in place. 

Maintenance

Most crowns and onlays last for many years if they are placed on good foundations and looked after properly. The restoration itself is very strong but decay can start where the tooth joins the crown or onlay if not looked after properly. It is crucial to follow your dentist’s advice and look after a crown like a normal tooth.

1. Brush and floss around the crown or onlay carefully each day
2. Limit the frequency of sugar in your diet (<4times per day) to avoid decay of the tooth underneath. (If a tooth decays under a crown, a new crown may be required which is costly or the tooth may need to be extracted).
3. Use a fluoride toothpaste, do not rinse after brushing.
4. Attend for regular check-up and hygiene appointments to help keep your mouth in good condition.

After a new onlay or crown is fitted please follow your dentist’s advice. Modern cements set quickly but as a precaution, eat carefully for 24 hours. Brush and floss your teeth as normal.