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Crown Procedure

When a large section of a tooth is compromised by either decay or a break, a crown is required.  A crown is the preferred treatment when the amount of natural tooth structure remaining is not stable enough for a large filling restoration.  Crowns can also be used for cosmetic purposes to alter the shape, length and color of a tooth, improving its appearance in your smile.

Typically, local anesthesia is used.  The tooth to be crowned is reduced on all sides by 3-4 mm.  This reduction is to accommodate the thickness of the crown needed to withstand the pressures of chewing.  Any broken area must be incorporated into the prep design, and it is essential that all decay be removed.  Sometimes, the amount of tooth lost by a break or decay is greater than the amount of reduction preferred.  In this case, filling material must be added to the crown prep to increase its strength.  This is called a Crown Build Up..

Once complete, a thin cord is placed around the tooth between the edge of the prep and the adjacent gingival tissue.  The Retraction Cord temporarily pushes the gingiva off the tooth so the impression material can flow below the gum line.  It is removed just prior to the impression.  An impression is made of the tooth and the opposing bite, and a temporary acrylic crown is made for the patient to wear while waiting for the lab to fabricate the final product.  This may take two to three weeks.

Next appointment, the patient returns for crown delivery.  At this appointment, anesthesia is not necessary, but available to the patient if they wish.  The temporary crown will be removed, and the prepared tooth cleaned of cement and debris.  The new crown is seated, and all aspects of its fit are checked by the Dentist.  Minor adjustments are made chairside to allow for the best fit and most natural feel.  Then the final crown is cemented in place, restoring the tooth to its natural function and appearance.

Types of Crowns

At the offices of Old Dominion Family Dental, our crowns are fashioned by trained dental lab technicians which we work very closely with to get the best results for our patients.  The technicians are true artists who create a crown which not only functions in the patient's arch, but looks like a natural tooth.  Today, modern dentistry is capable of providing the patient with several different types of crowns to choose from.

Porcelain Fused to Metal Crowns (PFM)

Porcelain Fused to Metal Crowns are the most common type of crown produced.  A thin layer of metal is cast by the lab to fit directly over the prepared tooth.  This metal Coping increases the strength of the crown.  The Coping can be made out of many different metals: however, our Doctors use only Nobel or High Nobel metals to lessen the chance of patients having metal allergies to the substance.  Porcelain is then layered to shape the crown and create the natural look of tooth structure.  On anterior (front) teeth, the gray of the metal may become visible at the gumline as the patient ages.  This can impact the esthetics. 

All Metal Crowns (CVC)

All Metal Crowns are considered by many to be the most superior and longest lasting type of crown.  Cast with High Nobel Metals, the material is very malleable allowing for thin crown margins and smooth contours: however, due to the esthetics, All Metal Crowns are not commonly requested by patients.  Appearing as Gold or White Gold in the mouth, they are not as cosmetic as other materials available today.  There are occasions with heavy bruxers when metal occlusal (biting) surfaces are recommended to extend the life of the crown.

All Ceramic Crowns

All Ceramic Crowns are becoming very common in modern dentistry, and as new materials develop, their strength and esthetics continue to improve.  Made completely out of various glass and porcelains, the lab technicians are able to create beautiful three-dimensional esthetics.  All Ceramic Crowns are highly recommended for anterior restorations.

Crown Lengthening

When a tooth develops decay or breaks below the gum line, it becomes necessary to remove gingival tissue to ensure the edge of the crown prep is completely on healthy tooth structure.  While under local anesthesia for the crown procedure, gingival tissue is removed from the side of the prep which is compromised below the gum.  Done with an Electric Scalpel, the tissue is removed and cauterized at the same time, reducing the amount of bleeding in the area.  This allows the Dentist to better view the area and create a proper edge for the crown prep.  While in the temporary crown, the patient is normally placed on a prescription mouth rinse for the surgical area and, when necessary, pain medication.  The gingiva heals within 2-3 weeks of the procedure, just in time to deliver the final crown.


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