Crowns

What Are Crowns And Why Are They Used?

A crown replaces the outer surface of a tooth, on all sides and on the biting surface, which requires that these surfaces of the tooth and any filling be carefully shaped in preparation for the crown to be made which is then attached and non-removable from the tooth. Crowns should restore good strength to the tooth as well as restore a natural appearance. Crowns can be used to make teeth appear straighter, to close small gaps and to make a bite even.

Frequently Asked Questions

How Is A Crown Made?

The first step is to design and plan the crown, similar to a construction blueprint to optimize its size, shape, your bite and access for cleaning. During the second step, your tooth is carefully and meticulously shaped in preparation to support the eventual finished crown. During this same shaping and measuring appointment, a temporary acrylic (plastic) crown is made which will keep the shaped tooth comfortable, protect them and allow you to eat, speak and have a normal appearance between appointments. Also during this second step, measurements or molds are made from which a precisely fitted and natural appearing crown can be custom made in the dental laboratory. The laboratory process of making your crown occurs between appointments and is completed by specially trained laboratory technicians. The final steps involve completion of any adjustments to your crown and its attachment, after which your crown is not removable.

A crown is most commonly made using an inner framework of alloyed gold (usually silver color) for strength and an outer layer of ceramic which is tooth colored. Crowns can be made entirely of gold in which case they are usually yellow in color. A tooth which supports a crown may first require a filling to eliminate defects created by previous decay, fractures or old deteriorated fillings. When a tooth is severely broken down, root canal treatment may be required in order to allow the use of a post inside the root to rigidly hold a large foundation filling, which would then provide a solid foundation and prevent the crown from coming loose. Root canal treatment may also be required before or after a bridge is placed if the nerve in the center of the tooth becomes infected or abscessed.

What Difference Does Quality Make?

High quality, natural looking crowns need to be more than just ‘white’, they must approximate the complex color scheme of your other teeth or they will stick out like a ‘sore thumb’. Color is approximately matched using standardized color tabs which are selected with your approval and is included in basic crown fees. If your crown is prominently visible, some degree of additional customization will usually be required to more closely match your other teeth. This customization process can proceed until the best possible match is obtained subject to the limitations of man-made materials and fees based on the length of time required for customization. When skillful clinical treatment is combined with artful laboratory technical work it is often difficult to detect the difference between a well made crown and your natural teeth. Natural teeth will tend to slowly darken with age. Teeth restored with a crown will remain the same color.

Shape is extremely critical and is one of the most frequently overlooked aspects of many crowns. This has resulted in an otherwise attractive smile being ruined by crowns not matching the remaining teeth and appearing as if they stick out. Proper shape is also required to prevent food jamming between teeth and to permit easy and thorough cleaning to avoid bad breath.

Red, blue or swollen gums and gum recession are ugly and can be caused by improperly made crowns. Many crowns are now quickly made ‘on the spot’ in the dental office but far too often have a poor shape, poor fit and a rough surface causing gum problems. The gum around the crown made with gentle, accurate techniques should be pink, firm, not bleed during cleaning and not suffer significant recession.

A well made crown should have a perfect bite and feel completely even with the other teeth on the very first day and does not require time to settle in. An uneven bite will either be uncomfortable or allow your other teeth to shift and become crooked.

The shape of the tooth under a crown is extremely critical. If properly designed and shaped, crowns should not fall off and should look like they have an excellent alignment and appearance. Expert treatment during the shaping of the tooth when the crown is first made can essentially eliminate needless future costs of re-attaching or remaking a crown that won’t stay on. Mistakes in shaping the tooth for a crown can cause harm to the gum or the tooth nerve resulting in the need for additional expensive treatment at best and at worst, can not be undone or reversed resulting in a permanent defect.

A crown should feel comfortable, look natural and maintain or restore your ability to eat and speak. Our patients routinely can’t feel much difference between a real tooth and a crown.

Do not expect your general dentist to obtain the results routinely obtainable in our prosthodontic specialty office. General dentists try to stay on top of all the general routine treatments patients need but can’t be expected to be capable of providing specialized treatment. There are some capable dental specialists in Mexico and elsewhere but always beware of ‘discount dentistry’. An attempt to obtain specialty treatment from those without the appropriate training and experience is likely to create problems and regret.

How Long Will A Crown Last?

Most crowns fail because of tooth decay under the edge of the crown or gum disease, both of which are frequently caused by average or poor fitting crowns and inadequate cleaning. An extremely well fitting crown is less likely to allow decay to get under the crown destroying the tooth underneath it. A crown that can be properly cleaned will last much longer, increasing the likelihood that you will keep your teeth a lifetime and reduce future dental care and costs.

Cleaning teeth with crowns is not too different from cleaning natural teeth. You must thoroughly brush your teeth and clean between the teeth using the appropriate cleaning aid every day. You will be shown and coached on the techniques necessary to care for your crown and supporting teeth. Crowns and their supporting teeth must be regularly cleaned and checked by your dentist to ensure the gum and bone does not break down or the supporting teeth do not get cavities or decay. An extremely well fitting crown, that can be properly cleaned will last much longer, and increase the likelihood you will keep your teeth a lifetime at less cost. A crown with average or poor fit can’t be cleaned properly and is not likely to last long.

Crowns should be strong and not easily break. Unfortunately, elsewhere, in an effort to decrease costs, crowns can be made cheaply and from weaker materials with very unfortunate results.

By using specialized knowledge, skill and experience in combination with careful planning and attention to detail, a crown can be made with excellent fit, appearance and function and is likely to last for many years.

…After consultation with Dr. Neale, I decided to proceed with the extensive dental work in my mouth. It was a challenging experience… The end result was worth the effort. Not only is the cosmetic effect great, more than that, the comfort in my mouth is such that I forget I have crowns, bridges and veneers. Thanks Dr. Neale.
A satisfied customer,Mrs. S.B. Slave Lake
I have been a patient of Dr. David Neale over a period of 6 years. Recently he carried out extensive, delicate and complicated restoration work on my teeth, to my complete satisfaction. I shall always be thankful to Dr. Neale and I would certainly recommend him with absolute confidence to anyone.
Mrs. B.L. Edmonton
I am impressed with the professional dental care I received from Dr. Neale and his staff. They were most accommodating and informative. Dr. Neale made me feel very comfortable, and he is someone I trust. His expertise and good judgment gave me a new confident smile.
Mr. P. G. NWT
You have given my girl the joy of smiling. You and your team are the Greatest!
Sincerely grateful, Mrs. K.C. NWT

Case Studies

Case Study

Ms. B.M. was referred to our office by her periodontist when she was 56 years old because her main concern was her two front teeth, which had crowns on them, looked like they were blackening at the gum line, the left front tooth looked longer than the right one and the crowns no longer matched color of the other natural teeth. Two new crowns were made for the front teeth to create the desired smile.

Case Study

Miss. L.B. was 22 years old when she decided that she wanted straighter front teeth but she did not want to have orthodontic braces put on her teeth. We made models of her teeth and developed a model of how much straighter we could make her teeth with crowns. Once Miss L.B. saw this model she decided to proceed with the crowns even though three teeth would also require root canal treatment. Once treatment was completed, Miss. L.B. had the smile she wanted which was very close to the model we had completed in advance.

Case Study

Miss. F.S. was 18 years old when she was referred by her orthodontist to our office for aesthetic improvement of her smile because of the poor appearance of her two front teeth. She had damaged the front teeth somehow a number of years prior and several previous attempts at bonding tooth coloured fillings had been completed. We recommended some gum surgery be completed initially to remove some of the excess gum height and to allow both front teeth to have the same length because the area was extremely visible. Once this was completed two crowns were placed on the front teeth to finish the new smile.

Case Study

Mr. D.L. was 44 years old when he presented to our office with his crown in his hand as it had fallen off his front tooth. He had chipped this tooth playing hockey when he was a teenager and a crown had been made for it which had recently fallen off several times. He had noticed that this tooth and the gum around it appeared to have moved down more than the other front tooth over the past while. He wondered if it was possible to repair his tooth. We advised that while this tooth would always be somewhat weak because of the extent of damage done to it, none the less, the tooth could be repaired with a new crown. We also advised him that the height of the gum was different on this tooth due to recent tooth movement and this could be corrected if he felt the area was aesthetically visible. Mr. D.L. decided that the gum did not show when he smiled and therefore decided not to have the length of the two front teeth exactly matched. We completed the foundation work and a new crown for this tooth.

Case Studies

Extensive Tooth Repair

Case Study

Mr. G.S. came to our office at the age of 42 years by referral of his general dentist because of the extreme wear on all of his teeth, cold sensitivity on some of his teeth and because Mr. G.S. wanted to have a better smile. Mr. G.S. had a history of lots of fillings that had often broken and thought he used to grind his teeth and that he still did a bit. A nightguard had been made 10 years previously which he had only worn for about 6 months. Following examination, it was obvious that the wear was very significant and had progressed through the entire enamel layer of the teeth and into the softer and more sensitive inner dentin layer. It was also very apparent to us that Mr. G.S. was still very much grinding his teeth and wearing them down even if he was not really aware of it, which is actually quite common. Mr. G.S. was eager to proceed and following some gum work, crowns were designed and built for virtually every tooth. By request of Mr. G.S., a space was left between his two upper front teeth as it had always been there (something like late night T.V. talk show host David Letterman) and his crowns were made to be quite white. Mr. G.S. still grinds his teeth, but now wears a very precisely made nightguard which is quite comfortable to wear and protects his teeth from wear and fracture. He doesn’t even think about his teeth anymore as the sensitivity has gone away and they function like normal teeth.

Case Study

Ms. L.P. saw our name in the telephone book and decided she wanted to consult with us on improving her smile when she was 45 years old. She was very definite. She wanted whiter and longer teeth with less upper gum showing. She also noted some tooth ache. Ms. L.P. had many fairly large fillings, a reasonable degree of wear and back teeth that did not align normally. We discussed her desired smile and designed a device to show Ms. L.P. the general nature of the changes that were possible prior to starting treatment. It was evident that to reduce the amount of gum display that some ‘gum renovations’ were required allowing the use of crowns that would be longer toward the biting edge and longer toward the gum so less gum would be visible. Crowns were made for almost all of the teeth and veneers for the lower front teeth. The tooth ache went away as the teeth were repaired and the bite made more even in the process of treatment. Ms. L.P. was very happy with her new smile and makes use of it every chance she gets.

Case Study

Mr. H.G. was 83 years old when his general dentist suggested he come to see us as he wanted to fix his teeth saying that his friends and relatives thought he should do something. Mr. H.G. had no difficulties eating or speaking and had no discomfort. Mr. H.G. definitely had a habit of grinding his teeth together both during sleep and during the day of which he was not aware, accounting for the vast majority of the wear. We explained that crowns could be designed that would make his teeth look and work more like unworn teeth and that he could pick whatever color he liked. Following some gum work on the upper teeth, some root canals and some foundation fillings, crowns were designed and precisely fitted for almost all of the teeth. A nightguard was also made to help protect the dental work and his supporting teeth from future wear and fractures. Mr. H.G. can eat, talk and use his teeth as if they had always been this way. Mr. H.G. is always in a good mood and very cheerful, but now you can see him smiling, which his friends and relatives feel is more appropriate. Mr. H.G. is also very appreciative.

Case Study

Mr. D.L. was only 36 years old when his dentist suggested he visit our office as Mr.D.L. was concerned about the gaps between his teeth as well as the wear and chips. He thought he had been grinding his teeth together for years. He was also in the process of a divorce and wanted a better looking smile. To ensure we had the kind of smile in mind that Mr. D.L wanted, we designed his smile on a model of his teeth and reviewed this with him prior to starting. After some required gum work on most of the upper teeth, crowns were made on most of the teeth to match the smile blueprint initially agreed on. The lower front four teeth had ceramic veneers made for them. Mr. D.L. picked the color he wanted his teeth to be. A nightguard was made for use every night to help protect his dental work. Mr. D.L. is very happy with his new smile and told us he is now primarily concerned about motorcycle riding.