A crown is a restorative dental procedure that places a tooth cap over a defective tooth after it has suffered some type of damage. The crown will not only protect your tooth but also restore it back to its original shape and function.
Although before it can do that, the tooth will need to be shaved down or prepared to accommodate the crown. Then an impression (mold) of the teeth will be taken and sent to the lab for fabrication. Once it comes back, it gets permanently glued in.
With that being said, no two crowns are alike because they can be made out of different types of materials. They can also be customized to different shapes and colors. The best part is you can take care of them the same way as any other tooth in your mouth.
Table of contents:
When would I need a dental crown?
Healthy teeth do not need crowns but unhealthy ones can benefit from having one. Here are some situations and conditions which may necessitate having one.
Tooth decay. Moderate to severe tooth decay may cause a cavity that is big enough to compromise a tooth's structural integrity. A dental filling would be insufficient for restoring teeth in this condition.
Weakened tooth. Teeth that are prone to chipping may need a stronger restoration.
Extremely large filling. Tooth fillings are only meant to repair small defects. When large fillings break down, they will need to be replaced with a crown instead.
Broken tooth. Tooth fractures which affect 50% or more of the tooth will need a crown for better protection.
Root canal treated. It is standard protocol to get a dental crown after having a root canal. The tooth becomes more brittle overtime due to the loss of its blood supply. It will also slowly discolor since it is now a dead tooth. The crown can restore its aesthetics by covering the unsightly grey tooth which is dead.
After an implant. A dental implant is technically just the titanium screw that gets implanted into the jaw bone. That treatment is not complete until a dental implant crown gets screwed into the implant. Of course this is a different type of crown.
Improve cosmetics. It can be used to change the shape and color of your teeth just like veneers. If the tooth is otherwise healthy, a veneer would be the better choice. However if there are large restorations or cavities then a crown would be best.
Severe teeth grinding. Patients who suffer from bruxism will have severely worn down teeth. Fillings will barely last a year on these patients. What they need instead is a bruxing crown that is made of zirconia that is strong enough to withstand teeth grinding.
What is a dental crown made of?
Crowns can be made of various types of materials, each with their own pros and cons.
Porcelain
Ceramic
Porcelain fused to metal (PFM)
Stainless steel
Metal
Gold
Composite
Acrylic
Below we have some images of what crowns can look like.
Porcelain
Despite what you may think, pure porcelain crowns aren't typically used in clinical practice. All porcelain ones are too fragile to be used for back teeth. You risk breaking them if you bite into hard foods.
Where you would find all porcelain is actually for veneers. The prettiest dental veneers are made of feldspathic porcelain. While they look good, their durability leaves much to be desired. Nonetheless when your dentist tells you they are giving you an all porcelain crown, what they really mean is an all ceramic crown.
Ceramic
Ceramic crowns are the "all porcelain crowns" that your dentist makes for you. Just to be clear, porcelain is a type of ceramic but not all ceramics are porcelain. These crowns have no metal in them and are desired by patients over the metal ones.
List of commonly used ceramics for dental crowns:
Lithium disilicate - in between the zirconia and feldspathic.
Zirconia - super strong and fracture resistant.
Alumina
Leucite
Feldspathic - very pretty but brittle.
Porcelain fused to metal (PFM)
PFM crowns are metal underneath but have porcelain fused over it for aesthetics. They've been around for decades and were the primary crown material until the advent of all ceramic materials.
Porcelain fused to metal crowns have two disadvantages.
Metal margin. If the gums recede, sometimes the metal along the margins can show through which is not aesthetically pleasing.
Cannot be bonded. These crowns can only be cemented and not bonded. That means it relies more on mechanical retention rather than chemical retention. Veneers get bonded.
Stainless steel
Stainless steel crowns are typically only done for primary teeth which means it is meant for children. They are inexpensive and very durable. The only downside is they are pure metal.
Metal
Adults don't get stainless steel crowns but they can get all metal ones. These are different from the stainless steel ones in that they get made by a dental lab instead of being pre-made.
Gold
Gold crowns are a very popular choice of material in Asian countries. It isn't used as widely here in the US but they are very biocompatible. They are a good material choice for second molars. Their durability is also second to none, we've seen some that have lasted for decades.
Most patients prefer all ceramic crowns over the gold ones due to aesthetics. However, some celebrities may opt for the gold purely as a wow factor. Just so that you know, gold crowns may vary greatly in price because you get charged based on weight. If you have a big tooth you're going to be paying a lot for it since it'll be heavy.
Composite
Crowns can be made out of composite but it isn't done very often in clinical practice. Having it made out of ceramic or some other type of metal will have better durability and longevity.
Acrylic
There are no permanent crowns made of acrylic but temporary crowns are all made of it. The material is less expensive than ceramic but it serves its purpose because it is only meant to be used for a short while.
What to expect during a crown procedure
The dental crown procedure will typically take two appointment visits. Although with the advent of new technology, it is possible to do it in one visit but it'll be a very long appointment. We'll go over what to expect for both ways of making a crown.
Two visit crowns
The first appointment for the dental crown should take about 45-60 minutes. The second appointment will take about 30-45 minutes. You should expect to be numb for both visits unless the tooth is dead.
First visit
Administer local anesthesia. Numb the tooth that needs treatment.
Crown preparation. Shave down the tooth to the appropriate measurements.
Pack cord. Place the cord around the gums to push it down. This allows for a more accurate impression of the prepared tooth.
Take an impression. Take a mold of the teeth in order to convey information to the dental lab so they know how to make the crown.
Fabricate a temporary crown. A temporary crown needs to be made in order to protect the shaved down tooth. Your dentist does not want you walking around with no tooth while you wait for the permanent one to be made. The temporary will be glued in with temporary cement.
Pick a shade. One of the most important steps is to pick a color that matches your teeth.
Second visit
Administer local anesthesia. If you're not too sensitive you may not need to be numb.
Remove temporary crown. You can't put the permanent one until you take the temporary one off!
Clean residual cement. Old glue may be stuck to your tooth which prevents the seating of the new crown. Your dentist will flick and scrape off the residual glue.
Try in the permanent crown. The try-in process is to make sure that it fits before it gets glued in. If it doesn't fit or the color is not right, it will need to be sent back for a redo.
Adjust the crown. If the new cap feels too tight, the contacts need to be adjusted. If the bite feels uneven, the occlusion will need an adjustment.
Permanently glue it in. You can finally glue the dental crown in once it fits well and you like how it looks.
Single visit crowns
For a single visit crown procedure, the entire appointment may take up to 2 hours. This new technique utilizes CAD/CAM which aids in designing and manufacturing the crown on the spot.
Steps:
Administer local anesthesia.
Crown preparation. Drill around the tooth so that it can accomodate a crown.
Pack cord. Placing the cord around the tooth will help push the gums down. This will lead to a more accurate scan of the tooth.
Scan the tooth and mouth. The scanner looks like a big wand or pen. It takes thousands of pictures of your teeth to feed as data to computer software.
Pick a shade. Identify the shade of your tooth.
Design the crown. Using software, the algorithm will help you design the shape of the crown.
Mill the crown. The milling machine will start making the dental crown. It'll take about 30-45 minutes for it to be done milling.
Try in the permanent crown. Trying it in ensures it fits before you cement it.
Adjust the crown. The tightness and uneven bite will need to be corrected.
Permanently glue it in. The last step is to permanently cement or bond it.
CAD/CAM
The only way to do the dental crown procedure in one visit is by utilizing CAD/CAM which stands for computer-aided design/computer-aided manufacturing. Computer software helps in designing and making of the crown.
The entire process has 3 distinct steps:
Scanning. This takes thousands of individual photos of your teeth which get pieced together to form a whole picture.
Designing. The software will auto-generate a blue print of what the crown should look like based on the other teeth in the mouth. The dentist can alter the design as they wish.
Milling. The milling machine then proceeds to "mill" the crown but cutting and shaving down a block of porcelain right in front of your eyes.
As per our dentists in Long Island City, this new technology is nothing short of amazing. However it is not universally adopted for every office because it presents two challenges.
Expensive. All of the equipment is very expensive but did you expect otherwise?
Milling time needs to be shortened. The total time for the patient to be in the chair still comes out to be as long if not longer than the two visit crowns. You will most likely need to re-numb the patient during the treatment. They will also be sitting in the chair for close to an hour while the dentist is designing and milling the crown. Although we suppose with smartphones these days, they can just doomscroll while they wait.
Aftercare
As with all things in life, if you take care of your dental crown it can last for a very long time. Here are some tips on caring for it to ensure that you get your value's worth.
Keeping it clean
You don't have to do anything special to take care of it. We've always told our patients that they can just treat it as if it was any other tooth. That means you should brush at least twice a day for two minutes each time. You should also floss it every night and use mouthwash whenever you can.
Food restrictions
Not that you can't eat whatever you want but there are certain foods which may be detrimental to the crown. Harder foods like nuts, olive pits, ice cubes, etc can damage it. However that isn't to say that it won't damage your non-crowned teeth either because they are notorious for doing so.
It's just good practice to minimize harder foods whenever possible. You should definitely not use your crown nor teeth to open bottles. You're just asking for trouble at that point.
In case you wanted an example, Dr David Chen has a crown on his front tooth. Can you guess when was the last time he bit directly into an apple? Over twenty years ago.
How long does a dental crown last?
On average, dental crowns can last five years and up to decades. We've seen some that have been in the mouth for over 40 years! We're just telling you about some of the possibilities. Of course the really old ones don't look as good as day one but its still functional.
The longevity of it really depends on how well you take care of it.
If you eat a lot of hard foods, you may chip or crack it.
If you don't stay on top of your oral hygiene, you can get a cavity underneath of it.
Parafunctional habits such as teeth grinding and clenching can shorten it's lifespan.
Complications
Dental crowns are not foolproof because complications can arise. Here is a list of what may potentially happen and what you can look out for if you decide to have this procedure done.
High bite. If the tooth cap was made to be too big or bulky, the bite may feel off. Patients often refer to this as a high bite.
Sensitivity. Your tooth may be sore and tender for a little while after getting a crown. After all it did get shaved down in order to complete the fitting. It is also not unusual for your tooth to be sensitive to cold or biting pressure for a little while. It should go away but if it doesn't, it may need an adjustment from your dentist.
Chipped crown. Crowns are not indestructible so they can sustain damage if you bite into hard foods or use it to open bottles. Small chips can be smoothed down but large ones will need a totally new replacement.
Loose crown. Once in a blue moon, the crown can get loose and fall off while you're eating. This is because most of them are glued in and the glue can dissolve over a long period of time. If this does happen, bring the crown in to your dentist and have them place fresh glue. As long as the tooth underneath is not damaged, it is an easy fix.
Allergic to crown material. This may be very rare but there have been reported cases about patients being allergic to their crown material. You can try switching to a different type of material if this is the case.
Black line on gum line. Porcelain fused to metal crowns may result in black lines along the gums if the gums recede. This is because these crowns have a metal substructure that can show through.
Color doesn't change. You may think this isn't a problem but over time the rest of your teeth can stain and yellow. Since the crown stays the same color forever, it creates a contrast with the stained teeth. The only way to get the color to match again is by replacing the entire crown. Alternatively you can whiten the rest of your teeth.
Alternative treatment options
Unfortunately there aren't exactly alternatives to dental crowns. All of these other options are either too aggressive or not aggressive enough to treat your tooth condition. Nonetheless we'll attempt to provide some to show you what we mean.
Onlay/Inlay. Onlays and inlays aren't considered crowns. They are an in between for crowns and large fillings.
3/4 crown. These are crowns that don't completely cover the whole tooth. They are in between a veneer and a crown. You can think of veneers as 1/2 crowns.
Dental bridge. You could take the tooth out and do a bridge to replace the now missing tooth. Certainly more aggressive than crowning the tooth directly.
Dental implant. Again, you can extract the tooth and replace it with an implant instead.
Partial denture. Alternatively you can remove the tooth and get a denture instead.
Tooth extraction. Last but not least you can pull the tooth and not replace it at all.
the crown with the exception of the extraction with no replacement. However you'd be missing a tooth.
How much does a dental crown cost?
The average cost of an all ceramic crown is $1316.05 and that is according to the ADA 2022 survey of dental fees. That number is an average so it may be higher or lower depending on the cost of living in your area.
The tenth percentile fee was 1025
The 95th percentile fee was 1688
Just so that you're aware, these numbers were only taken from those who participated in the survey. It is not all inclusive of every single dental office in the United States. We also gave you the fee for all ceramic crowns because that is the most commonly used material as of right now. In the past it was PFM crowns.
The cost with dental insurance
If your insurance approves the treatment, dental crowns are often covered at 50% and are considered a major procedure. That means you will be responsible for half of the cost of the procedure while your insurance will cover the other half.
The coverage percentage depends on the plan that you chose. We've seen some that cover more and others that cover less. So what insurance plan did you sign up for?
Is it worth getting a crown?
Most of the reasons for getting a crown are due to some type of damage that has occurred to your tooth. Therefore if you have some condition that is afflicting your tooth and you need one, you should get one. Protecting and saving your tooth is well worth it.
However, in our opinion if you were simply trying to get one because you didn't like the shape or color of your tooth, then it may not be worth it. This is because there are less costly and more conservative treatment options for that.
Veneers can change the shape and color of your teeth but remove less tooth structure to do it. That procedure would be preferred over the crown. Then there is also teeth whitening which is infinitely more conservative since it causes no irreversible damage.
