A dental implant crown is a procedure that places a tooth cap over a dental implant once it is ready to be restored. This is the part of the entire implant journey where you finally get a tooth to chew on.
Table of contents:
Overview
The implant crown looks very similar to a regular crown that you would get on any other tooth. The only difference is that it goes over an implant instead of your natural tooth. For that reason alone, it has its own separate name to help you distinguish between the two.
Material
There is no difference in the kind of material they're made of. They can come in any material that regular crowns come in.
Implant crown materials:
All ceramic like zirconia (metal-free)
PFM - porcelain fused to metal
All metal
Gold crown
The only type of material that your dentist wouldn't put on it would be the veneer type of porcelain. This includes feldspathic porcelain and EMAX crowns. It's not that you can't use them but dentists prefer a stronger type of ceramic for implants. Having it stronger is better for the longevity.
Vs Implant
Most patients think that the dental implant includes the crown which is false. We need to review the semantics of what all of the components of the entire implant system is. It technically comes in three separate components.
Implant system components:
Implant body. This is the titanium or zirconia fixture that gets "implanted" into the jaw body. Technically only this piece is called the implant.
Abutment. This is a screw-like structure that connects the implant body to the crown. Without it, the cap would have no where to sit on top of.
Implant crown. The actual tooth that goes over the entire prosthesis. Without this part, you wouldn't have a tooth to chew on or smile with.
For this article, we're mainly focused on the crown for the implant.
When can I get the crown?
After the implant gets placed into the jaw, you need to wait for the body to heal and integrate it into the bone. Essentially you are waiting for the bone to grow around it and lock it into place.
This process is called osseointegration, which can take up to 4-6 months before the implant is ready for restoration. That means there will be a waiting period before you can finally get your crown put in.
Second stage surgery
After 4-6 months, the implant will be ready for restoration but before then it needs to be "uncovered" via second stage surgery.
Your dentist will surgically reopen the gums to reveal the implant. They will then replace the cover screw with a healing abutment and place new stitches. After two weeks of healing, you can return to your restorative dentist and have the implant crown made.
Types of implant crowns
Your dentist may offer you two different options for implant crowns because there are two types, screw-retained and cement-retained.
Screw retained crown
A screw retained implant crown gets screwed into the implant. There will be no dental cement involved which means it is NOT glued in.
Since this crown gets screwed in, there will be an access opening through the top of the chewing surface. This hole is for your dentist to screw it into place. Of course once it has been inserted and torqued, they will fill the hole with a dental filling to cover it up.
In our dental practice, the screw retained implant crowns are the best option for posterior teeth. The fact that you can unscrew it if something happens is a godsend for dealing with complications. The retrievability is favored.
Cement retained crown
A cement retained implant crown is very similar to a normal tooth cap. Essentially this crown gets glued onto an abutment which gets screwed into the implant. This type will use dental glue.
This one is preferred for the anterior teeth because oftentimes it is not possible to have an access opening on the chewing surface. The downside is that if something happens to it, you need to drill the whole crown off. It lacks retrievability.
What to expect during the procedure
The dental implant crown procedure takes two visit:
Visit one - taking an impression of the implant and sending it to the lab for crown fabrication. This may take 2-3 weeks for it to come back.
Visit two - insert the crown into the implant once it comes back from the lab.
First Visit - Implant impression
This appointment may be ever so slightly uncomfortable but we've never had to numb any of our patients for it. You may feel a light squeeze or pinch here or there but nothing terrible.
The main purpose of this visit is to take an impression (mold) of the implant and choose a tooth shade. This is so that the lab can make your new tooth cap for you.
What to expect:
Unscrew the healing abutment.
Insert impression coping into implant.
Take an x-ray to make sure the coping is fully seated.
Take an impression of the impression coping.
Place healing abutment back on.
Take a counter impression of opposing teeth.
Take a bite registration.
Choose a tooth shade with a dental implant color chart.
The two photos above, one the coping screwed onto the implant and the other is what the impression with it looks like. We did an open tray impression for the implant so that the coping comes out with the impression. That is the most accurate way to transfer the positioning of the implant to the lab.
Another way to do it is with the closed tray impression technique. That is less accurate because you have to unscrew the impression coping and then re-insert it back into the impression. That extra step is a source for potential error.
Second visit - Crown insertion
Once the implant crown returns from the dental lab, it is ready to be inserted. Once again, this visit also does not require any numbing at all. The process is different depending on if the cap will be screw retained or cement retained.
What to expect for a screw-retained crown insertion
Remove healing abutment.
Screw in the crown.
Adjust the contacts.
Fill the access hole with PTFE/Cavit/PVS and then over that with composite filling.
Adjust occlusion and polish.
If you prefer a video, we've created one on the insertion of a screw retained implant crown on a stone model. It's just to give you a visual idea of what to expect for this procedure.
What to expect for a cement-retained crown insertion
Remove healing abutment.
Screw in the abutment.
Try in in the crown and adjust contacts if necessary.
Cover the abutment screw hole with material of choice.
Cement the crown with dental glue.
Adjust occlusion and polish.
Aftercare
The wonderful thing about aftercare for an implant crown is that you don't need to do anything special to take care of it. You can simply treat it as if it was any other type of crown or natural tooth for that matter.
You brush it and floss it just like any other tooth in the mouth. You can chew with it and speak with it as if it was your natural tooth. Although we do recommend avoiding chewing extremely hard foods like bones or crab legs with it. It's not that you can't but you do risk damaging the crown if you do. As a matter of fact, those foods will damage your natural teeth as well so it's just good practice to not do it.
How long does it last?
The longevity of dental implant crowns are very good since the survival rates are fairly high. There are 10 year survival studies on it which means that they can last at least a decade if not longer. The study followed 89 patients who had a total of 179 implants.
The three types of implants in the study:
112 hollow screws
49 hollow cylinders
18 angulated hollow cylinders
Implant Type | 10 year survival rate |
|---|---|
Hollow screws | 95.4% |
Hollow cylinders | 85.7% |
Angulated hollow cylinders | 91.7% |
In summary based on the survival rates over a period of 10 years, we can say that implants can last a very long time. Your shoes and car tires don't even last that long. It's a good investment in our book.
Complications
Implants may be immune to tooth decay but it it can still succumb to other diseases.
Loose crown. It can fall off or it can get loose and wobble around. If that happens you may need it reglued or tightened.
Broken crown. Eating hard foods can chip it or even crack it.
Implant failure. The success rate for this procedure is over 96% and hopefully you're part of the statistic. However that means about 4% of all cases do fail and we've seen it happen.
Peri-implantitis. Sometimes the gums around the implant can get infected with an abscess and become swollen. Pus oozing out of the area is a tell-tale sign.
Infection. The titanium screw may not get cavities but the bone and gums around it can always get infected if you don't keep it clean.
Discomfort with restoration. Sometimes it may feel uncomfortable after you get your new crown. There is an adjustment period but if it persists for more than a week, you may need a follow up appointment with your dentist.
Gum pain. The new implant crown can place a lot of pressure into the gums which may cause it to hurt for the first few days. This does self-resolve after a few days.
Screw showing. Implant diseases include bone loss around the implant which will result in the screw threads being visible.
Cost
The average cost of the implant crown is $2632.05 without insurance and that includes the abutment and the crown. The crown by itself is non-usable without the abutment which is why the fees need to be taken into consideration together. They work together so the total is what both combined would be.
Breakdown of the total cost:
Cost of abutment = $954.66
Cost of crown on abutment = 1677.39
If you wanted the dental billing codes (CDT) for them:
Abutment is D6057
Crown is D6066
The total cost of the abutment with the crown is $2632.05 ($954.66 + $1677.39). These numbers were from the ADA survey of fees. That is a national survey for dentists across the US. Of course it isn't inclusive of every office but only the ones who've responded.
Cost with insurance
With dental insurance, the coverage for this procedure is typically at about 50% coverage. That means your insurance will cover half of the cost while you'll be responsible for the rest. You can expect to pay about $1316.02 for the dental implant crown with abutment if you have insurance.
Alternatives
The only alternatives to replacing a missing tooth would be either a dental bridge or partial dentures. The former is a fixed replacement while the latter is a removable replacement option.
Dental bridge. By shaving down at least two adjacent teeth, you can connect multiple crowns to replace a single missing tooth. This procedure is less conservative than an implant in that it sacrifices the adjacent teeth.
Partial denture. A removable replacement option that you can take in and out of your mouth at all. This is by far the least expensive replacement option but also the least desired.
Finances always plays a role in the ultimate decision but if it wasn't an issue, our dentists in Long Island City believe that everyone would probably opt for the implant.
