What is a crown?
Crowns are an ideal way to rebuild teeth which have been broken, or have been weakened by decay or a very large filling. The crown fits right over the remaining part of the tooth, making it strong and giving it the shape and contour of a natural tooth. Crowns are sometimes also known as 'caps'.
Why would I need a crown?
There is a number of reasons. For instance:
the tooth may have been weakened by having a very large filling
you may have discoloured fillings and would like to improve the appearance of the tooth
you may have had a root filling and a radix post inserted and a crown will protect the tooth
you may have had an accident and damaged the tooth
a crown is an abutment tooth in a bridge
What are crowns made of?
Crowns are made of a variety of materials. Here are some of the options available at present:
Porcelain bonded to conventional metal: this is what most crowns are made from. A metal base is made and layers of porcelain are then applied over it. Good mechanical resistance and good aesthetic (metal is not visible)
New full porcelain (zirconium crown - e.g. PROCERA or LAVA): these crowns are very strong and they look very natural. This is the top quality reconstruction so the best mechanical properties combined with excellent aesthetic
Conventional full porcelain and composite: conventional porcelain (e.g. EMPRESS) and composite resin materials can sometimes look the most natural. However, these crowns are not as strong as bonded metal crowns or Zirconium crowns.
Porcelain bonded to titanium: these crowns look very natural, they have excellent durability and are usually used over the implants
Precious metal (gold and palladium): these crowns are very strong and hard-wearing, but are usually used at the back of the mouth, where they are not visible.
How is a tooth prepared for a crown?
The dentist will prepare the tooth to the ideal shape for the crown. This will mean removing most of the outer surface, and leaving a strong inner 'core'. The amount of the tooth removed will be the same as the thickness of the crown to be fitted. Once the tooth is shaped, the dentist will take an impression of the prepared tooth, one of the opposite jaw and possibly another to mark the way you bite together. The impressions will be given to the technician, along with any other information they need to make the crown.
Who makes the crown?
The impressions and information about the shade of your teeth will be given to a dental technician who will be skilled in making crowns. They will make models of your mouth and make the crown on these to be sure that the crown fits perfectly.
Will the crown be noticeable?
No. The crown will be made to match your other teeth exactly. The shade of the neighbouring teeth will be recorded, to make sure that the colour looks natural and matches the surrounding teeth. A temporary crown, usually made in plastic, will be fitted at the end of the first appointment to last until the permanent one is ready. These temporary crowns may be more noticeable, but they are only in place for about two weeks.
How long does the treatment take?
You will need to have at least two visits: the first for the preparation, impression, shade taking and fitting the temporary crown, and the second to fit the permanent crown.
Does it hurt to have a tooth prepared for a crown?
No. A local anaesthetic is used and the preparation should feel no different from a filling. If the tooth does not have a nerve, and a post crown is being prepared, then local anaesthetic may not be needed.
Are post crowns different?
Post crowns may be used when the tooth has been root filled. The weakened crown of the tooth is drilled off at the level of the gum. The dentist makes a 'post' to fit into the root canal. This can be either prefabricated stainless steel, custom made of gold/titanium or glass fiber. One end of the post is cemented into the root canal, and the other end holds the crown firmly in place.
How long will a crown last?
The life of a crown will depend on how well it is looked after. The crown itself cannot decay, but decay can start where the edge of the crown joins the tooth. It is very important to keep this area as clean as your other teeth, or decay could endanger the crown. Properly cared for crowns will last for many years - your dentist will be able to tell you how long.
How are crowns fixed to teeth?
Once the fit and appearance of the crown has been checked - and approved by you - it will be cemented in place with special dental cement. The cement also forms a seal to help hold it firmly in place.
Will the crown feel different?
Because the shape of the crown will be slightly different from the shape of you tooth before it was crowned, you may be aware of it to begin with. Within a few days it should feel fine, and you will not notice it. The crown may need some adjustment if it feels higher than the surrounding teeth. If it is at all uncomfortable ask your dentist to check and adjust it.
Why should I replace missing teeth?
Your appearance is one reason. Another is that the gap left by missing tooth can mean greater strain on the teeth at either side. A gap can also mean your 'bite' is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both decay and gum disease.
How are missing teeth replaced?
This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision. There are two main two ways to replace the missing teeth. The first is with a removable false tooth or teeth - a partial denture. The second is with a fixed bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.
Can I always have a bridge to replace missing teeth?
Yes, if you have enough strong teeth with good bone support and the distance between the core teeth is not too long. Your dentist will help you decide which is the best way of replacing the teeth within your budget.
What are bridges made of?
Bridges are usually made of a precious metal base or zirconium porcelain. Sometimes, there are other non-precious metals used in the base to reduce the cost.
Are bridges expensive?
Although a bridge may seem expensive it will last many years. It will also improve your appearance and bite. A bridge uses the considerable skill of the dentist and technician, and in this way, it's similar to ordering a piece of hand-made jewellery. The costs of the bridge also depends on the kind of materials used.
How should I look after my bridge?
You need to clean your bridge every day, to prevent problems such as bad breath and gum disease. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach.
Are there other methods for fixing false teeth?
There are other methods, such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight. These are quite specialised dentures, so you should ask your dentist about them. You can also have teeth implanted, ask your dentist for more information. Remember that it's as important to care for your remaining teeth as it is to replace the missing ones.
Are there different types of bridge?
Yes, there are different types of bridges which use different fixing methods. Your dentist will choose the most effective and conservative bridge for your personal situation.
What are veneers?
The principle of veneers is similar to that of placing false fingernails. Veneers are laboratory-constructed custom-made facings, which are mechanically bonded to the tooth surface.
How will my teeth look like with veneers?
Veneers provide excellent aesthetics because the lab can actually incorporate characteristics such as greater opacity and special stains and colours that allow an almost perfect match to your own tooth structure.
What are the advantages of veneers, compared to fillings?
One of the most exciting techniques in cosmetic dentistry today involves bonding a thin veneer made of porcelain to the etched enamel tooth surface. The primary advantages are the beauty, durability and flexibility of the material. Because porcelain doesn't stain like composite resin, it remains attractive for a much longer period of time. In addition, gum tissue tolerates porcelain well, thus reducing the likelihood that gum problems will develop.
When should I have veneers?
With the correct preparation veneers can be used to give a straighter appearance to crowded teeth, close gaps and spaces, cover stained teeth and fillings and generally brighten and improve your smile.
What are dental implants?
A dental implant is a titanium metal rod which is placed into the jawbone. It is used to support one or more false teeth. In practice, both the false teeth and their supporting rod are known as 'implants'.
Are implants safe?
Implants are a well-established, tried-and-tested treatment. 90 per cent of modern implants last for at least 15 years.
I have some of my own teeth. Can I still have implants?
Yes. You can have any number of teeth replaced with implants - from one single tooth to a complete set.
Can implants always be used to replace missing teeth?
It depends on the state of the bone in your jaw. Your dentist will arrange for a number of special tests to assess the amount of bone still there. If there is not enough, or if it isn't healthy enough, it may not be possible to place implants without grafting bone into the area first.
Do implants hurt?
Placing the implants requires a small operation. This is carried out under very effective local anaesthetic. You will not feel any pain at the time, but you may feel some discomfort during the week following the surgery. This is usually due to having stitches in place, and the normal healing process.
Can I have the new teeth straight away?
No. The implants need to bond (integrate) with the bone after they have been placed. This takes at least 3-4 months in the lower jaw and 6 months in the upper jaw. If you are having one, two or three teeth replaced, you will have a temporary restoration in the meantime. If you have complete dentures, then you can wear them throughout the healing period once they have been adjusted after the surgery.
What implants do you use and how long does the treatment take?
We use Nobel Biocare (Sweden) or 3i (USA) implants. In March 2006 we received the authorization of the best-known and the biggest implant producer - the Swedish company Nobel Biocare. This was the first company which placed implants 40 years ago. This company pays attention to a continuous development of technologies and is still modernizing its products. Nobel Biocare implants have a 10-years quarantee which is accepted by all authorized dentist's offices in the world. In April 2007 we introduced the 3i system. These implants have a 5-years quarantee which covers not only defects in the material or mechanical damages but also loss of the implant. This quarantee is also accepted by all authorized dentist's offices in the world.
How long does the treatment with implants take?
First visit - approximately 7 days (weekend included). After the first visit we need to wait at least two months, this is the healing period. The patient receives a temporary denture or uses his own denture during this time. After approximately 3-6 months it is possible to come for the second visit which takes 7 - 10 days (weekends included). During this visit crowns are put on the implants and the work is finished.
How much can I save?
For example let's take the case of a patient from the UK who needs to have 6 Nobel Biocare implants placed. (Nobel Biocare implants are one of the best implants in the world, we possess the authorization of this company). In the UK he has to pay 12 000 £ for 6 implants (2 000 £ for each implant). In our clinic he pays only 3750 £ for 6 exactly the same implants (approx. 625 £ for each implant). The dentist in the UK charges 8250 £ more than our experienced surgeon. The placing of the 6 implants takes approx. two hours.
Why are there so huge price differences in Europe? If it is cheaper in Germany than in the UK does it mean that the British use better materials?
No, the prices in countries depend in principle on two factors. The first factor is the wealth of the given country. Because the citizens of the UK, Ireland and Switzerland are one of the richest citizens of the European Union the dental services are there very expensive. The second factor is the amount of dentists in a country. It is commonly known that there are few dentists in the UK, for example much fewer than in Germany, thats why the patients have to wait very long for a visit and the dentists are very busy and increase the prices.
Let's analyse another example, this time from Germany. Some time ago a very nice patient from Germany came to our clinic. She requested the most expensive crowns in the world - the Swedish PROCERA crowns. One such crown costs in Munich approx. 2000 - 2500 €. The same crown costs in our clinic 500 €. For ten crowns she would have to pay 20 000 € in Munich but she paid only 5000 € in our clinic. What is interesting, is the fact that these crowns are neither made in Germany nor in Poland. The dentist prepares the teeth for the crowns, after this the scan of the situation is sent electronically to a laboratory in Sweden and after a few days crowns are delivered from Sweden. The preparation for these crowns isn't easy and take approx. 20 working hours. It is easy to count that for these 20 hours of work the dentist in Munich takes 15 000 € more than we and when we take 5 000 €, we also make a profit on it. This example shows clearly that the prices of dental services when using the same materials can differ on several hundreds per cent in countries that are only several hundreds kilometers away from each other.
Are the teeth difficult to clean?
Cleaning around the teeth attached to the implants is no more difficult than cleaning natural teeth. However, there may be areas that give you problems and you'll be shown methods to help.
If I had gum disease when I had my own teeth, will I get it with the teeth attached to the implants?
Yes, if you don't care for them well enough. If you keep them clean, and don't smoke, then you should not have any problems.
Can I take the teeth out if they are fixed to implants?
Most artificial teeth attached to implants can only be placed and removed by the dentist. However, if you have complete dentures fixed to the implants by bars, then you'll be able to take them out for cleaning.
Do the implants show?
Your dentist will make sure that the implants won't show during all normal movements of the mouth and lips. You will need to be able to see them, so that you can clean them properly.
Do I have an implant for each missing tooth?
No, unless you're only having a single tooth replaced. Normally, five or six implants are used to replace all the teeth in one jaw, as each implant can usually support two teeth. For a few missing teeth, two or three implants may be used.
What if I get hit in the face?
Implants and the teeth they support can be damaged by an accident in the same way that natural teeth can. However, if the false teeth are damaged and the remnants are left in the bone then they may be more difficult to remove than natural teeth would be. After healing, new false teeth can then be placed alongside the fragments.
What happens if the implant does not bond (integrate) with the bone?
This happens very rarely. If the implant becomes loose during the healing period or just after, then it is easily removed and healing takes place in the normal way. Once the jaw has healed, another implant can be placed there. Or, the dentist can make a bridge, using the implanted false teeth that have 'taken'.
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