When do you need a dental crown or dental cap?
Sometimes it is obvious that you need a dental crown and other times it is more of a preventive action and is highly subjective. A dental crown covers a tooth and restores it to its normal shape and size. We can use them together with other dental crowns to bridge an area that is missing a tooth. A dental crown also covers a dental implant. The most common reasons for getting a dental crown are
- Tooth has a large filling and has broken
- When a tooth has a large filling and now has more decay
- Tooth has a large filling and deep fractures (not superficial cracks – often hard to know if crack is deep or not so this is subjective)
- When a tooth has cracked tooth syndrome – basically means it hurts when you bite on it wrong. May need to have a root canal as well.
- A tooth that has a root canal or is getting a root canal (front teeth often do not need a crown even with a root canal, more on that here)
- Tooth has very little actual tooth structure left that isn’t filling and is starting to appear weak – this is preventive and subjective so tough to say when the “right” time to crown is
Steps to getting a dental cap
The day of the procedure you will get numb, although rarely a tooth with a root canal will not need numbing. We will shape the tooth with a dental bur into a circular stump by reducing .5-2mm in every direction. A dentist will remove all decay or existing unstable filling material. The dentists may need to build back up some of the tooth if too much of the tooth is missing. We use a flowable material to take an impression or a camera looking device will take a digital impression.
A milling machine in the office may make your crown while you wait or we will send an impression to a lab. Not all teeth can be made on site as the machines we use in dental offices are not as strong or capable as the ones they use in large dental laboratories. If we choose to make the crown in the lab, we will make a temporary dental crown to cement on.
At the next visit we will put the final dental crown on your tooth. There is usually a short adjusting that we need to do to fit the crown precisely. Usually we take an x-ray to confirm a proper fit.
Dental crown options
If you are getting a dental crown (dental cap) with today’s technology you have 1 of 3 options.
- Full gold crown non-esthetic won’t break but wears small amount reduction needed .5-1mm
- Porcelain fused to metal esthetic strong medium reduction 1.5mm
- All Porcelain highly esthetic strong medium reduction 1.5mm
- All Zirconia type of porcelain esthetic strong small reduction .5-1mm
Dental crown choice information
The vast majority of crowns done in the U.S. used to be porcelain fused to metal, although with advances in materials more and more are all porcelain. We likely have already passed the point at which all porcelain crowns have passed porcelain fused to metal in the US. At our office we have moved on to doing a majority of the crowns in all ceramic; mostly with a material called lithium disilicate (e.max) OR yttrium-stabilized tetragonal zirconia polycrystal (Bruxzir). An example of how Dr. Bauer treats teeth on a jaw is below = Zirconia crowns on the molars and emax crowns everywhere else.
The farther back in your mouth a tooth is the more force that you put on that tooth and the stronger it needs to be. If you are a grinder or a clencher you will want a stronger crown. The main esthetic disadvantage of porcelain fused to metal crowns is the black or dark line that shows along the gum line as you get older and the gums recede a little. You can see this easily on crown #2 and just barely on crown #3 in the photos below.
We can recommend a type of crown for you but what you want is very important to us. We will not let you make a choice that has a high chance of failing/breaking. Below is a picture of three of the historically more popular options available (the older crowns are not all-ceramic). This dentistry is Dr. Dettmer’s (1-3) and Dr. Bauer’s (4) over a significant number of years. There are four crowns on these teeth. 1 full gold crown 2 and 3 are porcelain fused to metal and 4 is all-ceramic dental crown (emax).
What is the cost of a dental crown?
We charge the same fee for all types of dental crowns, around $1600 in 2019. However, the final fee depends on the condition of the tooth. Things that influence the price of the dental crown are additional procedures that we must do. Those include things like a build up or post if the tooth is badly broken down or has a root canal. Also a root canal is a separate fee as well. Some teeth are broken down so badly that they are below the bone level and to restore we must remove some bone. We call this procedure a crown lengthening. However, if you need all that you should seriously consider a dental implant.
Cost of the fees for your zip code can be found on this website.
We list the procedures by name but it is easier to put all the codes in at once. Codes to look up
- A dental crown code is D2740
- A build up code is D2950
- The dental code for a post code is D2954 (We do not use this one that often)
- A molar root canal (the most expensive) is code D3330
- Crown lengthening code is D4249
What can go wrong when getting a dental crown?
There may not be enough tooth left to save. Unfortunately, sometimes the dentist does not discover this until after beginning the work. The tooth could end up hurting and needing a root canal. Your tooth nerve can handle the trauma from the relatively slow growing cavity or crack, but us removing all that decay and tooth structure at once is too much trauma. The combination of the slow growing crack or decay and then the dentist drilling can send a tooth that was borderline, over the edge and require a root canal.
A tooth that is badly cracked may get a crown and root canal and still hurt! We may need to extract it after all of that is done. This does not happen very often but a cracked tooth is very difficult to diagnosis accurately due to inconclusive information that the patient feels.
How long does a dental crown last?
The above link is research that answers that question. Insurance will pay for a new crown every 5 years, but the expected length is considerably longer. I replace any dental crown that doesn’t make it 5 years at no cost, as it rarely ever happens. We expect our dental crowns to last at least 20 years and kind of expect that many will be there when the person passes away or the tooth is lost due to other reasons.