About Crowns and Bridges

A crown is recommended for anyone who has a tooth that is beyond repair with a filling, inlay or onlay. Damage due to decay, accident, wear, or grinding can be repaired with crowns. It should be noted, however, that more conservative techniques in cosmetic dentistry, such as veneers, inlays, onlays, bonding, and bleaching have replaced some of the instances when crowns were used in the past to achieve esthetic goals.

A bridge is recommended for anyone who has a tooth missing. Like crowns, bridges are also being used less often, as implants are becoming a very popular means of replacing one or more lost teeth. However, for your particular situation, a crown or a bridge may be the best and most cost efficient method of getting back a functional, attractive smile after tooth damage.

Other important information

When making a decision between a bridge and an implant, note that the teeth flanking the bridge, which are healthy and whole, must be reduced in order to receive the bridge structure. These alterations are not necessary if the missing tooth is replaced with an implant.

Risks and Limitations

The placement of any restorative fixture in the mouth brings a risk of breakage, especially if care is not taken to avoid chewing things such as ice, popcorn kernels, or olive pits.

Furthermore, depending on the materials used to manufacture the fixture, there is a greater or lesser risk of breakage. As strength is often traded for esthetics, this issue should be discussed with your dentist when selection of the materials to be used is made.

Costs

The average cost of a single fixed bridge depends on the number of teeth you are replacing, with each crown or artificial tooth termed a "unit." Bridges usually run about $600-$1200 per unit, depending on the difficulty of your case, the material used and the geographic location of the laboratory used. The average cost of a single crown is $600-$1500. However, the price may vary depending on the difficulty of your case, material of the crown used and the geographic location of the laboratory.

Questions to ask your doctor:

Is a crown the most conservative measure that will restore my teeth or could veneers, bonding, or bleaching achieve the esthetic effect I am looking for?

Do you recommend a bridge or an implant to replace my missing teeth?

What are the different materials my crown or bridge could be made of and what are the relative strengths, appearance issues, and cost of each?

Are my expectations realistic?

Is there an alternative treatment that I should consider as well?

How long will the procedure take and how many appointments will be necessary?

What kind of anesthesia is used, if any?

How much does it cost?

What is your experience in performing this procedure and do you enjoy doing it? (How long has he/she performed this procedure, and how many in the past year?)

What percentages of patients have had significant complications? (The dentist should disclose this information to you.)

Will you repeat or correct procedures if it does not meet agreed upon goals?

And if the procedure must be repeated / corrected, will I be charged again? (The dentist should provide you with his/her policy on this issue.)

May I see "before and after" photos of recent patients? (The dentist should provide photos of recent patients.)

Could I observe the exact procedure I am considering before I decide to have it done? (Either on videotape or ask to view one in real life.)

What should I expect after the procedure, in terms of soreness, what to watch for, and any limitations?

Do you offer patient financing?

What are the most common benefits of this surgery?

Crowns and bridges are two restorative techniques that repair damaged or missing teeth. They restore tooth function and appearance. The use of crowns and bridges also avoids shifting teeth that can happen after a tooth is lost. By maintaining or restoring the patient's bite and their smile the effects of the tooth damage or loss are reversed.

What will happen at the initial consultation?

At the initial consultation your dentist will determine where the cause of your tooth problems lie. If a tooth is damaged, fractured, or decayed beyond repair, a crown may be suggested. If a tooth needs to be extracted, or has already been removed, a bridge may be the solution. The different approaches to solving your dental problems will be presented during the initial consultation and you can decide what is best for your dental goals and your pocketbook. One important decision if a crown or bridge is needed, is the material the laboratory will use to make the appliance. The replacement tooth or tooth portion can be made from different types of material, such as a metal base covered with a layer of tooth-colored material (often porcelain), or all porcelain for those not wanting metal. Metal restorations, such as gold crowns, are usually only used when the tooth is not visible. An advantage of a gold crown, though, is the relatively minimal tooth reduction that needs to take place to support it. Porcelain bonded to metal crowns are more esthetically pleasing than metal alone, although the metal layer reduces the translucency of the crown. The resulting crown is very strong but the tooth must be reduced slightly more to support this type of restoration. A final possible material choice is full porcelain, which can be made to be indistinguishable from a natural tooth. But the natural look does have a price, in that full porcelain crowns are slightly less strong than those that use metal and can be more expensive.

How is the procedure performed?

The procedures for making and fitting a crown or a bridge are very similar. Both require two trips to the dentist's office. During the first trip, the tooth or teeth that will be crowned will be reduced, that is, prepared to support the crown structure. This involves removing the 1-2 millimeters of tooth structure. Of course, if the tooth damage is the reason for the crown, that is the part that is removed. The reduction process leaves a thimble shape that will receive the crown or crown ends of the bridge. An impression is made of the reduced teeth and a temporary crown or bridge is put in place to function while the final bridge or crown is being made. The laboratory uses the impression to custom make the final restoration. It is important that the crown or crowns of a bridge fit exactly to avoid decay in the future and provide good function of the artificial teeth. During the second trip, the temporary crown or bridge is removed, the area cleaned, and the final crown or bridge is cemented or bonded into place.

How long does the procedure take?

The first visit to the dentist will be about one hour. If all goes well with the fitting, the second visit is slightly shorter, about forty-five minutes, but this could be longer if adjustments need to be made in the fit.

Where will the procedure be performed?

Both steps of the procedure are preformed in the dentist's office. If a custom shade is necessary due to various shades in the tooth, the dentist may request you visit the lab for a better match.

How much pain is there?

Because of the administration of local anesthesia, there is no pain during either of the two visits for getting a crown or a bridge. After the restoration is placed in the mouth, it is not unusual for the teeth receiving the new crowns to be mildly sensitive to extreme temperatures for several days following the treatment. If the sensitivity is severe - or if your bite feels uncomfortable you should contact your dentist because further adjustments to the bridge or the crown might be necessary.

What can I expect after the procedure?

One problem that can occur between the two procedures is a loosening of the temporary crown. If this should happen to you, place the crown back on your tooth immediately and as soon as possible call for an appointment to have the temporary crown refitted. It is important to act quickly as the surrounding teeth might move, significantly affecting the final restoration.

What is the recovery period like?

With bridges or crowns, recovery is quick, with teeth feeling back to normal within a day or two. If the teeth remain sensitive for a period longer than this, or there is pain that cannot be controlled by over-the-counter medication, you should return to your dentist. Further adjustments may need to be made with the crown or bridge placement. Because bridges can be great traps for food, it is especially important to brush, floss, and have regular visits to the dentist after it has been placed in the mouth. As the false tooth and the crown are a single, solid piece it is not possible to floss between them. Thus, you will need to use a special flossing tool called a floss threader to go under the false tooth and keep this area of the gum healthy.

What is the long-term outcome like for most people?

With care, crowns and bridges last 5 - 15 years, some significantly longer. If any damage is noticed to the structure of the crown or bridge an immediate trip to the dentist is recommended to avoid further damage due to the weakened structure.