Dental Crown Information and Facts
Materials, costs, and pain regarding dental crowns
- Does the material determine the price of dental crowns? No!
- Are there differences between materials with regard to durability? No!
- Can you develop an allergy to dental crowns? No!
Dental Crowns: Price
The price range of materials in the dental industry is very narrow. Low consumption plays a role in pricing because we are talking about a few grams per crown. This does not explain differences of up to several 100 € for different materials. Anybody using this as an argument is not telling you the truth! Price differences are only a matter of aesthetics. However, there is a difference when it comes to whether the dental technician prepares 10 crowns an hour or only one!
Dental Crown: Materials
The durability of a crown does not depend on the material, but on the tight marginal fit. This, in the end, depends on how precise the dentist’s work is. All materials utilized in the dental industry have a half-life that exceeds the average human lifetime by several times! More on that in the videos “Tangent Cut,” “Groove Cut,” “Step Cut,” and “Dental Crown!” Furthermore, all materials placed in patient’s in industrialized countries are subject to strict regulations; otherwise they would not be allowed to be processed.
Dental Crown: Pain
The dental crown is insulated from the tooth stump by a thin layer of cement. On the outside (facing the oral cavity), there is usually a ceramic layer. For there to be an allergic reaction, immune cells would have to be present! There are no immune cells in the tooth stump or in the cement, thus, no allergy can develop. Bleeding gingiva, burning sensations in the mouth, and gingiva recessions have nothing to do with allergies; these are caused by leaking crown edges and often and inflammation of the gums is often the result.
The Basics on Dental Crowns
If you live in an industrialized country, you don’t have to worry much about materials. Terms such as precious metal provisions, zirconium teeth, titanium, etc. are just used to hype products up and to extract more money from you, and this unnecessarily raises the cost of artificial teeth. All materials placed in patient’s mouths are subjected to strict restrictions and are thus biocompatible. The important thing for you to think about is the function and aesthetic look of the teeth.
The teeth should always fit, meaning that the bite should be correct and the edges of the crowns and bridges should be tight. Function does not depend on materials, but on a multitude of other factors, such as whether the dentist selects the proper cut – a groove cut provides good results, a tangent cut or a step cut do not. Furthermore, success and function depend on whether the tooth impression was done properly, whether the artificial tooth was bio-mechanically well designed and, finally, what materials the dentist/dental technician are used to working with.
A technician used to producing mostly gold inlays will have a hard time with a partial prosthesis and vice versa. A technician who’s worked with steel all his life will be able to provide you with a much better partial prostheses made of steel than one made of titanium, for example. So the price difference is not really determined by the type of dental material, but by aesthetics. However, there is a difference when it comes to whether a technician produces 10 crowns/prostheses per day or just one. Recreating teeth aesthetics is a costly art.
On the tightness of dental crown margins
Apart from aesthetics, the most important aspect of dental crowns is the tightness of the margins, meaning the transition from the crown to the tooth. Leaking crowns not only lead to caries, but can also cause periodontitis – bleeding gums are a sure sign of this. The gums start to recede and bleed slightly during brushing. Leaking crown margins are often to blame.There are a number of possible ways to cut a tooth for a dental crown. The easiest and fastest way is the so-called tangent cut. The problem with this cut is that the crown margins taper off and become very thin at the bottom. This can lead to the ceramic breaking. In order to prevent this, the dental technician leaves more space at the margin of the crown, which results in unattractive, bulging edges. In order for the patient not to notice the bulging edges, the tooth is prepared in such a way that the margins simply extend below the gums.
The result is bleeding gums and easily inflammable gingiva. In some cases, a gingival pocket and a fistula develop, and the result is receding gums! Sometimes, one can detect dark crown margins that give away the artificial tooth. Not only is this annoying, but it’s also unnecessary nowadays. Where do these unattractive crown margins come from?
First of all, it must be determined whether the discoloration is caused by the tooth or the crown! Sometimes, the root of the tooth is black and shows through the gums. A crown made of pure ceramics will not be helpful in such as case! The dental root turns black after a bad root canal treatment. If, after a root canal, bacteria remain in the root canal and/or if blood enters the canal during the procedure, then the iron contained in the hemoglobin is turns into a black haemosiderin.
This alone does not necessarily lead to a dark margin seam, however. If in addition to all this you have very thin and tender gums, then the dark root of the tooth could shine through. In this case, no crown will help – only redoing the root canal with subsequent internal bleaching will help.
Most people place the highest importance on the anterior teeth – unjustly so!
Many people are missing teeth in the posterior region and most are not bothered by this because they think that the important thing is that the teeth in the front – those on the display – look good.
That is a big mistake because the posterior teeth are very important because they protect the jaw joint and the anterior teeth from overloading. Missing posterior region teeth can cause tooth aches in the anterior teeth, as well as headaches, pain in the jaw joints, and back pain due to improper burdening and incorrect wear. When the masseter muscle contracts, the lower jaw is pressed against upper jaw. The teeth meet at the occlusal plane and the lower jaw comes to a stop due to the wear of the posterior teeth. A clear gap remains between the caput mandibulae and the jaw joint socket.
The teeth in the posterior region protect the jaw joint from excessive chewing pressures by providing support. This mechanism is additionally boosted by the fact that the teeth in the posterior region are the first to make contact when biting, while the anterior teeth follow them. Because of thiz fact, the lower jaw rotates away from the jaw joint when the teeth are clenched. Therefore, the posterior teeth function as a hypomochlion and protect the jaw joint.
If the teeth in the posterior region are missing or if the occlusal plane is sunken due to dental tipping, the masseter muscle pushes the lower jaw further towards the base of the skull and the joint gap is no longer present. The jaw joint is heavily burdened. After a while, this may lead to anything from light pain all the way to jaw joint surgeries. This is why it is important to replace teeth not only frontal teeth – in the aesthetic region of the mouth– but posterior teeth as well, as this is necessary for good health.
Furthermore, the anterior teeth are overburdened after years of chewing with missing teeth in the posterior region and often, bone degradation resulting in subsequent loss of the anterior teeth is the result! A partial prosthesis can also function as a replacement for posterior teeth. You don’t always have to get implant-supported teeth as long as you can bite on that side!
You have received your crowns and now you are experiencing painWhy does toothache occur? When a crown is cut, it is inevitable that the rotating drill causes a warming of the tooth stump. In order to prevent overheating, water is used for cooling. In cases when not enough water is used and/or the pressure is too high and/or the instruments are not sharp enough, overheating of the tooth may develop anyway.
The result is inflammation of the dental nerve, referred to as pulpitis. Later on, the dental nerve dies off in most cases. As a result, a root canal must be performed. Sometimes, however, it is not the cutting of the tooth that is to blame, but the fact that the dental nerve was slowly damaged by too many procedures (e.g. through the replacement of fillings).
A crown/inlay have come off – what is to be done?
A crown or an inlay coming off the tooth by itself should not be cemented back on. The reason for the loss of the technical work (which had been executed by the dental technician), is a loss of friction between the work piece and the tooth/tooth stump. This loss of friction can have various causes:
- A bad cut
- Secondary caries leading to the collapse of walls/the stump of the tooth
- A gap in the margin that was too large from the beginning; a cement gap caused by an ill-fitting crown/inlay that led to an erosion of the cement
- A fracture in the root/tooth stump
- Any combination of the above
Although a renewed cementing procedure may achieve stability for a short time, the loss is soon repeated, because:
- in case of a falsely cut tooth stump, the cement gap continues to be overburdened, which may lead to a renewed loss of the technical work at any time
- Caries are not removed by the renewed cementing, but continue to develop; it’s only a matter of time until the next part of the tooth is destroyed
- If the crown is incorrectly designed, the cement will erode again after a certain time
This is why a lost crown/ inlay should not simply be reinserted, but completely replaced. Either:
- A different cut has to be executed
- The caries have to be removed
- Crowns that fit tightly at the margin have to be produced
Then, a new crown/inlay has to be prepared!
This post is also available in: German