What are Dental Crowns?
In dentistry, a crown is the surface area of a tooth covered by enamel. After a tooth breaks, chips, or fractures, a dentist applies an artificial dental crown. Crowns are tooth-colored, gold, silver, or metal caps that fit over damaged teeth to restore their natural function, shape, and look. They consist of metals, ceramics, porcelain, or composite resin. Dental technicians custom make crowns for each patient to ensure they blend in with the surrounding, natural teeth. To determine the best option, a dentist considers the following factors:
- Location and function of the tooth.
- The position of gum tissue.
- How much of the tooth shows when smiling.
- The colors and shades of surrounding teeth.
- Any signs of clenching or teeth grinding, which determines the crown material used.
In a survey conducted by the American Academy of Cosmetic Dentistry (AACD), implant crowns were the most common dental procedure patients received in 2013 (74 percent). Participants could select as many procedures as applicable:
“40 million Americans (1 in 3 adults) need to replace one or more teeth.”
When is a Crown Needed?
Dental crowns serve many different functions. For example, dentists frequently use crowns to restore common dental conditions, such as:
- Weak Teeth — crowns protect weak teeth, typically caused by severe decay.
- Cracked Teeth — crowns hold together parts of cracked teeth and restore their natural shape, function, and look.
- Worn Down Teeth — crowns restore broken or severely worn down teeth, typically caused by bruxism (teeth grinding) or dental erosion.
- Large Fillings — crowns cover and support teeth with large fillings that have little remaining tooth structure.
- Tooth Discoloration — if teeth are severely discolored, tooth-colored crowns are often used to cover the discoloration. Other options include veneers or tooth whitening.
The fabrication and placement of a crown is the last step in a dental implant procedure. Implants, also known as artificial tooth roots, are invasive dental procedures that take a few months to fully complete. Patients receive implant treatment after a tooth extraction or tooth loss, typically caused by:
- Severe Tooth Decay
- Periodontal Disease
Implant Procedure: Firstly, a dentist drills holes into a patient’s jawbone and positions the implant (post) into the socket. Implants mirror the shape of a screw and consist of materials that bond naturally with the bone. Secondly, the dentist places abutments (implant support posts that are positioned above the gums) after several months of healing. Lastly, a temporary cap is placed on top of the post for a few months until the healing process is complete.
Role of Crowns: A dental crown sits on top of the abutment (in replacement of the temporary cap) and is the only visible part of the implant. Crowns are completely custom and restore the shape, look, and function of natural teeth. In addition, dental implants last longer than traditional crowns because they cannot get recurrent decay. For healthy patients who prioritize dental care, they should last forever.
The fabrication and placement of a crown is the last step in a root canal procedure, also referred to as endodontic treatment. In other words, they cover root canal treated teeth. Endodontic treatment restores infected dental pulp in a damaged or decayed tooth’s root, which eliminates the need for extraction. The process is different from a dental implant because a tooth’s root is restored, rather than replacing it with an artificial root and abutment. The placement of a crown is easier and doesn’t require as much healing time.
Root Canal Procedure: During the procedure, an endodontist or general dentist makes an opening through the natural crown, removes the dental pulp using small instruments, and then places a temporary filling on top of the tooth.
Role of Crowns: After the treatment is complete, a patient visits their dentist to have the tooth properly restored. The most common restorative treatment option is a dental crown. Fillings are also used if the natural crown has enough tooth structure remaining.
Retainers (crown look-alikes) fit on each end of a dental bridge and act as an anchor. There are four different types of bridges, including traditional, cantilever, Maryland, and implant-supported bridges. All bridges, except Maryland, use retainer crowns on the teeth bordering the space being filled in with replacement teeth (called pontics).
Dental Bridge Procedure: Traditional bridges consist of one or more fake teeth (pontics) that are held in place by crowns. They typically fill in the gap between one or more natural teeth on both sides. In addition, bridges are very durable and can also replace molars.
Role of Crowns: Dentists bond retainer crowns onto the abutment teeth, adjacent to the missing tooth. In order to support the force of chewing on the fake tooth in between them, crowns always cover traditional and cantilever bridges.
Types of Dental Crowns
The most common restorations for fixed crowns and bridges use combinations of porcelain and metal. When porcelain and metal are heated together, the porcelain chemically fuses to the oxides on the metal, which creates a durable bond. This type of crown is stronger than regular porcelain because a metal structure supports it. They also blend fairly well with the shape, look, and function of natural teeth.
Metal Crowns & Gold Alloys
Metal crowns come in a few different forms and colors. They provide a strong bond, are fracture-resistant, and do not wear away teeth. These crowns typically consist of gold, copper, and other metals. Some are non-noble metals that are extremely strong and corrosion-resistant. Crowns require the removal of tooth structure before placement. Although, metal-based crowns require the least amount of removal, making them a more conservative option.
Stainless Steel Crowns
This special type of crown is extremely durable and typically restores a child’s primary (baby) teeth. A dentist places it after pulpotomy treatment (removal of a portion of the dental pulp) or when normal cavity fillings, such as amalgams, pose a high risk of failure.
Cosmetic Crowns (Ceramic)
Ceramic refers to crowns made of porcelain. In dentistry, porcelain is used to create tooth-colored dental materials, such as cosmetic crowns, that mimic the look, shape, and function of natural teeth. Cosmetic crowns restore anterior (front) teeth and blend in with a patient’s natural tooth color. They are strong, durable, and do not chip or break easily. the most common alternative to all-ceramic crowns is “zirconia,” which is actually a metal.
All-resin restorations are less expensive than metal, ceramic, gold, and porcelain crowns. Although, dentists do not normally recommend resin crowns because they are more vulnerable to fractures, wear and tear, and do not last as long. Resin is a thinner and more fragile material than other dental restorations, such as metal and porcelain. These are usually only used on a child’s decayed baby teeth, not on an adult’s permanent teeth.
Dental Crown Procedure: Step-By-Step
After a root canal or dental implant is complete, a dentist places a crown. Most dental crown procedures take one day. Many offices use CAD/CAM machines to create same-day crowns to eliminate the second visit.
First Visit — X-Ray, Tooth Reshaping, and Temporary Crown Installation
First, a dentist takes an x-ray of the patient’s jaw and tooth. Then they reshape and contour the tooth, depending on the type of crown. Since metal crowns are thinner, they require the least amount of tooth removal. Lastly, after successful tooth preparation, a temporary crown covers the tooth while a permanent crown is being made in a dental laboratory.
Second Visit — Permanent Crown
After about three weeks, a permanent crown replaces the temporary crown. A dentist ensures the crown’s color matches the surrounding teeth and fits perfectly in the patient’s mouth. Then the dentist administers local anesthesia, only if the patient requests it, which numbs the area during the procedure. A special dental cement keeps the crown in place.
Pain Maintenance — once anesthesia numbness wears off, jaw soreness is common during the first few days. Dentists recommend simple analgesic medications, such as ibuprofen, to manage the pain. This reduces discomfort and tooth sensitivity during the healing process. Common pain symptoms include:
- Gum Sensitivity
- Tooth Sensitivity
- Sensitivity to Hot or Cold Liquids
If symptoms are severe and last longer than a few weeks, patients should visit their dentist to make sure there isn’t a more serious underlying condition.
Food — while a patient’s permanent crown is being fabricated, they will get a temporary crown to protect the abutment tooth. During this transition period, avoid eating foods that could dislodge or break the temporary crown, including:
- Chewy or sticky foods, such as candy and gum.
- Hard foods, such as chips, bagels, and nuts.
- Patients should also chew on the opposite side of their mouth and avoid flossing with a temporary crown.
- When flossing with a crown, there is a specific technique to use that the dentist will demonstrate post-op.
A patient can typically return to normal eating habits after positioning of a permanent crown is complete. Although, it is important to avoid sticky foods for another 24 hours following the procedure.
Treatment Cost & Insurance
The cost of a crown depends on the type chosen. For crowns, most PPO plans pay 50% to an in-network dentist. The prices below reflect the cost of a crown without insurance:
$875-$1400 (per tooth)
Ceramic (Porcelain) Crowns
$800-$3000 (per tooth)
Metal and Gold Crowns
$800-$1400 (per tooth)
Stainless Steel Crowns
$300-$500 (per tooth)
$600-$1300 (per tooth)