What to Know Before Getting a Dental Crown

What is a Dental Crown?

A dental crown is a fitted cap that covers a tooth that has suffered damage from decay or trauma. It can restore its size, shape, and appearance. Crowns can be made from different materials, such as ceramic (porcelain), metal, or a combination of the two.

For a crown to be fitted, your tooth will be shaped for the crown, an impression will be taken to make the crown, and then the crown will be permanently cemented onto the tooth.

What are Dental Crowns Made Of? 

Permanent crowns are typically made of:

• Ceramic or porcelain, such as zirconia or lithium disilicate 
• Metals, such as gold- or silver-based alloys, titanium, or stainless steel
• Metal-ceramic or PFM (porcelain fused to a metal framework)
• Composite resin, similar to that used in dental fillings

Which material your dentist uses will depend on your needs and preferences, as well as the availability of the material. Your dentist may also have a preference for certain materials.

Over time, most dentists have come to prefer ceramic crown materials rather than metal, especially for front teeth. This is because:^{1, 2}

• Ceramics mimic the natural tooth color
• Newer, more durable ceramics continue to be developed
• Ceramics can be low-cost compared to certain metals

Of the different kinds of ceramic, zirconia is the strongest and is becoming more popular for back teeth, especially in people who grind their teeth.^{2, 3}

High-performance plastics such as PEEK and PEKK have also recently been introduced in dentistry and may be a promising alternative to zirconia.⁴

You and your dentist will have to weigh the pros and cons of these different materials. After evaluating your situation, your dentist can recommend a specific material to you.

Temporary Crowns

If your dentist uses a conventional dental laboratory to make your crown, they’ll fit your tooth with a temporary crown while the final one is being made.

Temporary crowns are often made from composite resin, acrylic, or another plastic material. They may also be made from aluminum.

These less durable materials are used because temporary crowns are generally meant to last only a few days or weeks. 

When is a Dental Crown Necessary? 

There are various reasons for someone to have a crown placed. For example, your dentist may recommend a crown to:

• Restore a broken or otherwise damaged tooth
• Cover a tooth with a large filling
• Protect a tooth after root canal therapy
• Cover the abutment of a dental implant

Generally, a crown is necessary when the tooth in question would otherwise:

• Be vulnerable to further damage or infection
• Cause pain during normal daily activities
• Not be able to function like a tooth normally would
• Affect your bite
• Detract from your smile

Benefits and Risks of Dental Crowns

Crowns are indicated (recommended) for multiple situations. However, they aren’t completely without risks, especially if they don’t fit well or your oral health is poor.

Benefits

Dental crowns provide several benefits, including:

• Restoring normal tooth shape and function
• Improved aesthetics (a better-looking smile)
• Protecting the underlying tooth from infection or further damage
• Allowing for natural underlying tooth structure to be kept (as opposed to extracting natural teeth and placing implants)

Risks

Crowns also have potential complications, especially if they don’t fit properly. These may include:

• Heightened sensitivity
• Wear or damage to the opposing teeth over time
• Chipping or breaking
• Loosening or falling out
• Allergic reactions (to the nickel in metal crowns, for example)
• Tooth decay or gum disease surrounding the crown

If you are concerned about the risks, talk to your dentist. They can determine if a crown is right for you.

How Much Do Crowns Cost?

The total cost of a crown may be anywhere from $500 to over $2,500.⁸

Here are the average costs of crowns with insurance:

• Ceramic or porcelain — $800-$3,000 per tooth
• Metals — $600 to $2,500 per tooth
• Metal-ceramic or PFM — $500 to $1,500 per tooth
• Composite resin — $400 to $600 per tooth

Certain types of all-ceramic crowns, such as CEREC crowns, are more technique-sensitive, which may contribute to their higher cost.

Insurance may cover as much as half the cost of dental crowns. However, if your crown is considered cosmetic, the insurance may cover very little or none of the procedure.

Dental Crown Procedure: What to Expect

For your crown to be placed, your tooth will need to be prepared (cleaned and shaped). Then, the dentist will make an impression so that a dental laboratory can create your crown. 

It can take several days or weeks for your new crown to come back from the lab. In the meantime, you will be given a temporary crown. When the crown arrives, your dentist will remove the temporary crown and cement the permanent crown in place. 

You can expect your crown procedure to look something like the following:

1. Initial Exam

First, your dentist will take X-rays and examine your mouth to determine if any of your teeth need crowns.

Your dentist will make sure the shade of the ceramic matches your surrounding teeth, especially for a front tooth. They may be able to show you samples of the final result. You may even be able to get custom shading done to provide a better match. 

2. Preparing the Tooth

Your dentist will need to prepare your tooth to receive the crown. To ensure a good fit, some of the tooth may have to be filed away.

Before preparing the tooth, your dentist will inject local anesthesia. They’ll begin work once the tooth is fully numb. Your dentist may place a build-up or perform a root canal if there’s tooth decay or an injury to the tooth’s pulp.

Regardless of the type of work, the dentist will try to preserve as much of the tooth as possible.

At the same time, some viable tooth structure may have to be filed down. Otherwise, a weak crown could contribute to a greater loss of healthy tissue in the long run.⁵

3. Impressions and Crown Fabrication

Once your tooth has been prepared, your dentist may use a thin cord or another tool to gently pull your gum tissue back from the tooth. This is called gingival retraction, and it provides a clear view of the tooth.

Your dentist will then make an impression of your tooth. They may use a special silicone-based putty. The process will look like this:

• First, your dentist will dispense the putty onto a plastic or metal impression tray.
• They’ll then place the trays over your teeth and ask you to bite down. You’ll need to bite down steadily for several minutes.
• Once the impression putty sets, your dentist will remove the tray from your mouth.
• Next, they will examine the impression to make sure there aren’t any air pockets or irregularities.
• If there are any problems, they will repeat the process to get an accurate impression.

Some dental offices offer digital dental impressions, which can be taken without impression putty. In this case, the process may go as follows:⁶

If the mold is sent to a lab, a physical or virtual working model of your crown will be made based on your impression.⁷ That model will then be used to fabricate the final crown from the material your dentist recommends (porcelain, metal, or a combination).

4. Temporary Crown

While waiting for your permanent crown to come back from the lab, your dentist will make a temporary crown. This will protect your tooth and prevent any tooth shifting that might make it difficult to fit the permanent crown.

When the temporary crown is ready to be placed, they’ll use a temporary dental cement to securely attach it to your tooth.

5. Permanent Crown

At your next appointment, your dentist will remove your temporary crown and replace it with your new permanent one. The permanent one may still need some slight adjustments. It must be shaped perfectly to adhere to your tooth and provide a perfect seal.

Once your dentist is sure that your new crown has a proper fit, they’ll attach it to your tooth. They’ll use a strong dental cement meant to last for years.

After securely placing your permanent crown, your dentist will check to make sure your bite remains even. In some cases, they may slightly file down the opposing tooth that makes contact with the crowned one.

6. Aftercare

After the procedure, your dentist provides instructions on how to care for your crown. Some aftercare instructions include:

• Avoid using too much pressure when brushing
• Floss regularly, but make sure to do it gently
• Don’t eat hard and sticky foods like nuts or popcorn
• Chew on the other side of the mouth
• Use an over-the-counter topical gel or a pain reliever if needed
• Visit your dentist every six months for routine cleanings and checkups

How Long Do Crowns Last?

Most crowns can last for fifteen years or more.^{10, 11} Some may not last more than a few years, however. The material, your diet, your oral health, and the location of the crown are all factors in how long it will last.

Metal-ceramic (PFM) crowns may outperform all-ceramic crowns over the long-term (8 years or more), and zirconia crowns may last longer than other kinds of ceramic.^{1, 2, 12}

Composite resin crowns tend not to last as long as other crowns.¹¹ This is why dentists use composite resin more often for temporary crowns than permanent ones.

Your dentist can estimate how long your crown will last based on your specific situation.

Summary

Dental crowns are a kind of dental restoration. They’re meant to cover an existing tooth to protect and restore its original shape.

Crowns can be made from different materials depending on your specific situation. The process of preparing your tooth and making the crown can be complex.

If your dentist recommends a dental crown, talk to them about the options and any concerns you may have.