Treatment
Dental Crowns in Mesa, AZ
A tooth has cracked, or worn down, or is more filling than tooth by now, and you would rather keep it than lose it.
A crown caps what is left of the tooth, so your bite loads the cap rather than the weakened walls underneath. It is not always the right answer, and you will hear that if a filling or an onlay would do.
The treatment
What a crown actually is
A filling replaces the part of a tooth that has gone. A crown replaces the outside of it. The tooth is reshaped (reduced around all its sides and on the biting surface) and a cap is made to fit over what is left and cemented on, so that the crown takes the force of your bite instead of the weakened tooth underneath.
That is why crowns are used on teeth that have cracked, worn flat, had root canal treatment, or ended up more filling material than tooth. In each of those cases the problem is not a hole that needs plugging. It is that there is no longer enough sound structure around the outside for the tooth to hold itself together under load, and covering it moves that load off the walls of the tooth and onto something built to take it.
What it costs the tooth, said plainly
Preparing a tooth for a crown removes healthy tooth structure, and you do not get it back. From that point the tooth will need a crown, or something like one, for the rest of its life, and replacing a crown years later usually means taking a little more.
That is not an argument against crowns. It is an argument for only crowning a tooth that needs it, which is a conversation worth having before anything starts rather than afterwards.
What crowns are made of
In general terms there are four families, and the right one depends on where the tooth sits, how hard you bite and how much room there is.
- All-ceramic and porcelain. The closest match to a natural tooth, because light passes through them in a similar way. Usually the choice for teeth that show.
- Zirconia. A very strong ceramic, often used on back teeth where the bite is heaviest. Less translucent than porcelain.
- Porcelain fused to metal. A metal core with porcelain over it. Strong and long-established, though a dark line can appear at the gum over the years as gums recede.
- Gold and other metal alloys. Thin, durable and gentle on the tooth biting against them. Appearance is the only reason they are not used more often.
Living with it afterwards
A crowned tooth is looked after like any other. Brush it, floss it, and pay particular attention to the margin at the gum line, because that join is where trouble starts. The crown cannot decay but the tooth holding it can, and it usually gives no warning until it is well under way.
If you grind your teeth at night, mention it. Grinding is hard on crowns and harder still on the tooth underneath, and protecting it is a conversation worth having before the crown is made rather than after it fails.
Good to know
A cap over the whole tooth, not a patch in it
Usually two visits, with a temporary in between
Means reshaping the tooth, which cannot be undone
Porcelain, zirconia, metal, or a combination
Brushed and flossed like a natural tooth
What to expect
Four stages, spread over a few visits.
01
Deciding it is needed
Before anything is prepared we look at how much sound tooth is left, and say whether a filling or an onlay would do instead.
02
Preparing the tooth
Local anaesthetic, then the old filling and any decay come out and the tooth is reshaped. The shade is matched against the teeth either side.
03
The temporary
A temporary goes on before you leave, held with a deliberately weaker cement. Chew on the other side and pull floss out sideways.
04
Fitting the crown
The permanent crown is tried in, and the fit at the gum and the way it meets your other teeth are checked before cementing.
Candidacy
Is a crown the right call?
Not always. Preparing a tooth for a crown takes away sound structure and cannot be undone, so where a filling or an onlay would hold, that is what you will be told.
A cusp has broken off, or the tooth has cracked and the walls left are thin.
There is more filling than natural tooth left holding it together.
A back tooth has had root canal treatment and is brittle under a heavy bite.
Years of grinding have worn the tooth down to the point it is losing its shape.
An existing crown has come loose, or the tooth underneath it has decayed.
“They are so friendly, professional and do not try to push treatments I don't need. I love them!”
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Common questions
How long does a crown last?
There is no fixed lifespan, and anyone who quotes you one is guessing. It depends on how much sound tooth was left underneath, how hard you bite, whether you grind, and how well the join at the gum line is kept clean. Plenty of crowns are still doing their job fifteen or twenty years on; others need replacing much sooner because the tooth beneath them decays. The cleaning is the part you control.
Do I really need a crown, or would a large filling do?
Sometimes a filling is enough, and it takes far less tooth away. What decides it is how much sound tooth is left around the outside: thick, solid walls can often carry a filling or an onlay perfectly well. Thin walls, or a tooth that has already cracked, are the case where a filling tends to act like a wedge and the crack travels. We will tell you which of those your tooth looks like, and if it is genuinely borderline we will say that rather than decide it for you.
Will there be a gap while the crown is being made?
No. A temporary crown goes on at the end of the first visit and stays until the permanent one is ready. It is fixed with a deliberately weaker cement so it can be taken off again, so chew on the other side and go carefully with anything sticky. If it does come loose, keep it and call the office rather than trying to stick it back yourself.
Does having a crown done hurt?
The tooth is prepared under local anaesthetic, so you should not feel the work itself. Afterwards the gum around the tooth is often tender for a day or two, and a tooth with a live nerve can stay sensitive to cold for a few weeks while it settles down. A tooth that has already had root canal treatment has no nerve left in it to feel anything. If you are anxious, say so at the start. It changes how we pace the appointment.
Do I need a crown after a root canal?
Often, on a back tooth. Root canal treatment hollows the tooth out, and what is left is more brittle while still taking the full force of chewing, so covering it is usually what stops it splitting later. Front teeth are a different case: they take less load, and where the access hole is small a filling can be enough. It is a judgement about your particular tooth, not a blanket rule.
Can a tooth still decay underneath a crown?
Yes. The crown itself cannot decay, but the tooth under it can, and it starts at the margin where the crown meets the gum. That is why flossing a crowned tooth matters just as much as flossing a natural one, and why we look at the margins at your check-ups. Decay under a crown is not something you can see, and it often does not hurt until it is well established.
No obligation
Ask about dental crowns
Tell us what is going on and we will call you back to arrange a time. If it turns out you need something other than dental crowns, we will tell you that too.
Prefer to talk now? (480) 547-8034
Not sure what you need?
That's okay.
Many patients come in knowing something isn't right but aren't sure what treatment they need.
We'll start with a conversation and a thorough evaluation. Dr. Sandstrom will explain what he sees, discuss your options, answer your questions, and help you decide what makes sense for you.