How Much Is a Crown? Gate Dental Clinic 091 547 592 Dr Paul Moore Dr Paul Browne One of the most common questions we get at the dental practice is: “How much is a crown?” This is difficult to answer. Its a bit like asking a “How much is a car?” The answer depends on: What do you want? What can we offer you? What standards shall we choose for you? What do you want it to look like? How long do you want it to last? What is the condition of the remainingg tooth / implant? What load or function will the neighbouring and opposing teeth be imposing on it? What is the status of the nerve and the supporting gums and bone? Not an easy answer either on the phone, by email or to be honest even when we first see you.
We have to factor in a multitude of considerations to suit your needs, your philosophy, your expectations and your budget. The truth is there are a vast range of options for you and us to consider. Our job is to try and give you the best choice and result for the resources and expectations that you have. A “Dental Crown” is a thimble which wraps around the whole surface of a tooth or dental implant to miic a natural tooth. A Dental Veneer is a partial crown which covers the usually the front surface of the tooth, but can also extend around the sides and over the biting edge. Range of Fees December 2012 : E-Max full porcelain crown 1000 euro. LAVA Glass Ceramic 70% (Lithium Disilicate / Resin 600 euro There are many techniques and material and factors which influence the successful outcome. Here we explain some of the factors and choices that you and your dentist have to make.
The “success “of the crown is dependant on many factors.
The experience and skill of the clinician, - the choice of material, the precision of the tooth / implant preperation, the impression technique ( physical or digital ), the model preperation, the design of the crown, -the choice of material, the surrounding and opposing teeth, the health of the gums, the proximity / health of the nerve of the tooth, the experience and skill of the technician, the fabrication technique, the cement, the cementation or application of the cement, the aftercare and follow up. There is a lot to consider. TYPES OF CROWN AVAILABLE All the crown below will have their applications. Choosing the correct material for the patient’s needs depends on multiple clinical factors. There is not one type fits all. Gold crown.
Made of a gold alloy. Solid metal cast by a “lost wax technique”.
Metal crown.
A variety of metals can be used with a lower gold or no gold content.
Feldspathic crown.
Feldspathic porcelain only. Usually referred to as a PJC.
Feldspathic / metal fused crown.
Metal core fused to feldspathic porcelain.
Fledspatic / Zirconium crown
Zirconium core fused to flespathic porcelain
Zirconium crown
Zirconium one piece crown
Zirconium / feldspathic crown
Zirconium core fused to feldspathic porcelain.
Lithium Disilicate crown
Reinforced solid porcelain. “E-Max”.
Lithium Disilicate / zirconium core
Zirconium core fused to “Emax”
Composite crown
A glass resin and filler material.
“LavaTM Ultimate” CAD/CAM
Resin/Zirconia Ceramic filler and resin
“Enamic” Crown
A Ceramic Polmer Composite
PREPARATION.
The outer layer of tooth structure is removed and shaped to give a thimble like shape. Any decay must be removed. The margins of the preperation contoured to best suit the chosen material characteristics of the crown to be used. We would advocate the use of “Loupes� or microscopes to aid the accuracy of the procedure and the fine finishing required to give the best results. You can only treat what you can see.
IMPRESSIONS
Physical Impressions Use a “paste-like material” that sets in the mouth. The best choice of impression material and experiance with the techniques, correct uniform thickness, dimensional stability, moisture control, smooth preperation margins, control of the gums tissues around the tooth.. ......... All will contribute to increase the accuracy of the impression.
Digital Impressions use a digital camera to capture the data electronically using infra-red wavelength camera technology. This provides instant models that can be inspected for inacuracies and if neccessary retaken there and then and captures the “Occlusion”
THE SHADE
Usually a shade “guide” will be used by the dentist to draw a little map of the distribution of colour that they choose for you. Preferably records using photography and or digital photo-spectrometry can be used to give the technician the best chance of accurately reproducing the closest possible likeness to the natural tooth that matches and blend with your other teeth.
The better the communication between dentist and technician the better the chance of your tooth matching your Matching a single front tooth to the other front tooth is considered one of the most difficult challenges in modern dentistry, Using digital photospectrometry to analysis the colour can help the technician replicate the natural tooth “colours” no matter the diference between light source that the dentist and the dental technician are working with.
Strength and Wear Fracture strength, flexural strength, abrasive resistance. Determines the “fracturability of the material. Choice of the best materials, technicians, preparation techniques and cementation will reduce the chances of fracture of the crown.
The Porcelain on this metal bonded to porcelain crown has fractured, the crown has failed. Choosing “Emax�to replace this crown will give better aesthetics and long term success.
Colour Colour is the comination of hue ( shade), chroma ( intensity) and value ( brightness). Determined by the material selection, the techniques, the transluscency, reflectivity and the communication between dentist and technician.
Colour is the sum total perception of the combination of; The characteristics, hue, chroma, value, surface texture, translucency. It is the interpretation of the brain. Patient judge the result by the blend of the “colour” to the natural teeth Porcelain bonded to metal crowns done well can be a good solution to many problems, but it doesnt matter whether it’s a high quality gold or a base metal, neither will allow the light to shine through the tooth. This creates an aesthetic / cosmetic issue that the crown cannot transmit light like a normal tooth.
Transluscency The transmission of light through the material of the crown. Ideally this would normally mimic the that of the neighbouring teeth.
Micheal had these two front crowns for many years, the darkness at the roots of the crowns and the discoloured fillings were a casuse of concern so we placed two 360degree veneers /crowns and two veneers with all porcelain high transluscency crowns.
These restorations were placed in one visit using the CEREC system. They are designed and cut from solid blocks of homogeneuos porcelain to within 45 microns tolerance of fit. This is equivalent to half the diameter of a human hair.! This customised design process gives the dentist full control over the decision process and The final characterisations applied by the dentist to blend the colours and tones to suit the individual patient.
The surface texture of the porcelain can be varied to give a “brilliance”, just as a multifaceted diamond sparkles because it reflects the light. Smooth teeth can look dull and “old”.
Surface Texture and Reflectivity The micro-anatomy of the surface and the contour of the outer surface will determine the reflectivity. Similar to comparing cut diamonds with high reflectivity, it is the dispersal of light that gives the “brightness to the tooth�
Characterisation Matching the subtleties of unique characteristic. This is best made possible in surgery by application of final tints and colours with the neighbouring tooth and the crown side by side.
Here we have mimiced the natural “mottleing� on the real teeth
The Soft Tissues The correct attention to gum contours and how they “frame� the crowns is highlighted in this Implant Case
THE TECHNICIAN. Of equal importance is the skill, the training and the experience of the technician and the rapport and communication that the dentist and technician have together. The technician has to pour a stone model ( if physical impressions were used ). He has to create the correct anatomical features to replace the lost tooth structure. He has to create a margin or fit of the crown as perfect as possible to prevent later decay. He has to contour the material to give a beneficial soft tissue response. He has to create a perfect “contact point” where the crown touches to teeth beside it. He has to make it look like a “real tooth”, in form, “colour”, translucency, reflectivity, and surface texture.
CAD CAM (eg CEREC crowns)
Usually the dentist who took the optical impression will make your crown there and then. This avoids any communication or record taking for shade etc. You are present and the dentist can compare the work in progress with the real you as he proceeds! Allow the dentist to be in sole control of the design of your crown. Here we show a right central incisor made to match the left.
CEMENTATION At the fitting of the crown the choice of the best cement relates to the material used for the crown and the remaining tooth structure. Non metal crowns can be cemented with x-ray visible cements to assist monitoring long term With advances continuously in adhesive technology and research the correct choice and application of
The Crown on the right front tooth has been present for ten years. . technique will give a greater chance of success. The choice of material, of preparation finish line (or edge of the crown) and the cements used will determine any possibilities of “Black “Lines around the edges at a later date. The margins of this all porcelain crown are not below the gum line and the cement is the same colour as the tooth and the crown. This makes it easy to clean and to watch and means the less removal of the tooth structure in a “sensitive” area of the root surface.
PRIDE We want you to be as proud of your new teeth as we are. This we can only achieve with attention to detail from start to finish. Here we show how a new smile has allowed the patient to smile again. The initial photos show worn and chipped edges with a “restricted or “gaurded”smile. One year later see how the patient lip musculature has relaxed and adapted to the new smile line.
ANTERIOR CROWNS AND VENEERS TO CORRECT WORN TEETH
FOLLOW UP
As important as all of the above is that you continue to attend preferably the same dentist or dental practice to continuously monitor the crown once fitted. To keep the gums healthy and to monitor with x rays to compare to the original. It’s worth reiterating: Non Metal crowns have the advantage that x-rays will see through the material and allow early detection of any later developing problems.
SUCCESS RATES.
How long will it last? Its a fair enough question. It depends on all the above being done as well as possible, It depends on how you treat and look after your teeth and gums. We would ask you to see the hygienist at least every 6 months. It depends on what you eat. Sugar will endo even the best dentistry, no matter the materials and care. Its depends on the skill of the dentist, the technician, the choice of materials by the dentist. It depends on your investment.
So once again, how to answer the first question. “How much do you charge for a crown?” My best answer is come and talk to us. We can listen to what you would like. We can inspect examine and assess your needs. We can advise you what your options are. We can tell you what we think would do best ad the limitations of alternatives. Given the choice we will offer you our best techniques, materials and technicians.
You can tell us what you would like to choose.