Crowns & Bridges

Crowns & Bridges: More Choices than Ever

Space age materials from Composites and Metals to Super High Strength Porcelains, and Glass Ceramics cover all your needs.

Why Do I Need a Crown?

When a substantial part of your tooth’s structure is gone, damage, cracked, malformed, or mal-positioned, a Full Coverage Crown can restore it to near original or better than original condition.

A crown completely surrounds your visible tooth structure, kind of like a “thimble”  that slides tightly down the near parallel walls of the trimmed tooth. Once a good fit is determined, a “luting” or “cement” material is used to seal the gaps and margins.

All-Porcelain Crowns

Porcelain Crowns are generally held in place by cements that are very sticky or adhesive and bond the crown in place. The only way to remove them is to cut the porcelain away and destroy the crown.

Porcelain Crowns require that much more tooth structure be removed to allow room for the porcelain material. This is difficult to accomplish on small, or heavily damaged teeth or teeth where the decay extends below the gum line.

Porcelain Crowns are very hard and stay glass-like shiny for years, BUT they do not wear at the same rate as our normal teeth and fillings. As such, they start to hit “high”, or harder over time as the other teeth wear. Periodic balancing of the bite (Occlusal Adjustment) is needed to keep them from hitting too hard.

If left to develop high, hard hitting spots, Porcelain Crowns will break, or the opposing teeth will break or wear, or become tender, painful or loose, or the bone and gums may recede from the excess biting pressure over time.

All-Porcelain Crowns can be made with excellent esthetics since they can mimic the natural translucency of your teeth.

Full Cast Crowns

Crowns cast of metal that completely cover your teeth require very little removal of your natural tooth structure. This leaves a stronger base and longer life with less root breakage than more severe crown preparations.

Full Cast Crowns can best be made of Noble alloys, that is mixtures of metals that do not corrode. Gold and Palladium are common contents.

Inexpensive Full Cast Crowns are sometimes made of Chrome Alloys which suffer from an inability to be cast into very thin, exacting edges. This leaves larger gaps and ledges in the margins (bottom edges of the crown opening) which can trap food and bacteria over time. Chrome Full Cast Crowns are much harder than the natural teeth and, as such, must have the bite adjusted frequently to avoid excessive biting forces.

Full Cast Gold Crowns can be cast accurately to razor thin margins for a very smooth bottom edge. The Gold is soft enough that a “stretched” swage fit is achieved, providing a strong retention action over and above the cement.

The Soft Gold wears at about the same rate as normal tooth structure, so Gold crowns to a great extent, are self adjusting.  Some occasional adjusting will still be needed over time, but much less than with porcelain or harder metal.

Full Cast Metal Crowns can be cemented in place with a “reversible” cement, i.e., easily tapped loose with little damage. This makes them ideal if you think the tooth may later need a Root Canal or other internal work, since the doctor does not have to cut through the crown. If they are cemented with an “adhesive” cement, the Cast Metal Crowns will have to be cut off.

Second Permanent Molars suffer the greatest annual wear rates and can quickly get “high” and suffer or cause cusp breakage. A Full Cast Gold Crown will automatically adjust for this wear due to the softness of the Gold. We strongly recommend Full Cast Gold Crowns on Second Permanent Molars for this reason.

Porcelain Fused to Metal Crowns

Porcelain can be fused to a thin metal coping, giving you the good looks of Porcelain while reducing the amount of tooth structure reduction needed. Only the part that shows requires deep reduction of tooth structure.

Porcelain can be fused to Gold or other Noble metals which do not corrode, and can be cast to razor thin edges for smooth margins.

We highly recommend Porcelain Fused to Noble metals for most crowns in the esthetic areas.

It is possible for Porcelain Fused to Metal Crowns to be “tapped off” in some situations, but you always have the risk of porcelain breakage.

We are capable of providing any of the modern types of Crowns or Veneers.

Questions about Crowns?  Call 316-943-2266 to Schedule Your Free Consultation.

About Bridges

The term “Bridge” usually refers to a “Fixed Bridge” now days. Some people refer to a removable replacement for missing teeth as a “Removable Bridge”, but the most common term for that now is “Removable Partial Denture”, or “Partial”.

A Fixed Bridge consists of hollow crowns to fit on your remaining teeth which are connected to a “Solid Crown Pontic”. The most common is a 3 unit bridge where the two teeth adjacent to a missing tooth space are trimmed down and crowned with a solid, 3 tooth device, which “bridges” the empty space.

Fixed Bridges can be long – even extend from one wisdom tooth to the other – but often are split up into smaller numbers of teeth, or fitted with movable links to allow the teeth to move a bit while shouldering the load of the missing teeth.

Fixed Bridges can be “cantilevered”, that is, two teeth crowned next to each other with a fake tooth hanging off one end.

Fixed Bridges can be made of most crown materials, but longer bridges, or bridges in a heavy load area, are usually better reinforced with metal or high strength ceramics.

Fixed Bridges INCREASE the load of the teeth they hang on. In a typical 3-unit bridge, two crowns with a space filled in between, the load TRIPLES on each of the supporting side teeth. This shortens the life of the teeth and supporting structures somewhat.

Fixed Bridges are well accepted and comfortable to the user, MUCH BETTER THAN REMOVABLE PARTIAL DENTURES, but they are more difficult to clean than normal, stand-alone teeth.

Fixed Bridges can be made with EXCELLENT ESTHETIC APPEAL, and can easily correct crooked broken smiles in one visit (a temporary bridge would be placed for 2-3 weeks after the prep and impression appointment).

Over time, the gum and bone will shrink away from the bridge, especially in the missing tooth area, since bone only stays where there is a functioning root or implant.  Tissue revision can be done over time to correct this.

DENTAL IMPLANTS vs. Bridges

Dental implants are a superior way to replace missing teeth because they:

  • RELIEVE the adjacent teeth of damaging excess forces and EXTEND the lifetime of adjacent teeth
  • Stimulate the bone and help to maintain bone and gum tissue levels similar to natural teeth.
  • Can usually be flossed and cleaned much like normal teeth and do not prevent the flossing of the adjacent natural teeth.
  • Allow the crown to be removed without damage, or shots,  in most cases for cleaning and other maintenance in the area.

Whatever Solution Interests You, We can Do It Here.

Questions?  Call 316-943-2266 to Schedule Your Free Consultation.

Crowns vs. Fillings

When large decay results in a tooth with a filling over 1/3 the width, or undercutting the supporting enamel, a Full Coverage Crown is the best long-term treatment. While we can certainly put oversize fillings into or “onto” a cratered out tooth, the resulting thin enamel edges are weak and likely to fracture in a short time. Enamel is crystalline with a grain to it. Much like a diamond, if you hit it at the right angle, pieces just fall off, unless it is backed up by underlying tooth structure (Dentin).

A “Filling” generally refers to one substance inserted INSIDE another substance, i.e., the “Filling” is surrounded by the thing it fills. For example “Cream Filled” Cupcakes have the white cream filling completely surrounded by the chocolate cake. Just as it is unstable to just put the cream on top of a flat spot, it is unstable to just set a filling material on top of a shelled out tooth. We can put it there, but it just won’t stay.

If half of your tooth is gone, putting a filling “in” it is more like putting a filling “on” it.  It is like putting something on a stair step – there is nothing to hold it in place on 3 or so sides. When you go to load it, or step on it, it can just fall off the step.

Silver Amalgam Fillings do not attach to your tooth. The only significant thing holding them in place is having strong, thick Dentin and Enamel surrounding the Filling with undercuts placed to keep the Silver Filling from falling out.

Composite Fillngs, Tooth-Colored Fillings, do bond to Dentin weakly and Enamel strongly. However, the bonds can weaken over time, and are not strong enough, even in the beginning, to support biting pressures from the bond strength alone. You must have some reasonably thick, sturdy Dentin and Enamel to support even the Composite Fillings.

Full Crowns completely surround your remaining tooth structure, giving you the greatest amount of support and protection over time of any restoration. If your tooth has a Fracture Line, or Partial Crack, or Greenstick Fracture, a Full Crown can help to stop or reduce movement in the fault line.

Crown-Related Procedures

Build Ups or Core Build Ups refer to a filling placed in the prepared tooth stub before the Crown is seated. This is usually done to protect the nerve, bolster remaining dentin, and/or to fill in undercuts which would require too much trimming for the crown to slide on and off clearly.

If your decay is into or near the nerve chamber, a Pulp Cap may be placed. A Direct Pulp Cap is a medicated covering over a hole directly into the nerve chamber. An Indirect Pulp Cap is a medicated covering over a hole very near the nerve chamber, but not all the way into it.

Teeth that have had deep decay or cracks near the nerve may eventually need Root Canal Treatment (Endodontic Treatment). Once a tooth has had a Pulp Cap, it has about a 50:50 chance of needing a root canal at the time of placement and greater chances of needing a root can as time passes in the future. In many cases, teeth with deep decay do not hurt you until they are sealed with a filling or crown. This can lead a patient to erroneously believe that the recent filling or crown caused the tooth to die.

If you decide to have a Full Crown, your tooth will be trimmed down, and impression made, and a custom Temporary Crown placed at the first visit. Your new, final crown is usually delivered 2-3 weeks afterward

Call us at 316-943-2266 for a Free Consultation Visit about Your Unique Needs