Crowns

crown

Many patients have a vague idea of what a full coverage restoration is and they will often call it a “cap” as in “she got all her teeth capped”. They either have the notion that this “cap” is a thin covering that is merely put over the whole tooth to make it look better or that the tooth is “ground down to a peg” to get this cap on. Discussions about what a crown is and when it is indicated and how it is done will go a long way in patient understanding and acceptance of these more involved procedures (and their fees).

“Mrs. Jones, when a tooth is badly broken or would require a very large filling, we can often protect and strengthen the remaining tooth structure by covering it with a crown (cap). Rather than have the tooth try and hold a filling, a crown covers the tooth and binds it together for strength. This can withstand chewing pressures better than a heavily filled tooth. A crown can be stronger and less likely to break another corner off then if we just did a large filling” (restoration).

A tooth holds a filling and a crown holds a tooth.

” Will you have to grind it down to a peg (or file it off to a point)?”
Many patients have had an old crown come off or have seen a friend with a lost crown and they are often aghast that the remaining prepared tooth structure is so small. (Regrettably, this can also be a very over-prepared tooth.)

“No, actually we only have to remove enough tooth structure, (which in your case is mostly filling now) to let the crown have room enough for strength. This is like removing just the original thickness of the enamel that was on the tooth before it was repaired (broken)(filled). The tooth is carefully shaped and prepared and then a print (impression) is made of the tooth. Then our dental lab and I make the tooth-shaped crown that exactly fits over the tooth. This can be made of strong tooth-colored porcelain or dental gold. While this is being done, we will put on a temporary white acrylic (or resin) crown (don’t say “plastic”; it connotes cheapness) for a week or two to protect the tooth so you should be able to chew normally in the meantime.”

If the crown is to be imaged and fabricated by CAD-CAM (Cerec, etc) you can extol the convenience of a one appointment procedure and you can explain that dental technology can now  fabricate (mill) their crown to precisely fit from a computer image of their tooth. For patients that were a bit leery of computer involvement I reminded them that practically all body part replacements these days (hip, knee, etc.) were designed and fabricated by computers. For the still wary, I humorously asked if they would rather fly on a plane made of hand made parts or computer designed and fabricated parts. Acceptance at that point was solid.

If for financial or other reasons a full coverage restoration is declined-

“Mrs. Jones, if it is not possible to do a full-coverage crown at this point, then I would at least like to use a special filling material that adhesively bonds with the remaining tooth structure to help hold the tooth together. It is the strongest thing I can do besides covering the tooth with a crown. Hopefully, if your tooth breaks again, there would still be enough solid tooth structure to protect it with a covering crown.

(Future needs are often agreed upon very readily- if the tooth has no further problems for several years, you are a hero, if it breaks or has recurrent decay in a short time, the patient already knows that a crown is now called for (win-win)

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