Crowns and Onlays

"The Indirect Restoration holding everything together"

Tags: dentist, london dentist, nhs, whitening, inman aligner, cosmetic dentist, checkup, dental, anish, anish dentist, london hygienist, dental hygiene, root canal., crown, cap, onlay, veneer

by Mr Anish Patel
crown
A dental crown fits over and protects the underlying tooth from damage and restores the lost shape and colour.

Overview

We choose to place a crown or an onlay (half crown) because greater than half of the tooth has been lost to decay or fractued off. They are also used as definitive restorations after root canal treatment, helping to protect the heavily treated tooth from breaking down further and preventing re-infection of the root canal system. A crown/onlay has the effect of replacing the lost part of the tooth, bracing the remaining parts against damage, which together restore function and aesthetics.

When choosing a crown you have a few options. Broadly, the options are a silver crown (standard), gold (best for back teeth), a metal-white (PFM) , or a fully white crown. The type chosen will depend on the individual case, and would need to be discussed with your dentist.

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The Procedure

Even though it may sound scary, I assure you that it involves many of the steps of a normal filling. You will be completely numb, and will not feel a thing. It is done at the practice many times a week and is a perfected routine procedure. Crowns/ onlays are done at the practice over two visits.

1st Visit- 30-45 Minutes (More time for rehabilatation cases)
1.  We will place numbing gel where we plan to place the anaesthetic, so you are less likely to feel the small pinch. We then wait a minimum of 10 minutes for it to work.

2.  While we wait you will see us preparing a material to take an impression of your tooth. This will be taken now so we can re-create the tooth for a temporary crown while your real crown is custom made at the laboratory.

3.  Once you are ready we will proceed to gently reduce the size of your tooth, stopping every few seconds to check the tooth and yourself. The tooth is reduced enoughso as to make room for the new crown so it fits well with the rest of your teeth and is thick enough to mask any underlying discolouration.

4.  After this, a mould of your teeth is taken to be sent to dental laboratory. Here a team of skilled technicians make your new veneer/crown to your specifications.

5.  A temporary crown is made from the initial impression and cemented in place. Once completed a shade is taken at the practice where we assess the colour and shape of all your teeth. For larger cases we often ask you to attend the technicians’ laboratory to be colour matched by the laboratory.

2nd Visit (30-45min
1.  The same applies for this visit and we will place numbing gel followed by the anaesthetic. We will then wait until you are ready to proceed.

2.  The temporary filling will be removed along with the paste that we place inside. We will clean the tooth again with same disinfectant used last visit.

3.  Only if the answer to the above it yes, will we proceed to cement the tooth in with permanent cement. The tooth will then be polished and adjusted until you are completely comfortable with the final result.

This may look overwhelming; however it is all done with you in complete control. You decide when you want to start and what you want the final result to look like.

crown_2

What To Expect After A Surgery

After a crown preparation, your lips and gums may remain numb for a few hours until the anesthetic wears off. Later you may have throbbing pain which you can treat with pain medicines, such as ibuprofen, paracetamol, or a stronger prescription painkiller(on advice from your medical professional). The pain usually lasts only a day or two. You may have some discomfort biting down, if you do, return to the surgery to have some adjustments.

Risks Of Having And Not Having Treatment

Not having treatment would only lead to further breakdown of the tooth, frequently beyond repair. The would lead to complications with your bite later on. Success rates for root canl treatment drop if not crowned after, as these teeth fracture easier as well as allow bacteria to seep into the root canal system alongside the filling.

With any crown/onlay being placed there are associated risks, albeit small and unlikely, it is something everyone should know. They include: prolonged numbness and altered sensation, fracture of the tooth while preparing it, recurrent infections despite treatment, jaw ache (due to keeping mouth open for a long time), and extraction if crown fails as a result of improper home hygiene and failing to attend for checkups after procedure.

Alternatives

An alternative to a crown would be to attempt to fill the tooth. This is definately not an ideal solution and only done at the practice as an interim measure before placing a crown. If a filling is placed it must be adhesive in nature (either white composite or a bonded metal filling). Being "stuck" to the remaining part of the tooth without crown coverage will only serve to replace the missing area and WILL NOT brace the remaining parts of the tooth.

What To Think About

A fractured tooth without decay is a sign of bite imbalance. If this has occured the underlying cause of the fracture (cmprehensive exam) and post treatment protection (occlusal splint) would be the only way to ensure long term success.Gold responds most like your natural tooth, and therefore is the ideal replacement or teeth that can't be seen and are used to grind (back teeth).

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