Crowns & Bridges

Crowns

Cast Gold

When a tooth is fractured or decayed to the point that there is not enough natural tooth structure to support or retain any other type of restoration, a crown or cap is necessary. A crown covers the entire tooth surface above the gumline and restores its shape and function. Teeth that are fractured can often be restored with crowns that prevent the crack from progressing. There are three primary types of crowns: cast gold, porcelain fused to metal (PFM), and all-ceramic (metal-free) crowns. All have advantages and disadvantages. When necessary, we will discuss each and give a recommendation for what is the best treatment option for each patient.

For patients who grind their teeth or for teeth in the back of the mouth, the best type of crown is a cast gold crown. Hidden from view, they are the most durable and can withstand heavy biting forces. The gum tissues also respond favorably to the gold surface.

A gold crown procedure requires two appointments. At the first appointment, the tooth is prepared for the crown. An impression (mold) of the preparation is taken to be sent to the laboratory. A temporary restoration is placed to wear until the next appointment. The lab makes a plaster model of the tooth to be restored and, using precision instruments, fabricates the crown in the lab. Because they are able to look at the model of the tooth directly, the crown will be fabricated such that is fits the tooth exactly. At the second appointment, the temporary restoration is removed and the tooth is cleaned off. The crown is fitted and adjusted, if necessary. Once the fit is perfect, the crown is cemented into place and polished. You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new crown.

Porcelain fused to metal (PFM)

When a tooth is fractured or decayed to the point that there is not enough natural tooth structure to support or retain any other type of restoration, a crown or cap is necessary. A crown covers the entire tooth surface above the gumline and restores its shape and function. Teeth that are fractured can often be restored with crowns that prevent the crack from progressing. There are three primary types of crowns: cast gold, porcelain-fused-to-metal (PFM), and all-ceramic (metal-free) crowns. All have advantages and disadvantages. When necessary, we will discuss each and give a recommendation for what is the best treatment option for each patient.

A porcelain-fused-to-metal (PFM) crown is best for teeth that will be visible when smiling. The PFM crown is made of a metal sub-structure with tooth-colored porcelain bonded to the metal. The porcelain shade is matched to the surrounding teeth so that the crown looks like a natural tooth. It is the most popular type of crown in dentistry.

A PFM crown procedure requires two appointments. At the first appointment, the tooth is prepared for the crown. An impression (mold) of the preparation is taken to be sent to the laboratory. A temporary restoration is placed to wear until the next appointment. The lab makes a plaster model of the tooth to be restored and, using precision instruments, fabricates the crown in the lab. Because they are able to look at the model of the tooth directly, the crown will be fabricated such that is fits the tooth exactly. At the second appointment, the temporary restoration is removed and the tooth is cleaned off. The crown is fitted and adjusted, if necessary. Once the fit is perfect, the crown is cemented into place and polished. You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new crown.

All-Ceramic (Metal-Free)

When a tooth is fractured or decayed to the point that there is not enough natural tooth structure to support or retain any other type of restoration, a crown or cap is necessary. A crown covers the entire tooth surface above the gumline and restores its shape and function. Teeth that are fractured can often be restored with crowns that prevent the crack from progressing. There are three primary types of crowns: cast gold, porcelain-fused-to-metal (PFM), and all-ceramic (metal-free) crowns. All have advantages and disadvantages. When necessary, we will discuss each and give a recommendation for what is the best treatment option for each patient.

An all-ceramic (metal-free) crown is best for teeth that will be visible when smiling and are not under heavy chewing or biting forces. The esthetics of an all-ceramic crown are excellent but they can be brittle and fracture when under too much force. The porcelain of the crown is matched to the surrounding teeth so that the crown looks like a natural tooth. For front teeth where esthetics is of paramount importance, an all-ceramic crown will often be the best treatment.

An all-ceramic crown procedure requires two appointments. At the first appointment, the tooth is prepared for the crown. An impression (mold) of the preparation is taken to be sent to the laboratory. A temporary restoration is placed to wear until the next appointment. The lab makes a plaster model of the tooth to be restored and, using precision instruments, fabricates the crown in the lab. Because they are able to look at the model of the tooth directly, the crown will be fabricated such that is fits the tooth exactly. At the second appointment, the temporary restoration is removed and the tooth is cleaned off. The crown is fitted and adjusted, if necessary. Once the fit is perfect, the crown is cemented into place and polished. You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new crown.

Fixed Partial Dentures (Bridge)

Cast Gold

A fixed partial denture (bridge) is another alternative to replacing a missing tooth. Unlike a removable partial denture, a bridge is cemented into place and does not come out of the mouth. A traditional bridge consists of crowns attached to at least one tooth on either side of the gap to be restored (abutments). The crowns are attached together forming the replacement teeth (pontics) and the entire unit is cemented into place. For patients that clench or grind their teeth, a gold bridge may be recommended. With good brushing and flossing habits, a bridge can last for many years.

We recommend fixed partial dentures when the teeth around a space have large existing restorations and may need full coverage crowns in the future. Bridges may also be the treatment of choice when the quality of the bone in the area will not support an implant supported crown. Some patients with a removable partial denture may wish to upgrade to a bridge so that they do not have to take their “teeth” out of their mouth every night.

A bridge typically requires at least two appointments. The abutment teeth are prepared for crowns and an impression (mold) is taken. A temporary bridge will be fabricated which allows the patient to get a sense of how the permanent bridge will feel. The impressions will be sent to the dental laboratory where a technician will meticulously fabricate the bridge. At the second appointment, the temporary bridge will be removed and the teeth cleaned off. The bridge will be fitted and adjusted. Once the bridge fits perfectly, it will be permanently cemented. It is very important to learn how to floss around and under a bridge. Our dental team will take time to show you how to achieve good dental health around the new bridge.

Porcelain fused to metal (PFM) fixed partial denture (bridge)

A fixed partial denture (bridge) is another alternative to replacing a missing tooth. Unlike a removable partial denture, a bridge is cemented into place and does not come out of the mouth. A traditional bridge consists of crowns attached to at least one tooth on either side of the gap to be restored (abutments). The crowns are attached together forming the replacement teeth (pontics) and the entire unit is cemented into place. For most situations, the best material to use is porcelain fused to metal (PFM). This allows for good strength while achieving excellent esthetics. With good brushing and flossing habits, a bridge can last for many years.

We recommend fixed partial dentures when the teeth around a space have large existing restorations and may need full coverage crowns in the future. Bridges may also be the treatment of choice when the quality of the bone in the area will not support an implant supported crown. Some patients with a removable partial denture may wish to upgrade to a bridge so that they do not have to take their “teeth” out of their mouth every night.

A bridge typically requires at least two appointments. The abutment teeth are prepared for crowns and an impression (mold) is taken. A temporary bridge will be fabricated which allows the patient to get a sense of how the permanent bridge will feel. The impressions will be sent to the dental laboratory where a technician will meticulously fabricate the bridge. At the second appointment, the temporary bridge will be removed and the teeth cleaned off. The bridge will be fitted and adjusted. Once the bridge fits perfectly, it will be permanently cemented. It is very important to learn how to floss around and under a bridge. Our dental team will take time to show you how to achieve good dental health around the new bridge.

All Ceramic (Metal-Free)

A fixed partial denture (bridge) is another alternative to replacing a missing tooth. Unlike a removable partial denture, a bridge is cemented into place and does not come out of the mouth. A traditional bridge consists of crowns attached to at least one tooth on either side of the gap to be restored (abutments). The crowns are attached together forming the replacement teeth (pontics) and the entire unit is cemented into place. In situations requiring absolute esthetics, an all-ceramic (metal-free) may be indicated. With good brushing and flossing habits, a bridge can last for many years.

We recommend fixed partial dentures when the teeth around a space have large existing restorations and may need full coverage crowns in the future. Bridges may also be the treatment of choice when the quality of the bone in the area will not support an implant supported crown. Some patients with a removable partial denture may wish to upgrade to a bridge so that they do not have to take their “teeth” out of their mouth every night.

A bridge typically requires at least two appointments. The abutment teeth are prepared for crowns and an impression (mold) is taken. A temporary bridge will be fabricated which allows the patient to get a sense of how the permanent bridge will feel. The impressions will be sent to the dental laboratory where a technician will meticulously fabricate the bridge. At the second appointment, the temporary bridge will be removed and the teeth cleaned off. The bridge will be fitted and adjusted. Once the bridge fits perfectly, it will be permanently cemented. It is very important to learn how to floss around and under a bridge. Our dental team will take time to show you how to achieve good dental health around the new bridge.

Maryland bridge

A fixed partial denture (bridge) is another alternative to replacing a missing tooth. Unlike a removable partial denture, a bridge is cemented into place and does not come out of the mouth. A Maryland bridge is a less invasive method of replacing a tooth. The back (tongue) sides of the teeth adjacent to the space are lightly prepared for “wings” that will hold the pontic tooth in place. The wings are bonded to the adjacent teeth providing a good, less aggressive method of replacing a missing tooth. With good brushing and flossing habits, a bridge can last for many years.

A Maryland bridge is a good alternative for missing front teeth that have good, strong adjacent teeth to support the bridge. Maryland bridges may also be the treatment of choice when the quality of the bone in the area will not support an implant supported crown. Some patients with a removable partial denture may wish to upgrade to a Maryland bridge so that they do not have to take their “teeth” out of their mouth every night. We do not typically recommend a Maryland bridge to replace a missing back tooth.

A Maryland bridge typically requires at least two appointments. The backsides of the abutment teeth are prepared for the wings and an impression (mold) is taken. The impressions will be sent to the dental laboratory where a technician will meticulously fabricate the Maryland bridge. At the second appointment, the teeth will be cleaned off and the Maryland bridge will be fitted and adjusted. Once the bridge fits perfectly, it will be permanently cemented. It is very important to learn how to floss around and under a bridge. Our dental team will take time to show you how to achieve good dental health around the new bridge.

Temporary Solutions

Crowns/Sedative Fillings

For some patients, a temporary crown may be indicated to help diagnose a crack or an infection. Teeth that are sensitive to biting or chewing may have developed cracks that are difficult to diagnose even with dental radiographs. In these situations, a temporary crown will help determine if the best treatment is a permanent crown, root canal, or extraction. We often recommend that patients wear the temporary crowns for a period of a few months to ensure that they receive the proper treatment for their damaged tooth.

For teeth with decay or large restorations that are causing pain or discomfort, a sedative filling may be indicated. A sedative filling is a type of restoration that is semi-permanent composed of materials that will help the tooth combat the disease-causing bacteria. If the sedative filling helps to “calm” the tooth, a permanent filling or crown may be indicated. If not, root canal therapy or an extraction may be required.

Removable Partial Dentures

When teeth are extracted due to fracture, decay, or periodontal disease, it can be traumatic for the patient. One good solution, particularly for patients that are missing multiple teeth are partial dentures. Full or complete dentures replace all of the teeth in an arch (upper or lower) and removable partial dentures (RPD) replace one or more teeth in an arch. Dentures are fabricated by the dental laboratory to mimic the natural dentition and the supporting gum tissues.

Complete dentures can be made to be worn on the same day as the extractions or fabricated years after teeth have been extracted. Because the tissues under the dentures will shrink over time, they often need to be relined with new acrylic material to enhance their retention and fit. Dentures that fit well should not require the use of adhesives to stay in the mouth. If you are having issues with your dentures staying in place, you should consider having them relined.

Dentures require many appointments to ensure they fit well, have a natural look, and function well. Impressions (molds) are taken of the teeth and/or tissues and measurements are taken to ensure an accurate fit. The impressions and measurements are sent to the dental laboratory where the dentures are meticulously fabricated. If the dentures are to be delivered to the patient on the day of extractions, these impressions are taken prior to the extraction appointment and the dentures delivered to the patient after the extractions are complete. A period of adjustment is normal and will often require several visits to ensure the dentures fit well and do not cause discomfort. As patients become familiar with the dentures, the soreness and salivary issues will typically subside. With proper care, dentures will last for many years.

Update 5/18/20: We are slowly re-opening for more than just emergencies with a goal of returning to our normal schedule Monday, June 1, 2020. We have very much missed seeing our patient family!