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Crowns & Bridges

Crowns Instead Of Additional Fillings

Alternatives should be considered when a filling reaches the end of its life. Normally the best choice is switching to a crown. Unlike a filling, a crown covers and protects a damaged tooth and can keep it from breaking.

In the illustration to the left, shown is that the edges of these small fillings have broken and losttheir seal. In this case, since most of the tooth is still intact, it is quite appropriate to replace them with new fillings.

Large fillings produce a different problem. In the event little tooth structure remains to keep the tooth from breaking, not many choices exist other than a crown to protect and save the tooth from breaking, because after a tooth breaks, it is much more difficult to repair. Switching to a crown when a large filling has worn out protects and strengthens the tooth.

Remedy For A Cracked Tooth

Some cracks in teeth can be a problem, while others are not. Cracks that appear near fillings definitely are a problem and are prone to breaking. Before a cracked tooth breaks, it may produce pain while chewing, or it could be sensitive to hot or cold, and then again, it may feel just fine.

To prevent the tooth from breaking, the solution is a crown. It covers the crack and protects and strengthens the tooth.

Detecting A Failing Crown

If is possible for a crowned tooth to develop a cavity beneath the crown, which generally begins its development at the edge where the crown and tooth meet.

This is one of the most difficult areas to keep free of plaque, and is what will cause the cavity. During the early stages of development, cavities are easy to remedy with a filling, unless they happen to be located between the teeth where the cavity may prove to be nearly impossible to be reached.

However, once established, cavities develop rapidly, because they are already well past the first line of defense. At this point, the crown must be replaced. Also, by replacing the crown prior to the cavity reaching the pulp chamber of the tooth, a root canal can be avoided.

Crown Remedy For A Large Cavity

Small cavities can be fixed with fillings due to the remaining large volume of healthy tooth structure. However, large cavities require being fixed with crowns, because they weaken the tooth. Without a crown to strengthen the tooth, it is highly likely that the tooth will break. Application of a crown strengthens a damaged tooth by covering and protecting it.

Crown Following A Root Canal

Following a root canal treatment, the tooth becomes weak and brittle. It becomes weak due to the center of the tooth having been removed to access the infected nerve, and only the sides of the tooth remain for support. The tooth is more brittle, because the nerve and blood supply have been removed.

A tooth that has received root canal treatment is likely to break if it is not crowned to provide strength and protection. After a tooth breaks, it is much more difficult to repair.

Porcelain Crown For A Front Or Back Tooth
Or Gold Crown For A Back Tooth

On the average, two appointments are required to restore your teeth with a crown. This is due to the Dentist needing to prepare the tooth for the new crown, making impressions and molds for the dental laboratory, and the laboratory requiring time to custom-craft the crown to precisely fit your tooth.

To make the entire process comfortable for you, the first action performed by your dentist is to make the affected area thoroughly numb. Afterwards, any decay is removed, and the tooth is shaped.

To make a more accurate impression of the teeth, normally a length of string is placed between the tooth and gums. This gently pushes the gums away from the tooth.

Impressions create an accurate working model of the mouth, including the prepared tooth. This helps to recreate your natural bite.

During the time required for the dental lab to fabricate your new crown, you will be fitted with a temporary crown. At your next visit, the temporary crown will be removed, and your new crown will be fitted and installed. When everything has been checked to assure a perfect fit, the new crown is cemented into place, and the procedure is complete.

Alternatives To Crowns

After a substantial amount of tooth structure has been lost, your alternatives are limited.

  • Delay treatment
  • Have the tooth extracted
  • Try another filling
  • Have a crown put on the tooth

No matter whether tooth structure has been lost due to breakage or cavities, if treatment is delayed, the problem simply becomes worse.

If the tooth is allowed to go unattended by your Dentist and it happens to break more, it will simply become very difficult to remedy, and there may be no choice but to extract the tooth. Unfortunately, an extraction is only a short-term solution, because teeth require each other for support. A missing tooth sets off a chain reaction of shifting teeth and additional dental problems.

By delaying treatment, cavities simply become larger and larger . Their growth is slowly while still in the hard outer enamel, but if a cavity is allowed to reach the softer inner dentin, it grows much more rapidly. Ideally it is best to fill the cavity prior to it reaching the pulp chamber, because if it does reach the pulp chamber, the tooth will require root canal treatment.

A filling may be a viable alternative, but fillings don not add strength to the tooth. They simply fill in the damaged part of the tooth lost to decay. For a filling to be successful, there must be adequate tooth remaining to hold the filling in place and to keep the tooth from breaking when chewing.

Applying a crown on the tooth strengthens it and protects it from breaking.

Instructions Following Installation Of A Crown Or Bridge

Crowns and bridges usually take two or three appointments to complete.

On the first appointment, the teeth are prepared, and temporary crowns or bridges are placed to protect the teeth while the custom restorations are being made.

When anesthetic has been used, your lips, teeth and tongue may be numb for several hours. Avoid any chewing until the numbness has completely worn off.

On rare occasions, temporary crowns come off. Call your Dentist if this occurs, and protect the temporary in the meantime so that it can be re-cemented. For proper fit of your final restoration, it is very important that temporaries stay in place. It is also quite normal to experience some sensitivity to heat, cold, and pressure after each appointment. Also, your gums may be sore for several days. It is recommended that you rinse at least three times a day with warm salt water to reduce pain and swelling. Use medication only as directed by your Doctor.

To help keep your temporary in place, avoid eating sticky foods (especially gum), hard foods, and if possible, chew only on the opposite side of your mouth.

It's important to continue to brush normally, but floss very carefully and pull the floss out from the side to prevent pulling out the temporary crown. If your bite feels uneven, you experience persistent pain, or you have any other questions or concerns, please call your Dentist's office for advice or a return visit to remedy the situation.

Eating Following A Crown Installation

You can eat 30 minutes after the anesthesia wears off. If you attempt to eat sooner, you risk biting your cheek or tongue.

What To Do If A Temporary Crown Falls Off

Call your Dentist and schedule an appointment to have it re-cemented. Acting quickly will help keep teeth next to the missing crown from shifting.

Root Canal Followed By A Crown

You will not require a root canal unless decay has migrated into the nerve of the tooth, or if the nerve has to be contacted in order to prepare the tooth for restoration.


Placing A Bridge After A Tooth Has Been Lost

Placing a bridge after a tooth has been lost can prevent a series of potential problems that could affect your entire mouth.

Your teeth support each other. Should you happen to loose a tooth and choose not to replace it with a bridge or other solution, the biting force changes on the teeth next to the space, and they begin to shift towards that empty space. Also, since the tooth above the empty space no longer has anything to chew against, it begins to extrude from its socket, and there is a possibility that you can eventually end up losing that tooth as well.

As your bite changes, chewing your food becomes more difficult. This can cause damage to your jaw-joint, also known as "TMJ". TMJ is the temporomandibular joint, the point where the lower jaw attaches to the skull, a term given to a condition characterized by facial pain and restricted ability to open/move the jaw.

It is also much more difficult to clean teeth that have shifted. Harmful plaque and tartar accumulate in these new hard-to-reach places, which can result in cavities, gum disease, and permanent bone loss.

A dental bridge uses "abutments" for support to hold it in place and are custom-crafted in a dental laboratory to precisely fit your teeth.

A missing tooth substantially modifies one's smile, but a bridge is an excellent method of recovering your natural smile!

Benefits & Differences Of A "Maryland Bridge"

A Maryland Bridge utilizes adjacent teeth for support, the same as any other bridge. Unlike other bridge installations, a Maryland bridge does not require extensive reduction of the adjacent supporting teeth.

In this case, only the backs of the teeth receive a slight reduction. Small "wings" of the bridge, which may be made of metal or resin, are bonded to the backs of the adjacent teeth in the reduced areas.

Overall advantages of a Maryland bridge are:

  • Less tooth reduction
  • Stronger teeth and less likelihood of tooth sensitivity
  • Retained natural color and shape of the supporting teeth
  • Healthier gums with less risk of future disease
  • A highly-aesthetic option that conserves as much tooth structure as possible

Placing a Gold Bridge on Back Teeth

A minimum of two appointments are normally required to replace a missing tooth with a gold bridge. During the 1st appointment, your Dentist will, after numbing the area, will remove any decay and then shape the adjacent teeth. Next, an impression will be made for the laboratory to custom craft the bridge for you. To make a more accurate impression, string is placed in the space between the tooth and the gums to gently push the gums away from the tooth. Also, Impressions give an accurate working model of your mouth, including the prepared teeth. This lets your dentist re-create your natural bite.

During the short period (one to two weeks) required for the dental lab to construct your new bridge, a temporary bridge will have been placed in your mouth by your Dentist.

During your next visit, the temporary bridge will be removed, and you will be fitted with your new bridge. Your Dentist will assure the fit and quality of your bite. When everything has been accurately positioned and all check points have been assured as being correct for you, your new gold bridge will be cemented in place.

The Same Proceedure Also Applies To:

  • Placing a Porcelain Bridge on Back Teeth
  • Placing a Three-Unit Bridge on Front Teeth
  • Placing a Maryland Bridge
  • Placing a Cantilever Bridge

Proper Care For Your Bridge

A dental bridge is highly dependent on the health of the adjacent teeth and gums for support. Care of your bridge includes brushing and flossing normally after each meal.A dental bridge is highly dependent on the health of the adjacent teeth and gums for support. Care of your bridge includes brushing and flossing normally after each meal.

It is recommended you use both "Superfloss" and "floss threaders" to keep the area beneath your bridge plaque-free.

Superfloss has a stiff end that helps in threading it through tight areas, and a fuzzy tufted segment that can remove plaque as you floss. When you insert superfloss beneath the bridge, you can use it to floss the sides of the teeth and the area beneath the bridge.

Floss threaders can also be used to assist in removing plaque. Using approximately 18 inches of floss, insert it through the floss threader, and then use the threader to insert the floss beneath your bridge. Floss to remove food particles and plaque from the sides of the teeth and beneath the bridge.

It is recommended that you use the same procedure to care for your temporary bridge, but you must be very careful not to dislodge it when you brush and floss. If it does come loose, gently re-attach it; and consult with your Dentist if the temporary bridge does come loose frequently.

Also, depending on your specific situation, your Dentist may provide you with additional tools and instructions to help keep all the areas around your bridge free from plaque buildup.

Alternatives To Bridges

Options when missing one or more teeth that you can consider as viable options are:

  • Delay treatment. This is the least-desirable option. Things will only get worse.
  • Implants. An implant with a crown might be a good choice.Treatment time is much longer, but your dentist wouldn't have to modify the teeth next to the space.
  • A partial denture. A partial denture could work well if several teeth are missing throughout the mouth. It fills in the spaces and restores your natural bite.
  • A space maintainer. Space maintainers are used as a temporary solution when children lose a tooth. It keeps the teeth from shifting, as it holds a space for the emerging permanent teeth.
  • A bridge

After Receiving a Crown or Bridge, What Next?

Crowns and bridges usually take two or three appointments to complete.

On the first appointment, the teeth are prepared. Temporary crowns or bridges are placed to protect the teeth while the custom restorations are being made.

After each appointment when anesthetic has been used, your lips, teeth and tongue may be numb for several hours. Avoid any chewing until the numbness has completely worn off.

On rare occasions, temporary crowns come off. Call your Dentist if this happens, and keep the temporary so it can be re-cemented. It is very important for the proper fit of your final restoration that temporaries stay in place. It is also normal to experience some sensitivity to heat, cold and pressure after each appointment.

Your gums may also be sore for several days afterwards. Rinse three times a day with warm salt water to reduce pain and swelling. Use any prescribed medication only as directed.

To help keep your temporary in place, avoid eating sticky foods (this includes chewing gum of any kind), hard foods, and if possible, chew only on the opposite side of your mouth.

It's important to continue to brush normally, but floss very carefully and pull the floss out from the side to prevent dislodging the temporary crown. If your bite feels uneven, if you have persistent pain, or you have any other questions or concerns, call your Dentist's office.

Frequently Asked Questions

  • Will there be any pain after receiving a bridge?

    Your gums may feel sore and you may find that your teeth feel more sensitive to changes in pressure and temperature. These feelings usually disappear after a few days.
  • After my bridge has been fitted, how long will the numbness last?

    Anesthesia on the upper jaw lasts two to three hours; for the lower jaw, allow about three to four hours for it to wear off.
  • How long will it be necessary to wear a temporary bridge?

    Most patients wear a temporary bridge for about three weeks. If your treatment includes extractions, you may need to wear them for up to three months. Periodontal surgery could extend this period to six or more months.

Temporary Crown Falls Out

Temporary crowns or bridges cover and protect the involved teeth and functions as an anchor to keep adjacent teeth from moving. Temporary crowns or bridges are generally cemented in place with temporary cement that allows your Dentist to easily remove the temporary crown or bridge when the permanent bridge is ready to be fitted. Unlike most permanent cements used by your dentist, temporary cements are capable of being dissolved over time by your saliva. Should this happen, it is possible for your temporary bridge or crown to come loose.

Treatment:

If a temporary comes off, it's very important that it be replaced immediately to prevent both the adjacent teeth to the crown or bridge and the opposing teeth that chew against it from shifting. This shifting, which can happen in only a few hours, can permanently change your bite and make it impossible to place the permanent crown or bridge. If your temporary crown or bridge comes off, be sure to save it, and call your Dentist immediately to have it re-cemented. It is strongly recommended that you not attempt to replace it yourself. Your bridge or crown may come off and cause more problems, particularly when you are asleep. Also, NEVER USE ANY GLUE, ESPECIALLY "SUPER GLUE", in your mouth.

Permanent Crown Falls Out

Some of the permanent dental cements over time are capable of being dissolved by the moisture in your saliva and allow your crown or bridge to come off. Also, sticky foods such as gum, caramels, or suckers may also pull crowns off of your teeth, even though they were properly cemented with permanent dental cements.

Treatment:

If you experience a crown or bridge coming off, take great care to store it safely. In many cases it can be cleaned up and re-cemented. A crown, bridge, or inlay that has come off should be replaced immediately. Your taking immediate action will prevent shifting of both the adjacent teeth and those that they chew against.

It is possible for this shifting to occur in only a few hours, and if this does occur, it can permanently change your bite and make it impossible for your permanent restoration to be re-cemented. If your crown, bridge, or underlying teeth have been damaged, this may also require a totally new restoration to be fabricated following the customary impression and model being prepared for the laboratory.

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