TOOTH REPLACEMENT - PORCELAIN CROWNS AND BRIDGES

Indication

As a precautionary measure, a crown should be placed on root canal treated teeth, since in these teeth blood circulation ceases, and they become dry and brittle. If the tooth fractures in such a way that a post can be made, the crown should be prepared after the post is cemented. Preparation of a bridge is advisable 4-5 weeks after any tooth removal, since the unity of the teeth is broken, the tooth behind the removed tooth could tilt forward, the opposing tooth could supra erupt, and due to tooth drifting, temporomandibular joint problems can develop in the long run.

Preparation for treatment

A dental examination and preparation of a detailed treatment plan precedes any tooth replacement. We take digital x-ray's of the abutment teeth. Some pre-treatments might be necessary before tooth preparation, like root canal therapy, post and core, or buildup. If a patient is suspected of being allergic to metal, a special dental metal allergy examination is conducted. Upon the completion of these pre-treatments, we prepare the tooth. The procedure takes place with local anesthesia, so we ask our patients to eat before, since they will not be able to eat again until the anesthetic wears off.

Steps of making crowns, bridges

We take a study model, before preparing the tooth, so both the dental technician and our clinic have the initial phase on file. This is important, because the face determines the teeth that are needed, and the dental technician works solely from the impression of the prepared teeth, which does not include access to the patients face, so, his only assistance is the study model. For anesthesia we use 2% Lidocaine. By tooth preparation we create a smooth surface that the crown can be cemented on. The preparation is done using a bur, just as we would for filling preparation, only in this case we don't prepare the cavity walls, but rather we prepare the occlusal surface and the side of the tooth, to accomodate the thickness of the prepared crown. After this we place a retraction cord between the gum tissue and tooth, so we can make the preparation margins visible for the dental technician. Next, we take lower and upper impressions. If needed, we place provisional crowns on the prepared teeth, this is to protect the teeth from sensitivity and to keep the teeth from drifting. The provisional crown can be prepared chair-side, or it can be prepared by the dental technician for the next day, the second option yields a more durable and esthetic result. The dental technician fabricates the crown or bridge in multiple steps. We try-in each step in our office, to insure that the finished tooth mimics the original tooth as closely as possible. First, we try the crown/bridge framework, then the opaque ceramics, which was installed in two layers, because at this stage, both color and shape can still be adjusted.After the last layer is in place, the replacement is done. At this point, we only place it on temporarily, and later, once the patient gets accustomed to the new tooth, we cement it permanently.

Material of crowns and bridges

In 90% of the cases, we make porcelain crowns in our office. These crowns are tooth-colored on all visible surfaces, on the non-visible surfaces, i.e. by the gum tissue, they have a narrow metal rim in order to make the crown's margins thinner, this prevents irritation of the gum tissue. The metal below the porcelain could either be silver or gold alloy. The advantage of gold is that the crown feels more natural, the disadvantage is that it is more expensive. In case the patient is allergic to metal, the dental technician can make the base from any combination of metals. We usually do not recommend plastic crowns, because they have a shorter life span than the porcelain ones. Furthermore, only the visible surface is tooth-colored, while the tongue side and occlusal surfaces are metal colored. This makes them less esthetic, less wear resistant, and because their margins are thicker, they are more likely to cause inflammation of the gums. In addition, plastic discolors faster than porcelain. It takes 1-2 weeks to prepare a crown.

Possible complications of crowns and bridges

The average lifespan of a crown is 8-10 years. In case of gum recession, the crown might have to be replaced even sooner. We can increase a crown's lifespan by using proper brushing technique. Flossing is recommended in between crowns.By using a proxy brush, the patient is able to keep those areas of the pontic clean which are not accessible by tooth brush. Gingivitis may occur, if the crown's margins are in asubgingival position, or if the gums are damaged due to improper brushing technique. Temporomandibular joint pain may be caused if the crown, bridge does not fit well. Bite sensitivity of some teeth might result if the bite is off, since then the teeth are overloaded. If we remove too much tooth structure during the preparation of the bridge or crown, vital teeth might necrotize. In order to avoid this problem, the incisors and the premolars have to be root canal treated in almost every case before bridge preparation. In case of allergic reaction to metal, severe gingivitis might result, black discoloration around the gum line becomes noticeable. Therefore, preceding extensive replacements, it is recommended that the patient undergo a special metal allergic examination.

Warranty

The technician guarantees the work for a year. The warranty is only valid, if the patient appears at the half-year follow- ups.

Fees

25.000 HUF > Euro
Charge for examination and consultation: 4.000 HUF > Euro

Appointments: Monday - Friday, 8 am - 8 pm.
Telephone: + (36 1) 266 7766