CROWNS:

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that has been weakened and cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, a porcelain (tooth colored) containing restoration is the most desired, because it closely resembles your natural teeth. There are many choices for a dental crown, each with its own set of benefits and weaknesses. To list a few, dental crowns can be made of gold, silver (noble metal), porcelain fused to metal, porcelain fused to gold, porcelain/ceramic and zirconia, as well as they can be milled, baked/fired, pressed, cast. The list goes on, but as you see there are many options to fit all sorts of needs. Dental crowns are highly durable and will last many years.  Porcelain crowns are made to match the shape, size and color of your teeth, giving you a natural, long-lasting beautiful smile.

There are several factors that need to go into the selection of a crown material: strength requirements, esthetic requirements, the abrasivity of the material against the opposing teeth and the skills of the dentist. There is not a single crown that is clearly superior for all situations. Many cosmetic dentists will have several types that they will use, each for a different situation and purpose. Here at Old Hook Dental, we provide all of the options listed below and more, we can discuss which option best suits your needs with you at your appointment. 

Gold Crown: 

Gold crowns provide an excellent restoration for a tooth requiring a crown - the preparation is more conservative than porcelain. Gold is a very bio-compatible material, it is strong, durable and has a similar wear resistance to that of natural tooth; it is probably the longest lasting crown restoration you can get. The downside to gold crowns is the esthetics; therefore, it is mainly used for back teeth as a result, although some patients view gold crowns as a sign of wealth and prosperity, and also request them in the front.

Silver (noble metal) Crown: 

Similar to gold crowns, silver (noble metal) crowns also provide an excellent restoration for a tooth requiring a crown. The preparation is the same conservative approach, noble metal is also a very bio-compatible material (unless you have a severe metal allergy), strong, durable and has a similar wear resistance to that of natural tooth. The downside to silver crowns is the same esthetics; therefore, it is mainly used for back teeth. This is the most cost efficient method for crowning a tooth. 

Porcelain Fused to Gold or Noble Metal crown:
             
Porcelain fused to gold provides a nice compromise of both worlds: the excellent strength properties of gold and the esthetic qualities of porcelain covering the outer surface. It offers better esthetics than an all metal crown but not as high as an all porcelain crown due to the metal substrate, which may become visible if there is gum recession, and does not offer the same light reflection. Nevertheless, it does provide a high quality, esthetically pleasing restoration. Porcelain fused to noble metal is the most common type of crown used today: they are time tested, strong and provide a nice, esthetic, long lasting result. 
Porcelain fused to Gold veneered 

The options above can also be fabricated with just a porcelain veneer face: this choice provides additional benefits to those described above in that it is a semi-conservative preparation and provides a similar wear resistance to that of natural tooth.

Porcelain/Ceramic Crown:
            
An all porcelain or ceramic crown provides by far the most superior esthetic results. The crown can have an amazingly life-like appearance that is unmatched by any of the other restoration types. These are best used where an exquisite cosmetic result is the primary concern, such as front teeth. However, porcelain does have its drawbacks: porcelain is very hard and therefore brittle, so it has a higher tendency to fracture and require replacement if subjected to improper forces; there is also concern for the opposing teeth as it is a harder substance. The preparation needs to be carefully done as it is different from those above. Porcelain is also a poor thermal conductor of cold and heat, so sensitivity with these types of restorations is often reduced. The lustrous (shiny, glossy, luminous, sparkling) look of a natural tooth is generated by the way light penetrates into its enamel layer through the tooth and then is reflected back out to your eyes, similar to a diamond. The goal of an all porcelain crown construction is to mimic this effect and it does it well, providing a highly esthetic result that will look beautiful and not stain or discolor over time. Like any porcelain, it has the ability to be tinted with numerous shades to match the surrounding teeth and give it a more life-like appearance as no natural tooth is one single color.  

Zirconia Crown:

Zirconia crowns have had a lot of advancements recently. They are becoming similar to porcelain crowns in their appearance and lack of any metal. Where porcelain crowns are fired, zirconia crowns are milled from a solid block. This makes them much stronger and more resistant to breakage when chewing forces are applied than porcelain. Resulting from this increased strength a more conservative preparation can be done as less material is required. Once primarily used for back teeth only due to lack of esthetics, the advancements in color and translucency have made for beautiful zirconia restorations that are gaining popularity for being used in the front as well. Providing both a life-like appearance and strong restoration with no metals involved, zirconia is an excellent choice where strength and esthetics are required.  

Reasons for crowns:

• Broken or fractured teeth
• Cosmetic enhancement
• Unwanted spaces
• Decayed teeth
• Fractured fillings
• Large fillings
• Tooth treated with a Root Canal

What does getting a crown involve?

A crown procedure usually requires two appointments. First, a preliminary impression will be taken of your teeth - this will also serve for the fabrication of a temporary crown while the laboratory prepares the permanent one over a period of approximately two weeks. While the tooth is numb, any decay or old filling material will be removed, and the tooth will be prepared by shaping the surface to properly fit the crown. The amount of tooth structure removed and final preparation will vary based on the type of crown being inserted and the condition of the tooth prior, regardless sufficient room must be created for the crown to fit and material thickness. If too much tooth structure is missing to begin with, a core buildup will be necessary to provide sufficient support for the crown and/or retention groves may be added (as in the picture above on the left). If a Root Canal has been performed, it will require an additional post for strength. Once these details are accomplished, a highly accurate final impression will be taken and sent to the lab. At this point a temporary crown will be fabricated and retained with temporary cement, your bite will be checked to ensure you are biting properly and that the crown has good contacts.  
At your second appointment, the temporary crown will be removed, the tooth will be cleaned, and your new crown will be tried in for an accurate fit; any necessary adjustments will be made. Once satisfied, it will be permanently cemented in place with one last check to ensure the spacing and bite are accurate.

INLAYS / ONLAYS:

An inlay/onlay is a custom, laboratory-made restoration that can be fabricated by Old Hook Dental from a number of materials of choice. Those include composite, gold, base metal, tooth-colored porcelain or zirconia. Porcelain inlays/onlays are the most popular because they closest resemble your natural tooth. Zirconia will also give a pleasing esthetic result with very high strength.

An onlay is sometimes also referred to as a partial crown and is similar to an inlay: the major difference between the two is determined by whether the defect in the tooth involves a chewing cusp surface of the tooth. Both of these restorations are considered a conservative approach for large defects (when compared to a full crown) when a tooth has been damaged by decay or trauma and highly used when the damage is large enough to not support a traditional filling, but not large enough to require a full crown. Porcelain inlays/onlays are made by a professional dental laboratory technician, requires two visits to complete and will be permanently cemented onto your tooth verses mechanical or chemical retention. While it is a more expensive option than a filling, it is less expensive than a full crown and the results provide an ultra high quality appearance, with excellent strength and durability when compared to others above.

Porcelain Inlay and Onlays cast mounted:                                                    Gold Inlays:

Inlays are the ideal alternative to conventional silver and composite fillings.

Onlays are an ideal alternative to full crowns, less tooth structure is removed in the preparation.

What does getting an onlay involve?

An inlay/onlay procedure usually requires two appointments with us. Your first appointment will include preparation of the tooth by removing any old filling material and decay. Next the tooth will be prepared by shaping the surface to properly fit the inlay/onlay. Lastly a highly accurate impressions (molds) will be taken and sent to the lab to create your custom inlay/onlay; a temporary restoration will be fabricated the same day. The second appointment will include removal of the temporary restoration, cleaning of the preparation site and the new inlay/onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable. At Old Hook Dental, we offer a full line of inlays and onlays to suit your needs.

Call to schedule your appointment with us at Old Hook Dental (201) 358-5005