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A crown is a ceramic cap that covers the whole tooth above the gum line. We recommend one when a tooth is cracked, when a large filling has failed or left too little tooth to hold a new one, when a tooth has broken, or after a root canal on a back tooth. A crown is also used to change the shape or color of a front tooth that is too damaged for a veneer. At Vizcaya Dental Arts all crowns are all-ceramic, made by a laboratory we have worked with for years, and fitted over two visits about two weeks apart.
Filling, onlay or crown?
The size and position of the damage decide. A small cavity above the gum line is a filling, and we do not crown a tooth that a filling can restore. When the damage reaches below the gum, or the restoration would cover most of the tooth, composite wears and leaks, and a crown protects the tooth better.
Inlays and onlays are partial crowns that cover part of the tooth. They remove less tooth structure, and many dentists like them. Gold onlays are very durable, but few patients want gold today. Our inlays and onlays page explains both sides. For most teeth that have outgrown a filling, we recommend a crown.
Cracked teeth
A crack is a common reason for a crown, particularly one running toward the gum. Cracks tend to grow, and a tooth that splits below the gum line usually has to be extracted. A crown placed while the tooth is still whole holds it together, and it costs far less than losing the tooth and replacing it with an implant. Not every crack needs a crown. The direction and depth matter, and our diagnostics page describes how we assess them.
What a good crown has
- Contacts with the neighboring teeth that are firm enough to keep food from packing between them, and still let floss pass.
- A margin that sits flush with the tooth all the way round, with no gap or ledge where plaque can collect.
- Contact with the opposing teeth that holds the bite and keeps the teeth from shifting, without hitting first.
- A shape and shade that blend with the teeth around it.
- Contours you can keep clean with a brush and floss.
- A strong ceramic, cemented so that the seal lasts.
These are the things we check at the try-in, and the crown is cemented when all of them are right. A well-made crown from a good laboratory needs little adjustment at that visit.
The materials we use
All of our crowns are all-ceramic, with no metal. For front teeth we use feldspathic porcelain layered by hand over a zirconia core. The zirconia gives strength, and the layered porcelain gives the translucency and detail of a natural front tooth. For back teeth we use monolithic zirconia, a single dense block of ceramic that is very hard to break under heavy chewing. Newer zirconias look good enough that the two are hard to tell apart from a normal distance.
When the tooth is prepared, we remove as little tooth structure as possible. A crown needs only enough room to be strong and to stay on, and the more natural tooth remains underneath, the longer the tooth lasts.
The two visits
- Step 1 of 4 Preparation and impression
With the tooth numbed, it is shaped to make room for the crown. We take a physical impression with a silicone material, which in our experience gives the laboratory the most accurate record. We have digital scanners and use them for selected cases. A temporary crown is made and fitted the same day.
- Step 2 of 4 Two weeks in a temporary
The temporary feels much like a tooth. Avoid sticky and hard foods so it stays put; otherwise eat normally. Mild gum tenderness for a day or two is the usual extent of discomfort.
- Step 3 of 4 Try-in and checks
The finished crown is tried on the tooth and adjusted. We check the contacts with the neighboring teeth, the margins, the bite and the appearance, and that you can floss around it.
- Step 4 of 4 Cementing
The crown is cemented once every check is right. This visit usually needs no anesthesia.
Crowns on front teeth
A crown on a front tooth is judged more closely, because everyone sees it. The zirconia core gives it strength. The feldspathic porcelain the ceramist layers over it provides the translucency at the edge, the color changes from gum line to tip, and the surface texture of a natural tooth. We match the shade to the neighbors in daylight. Where several front teeth are involved we often combine crowns with veneers in one design. The gum contour matters as much as the porcelain, and the gum needs to be healthy and stable before the tooth is prepared.
After the crown is cemented
- The tooth may feel slightly unfamiliar for a day or two.
- The bite is checked at the fitting and can be adjusted if anything feels high once the anesthetic has worn off; a crown that feels high should be adjusted.
- Mild sensitivity to cold can last a couple of weeks on a living tooth and then fades.
- Floss the crowned tooth like any other, sliding the floss out sideways if the contacts are tight.
- If you clench or grind at night, a night guard protects the crown along with your other teeth, and we recommend one for any crown on a back tooth in a heavy bite.
Will I need a root canal?
Usually not. Most of the crowns we place go on living teeth, and the tooth keeps working normally with its nerve intact. A root canal is needed only when the nerve is already damaged by deep decay or a crack that has reached it, and we test for that before preparing the tooth. If a root canal is needed, we tell you, and the crown follows the root canal.
How long a crown lasts
We expect a crown to last twenty years or more, and modern zirconia crowns are very hard to break. What usually ends a crown’s life is the tooth under it: the edge where crown meets tooth can still decay if plaque sits there. A crowned tooth needs flossing and checkups like any other. With that care a crown can serve for decades. A younger patient may eventually need one replaced.
Staged treatment
Not every large cavity goes straight to a crown. For a tooth that needs more than a filling but is not yet a clear crown case, we often place a large composite filling that may serve for years, and crown the tooth when the filling eventually fails, skipping an onlay in between.
Frequently asked questions
Does getting a crown hurt?
The preparation visit is done with local anesthesia and is not painful. The temporary crown feels much like a tooth, with at most mild gum tenderness for a day or two. The second visit, fitting the final crown, usually needs no anesthesia at all.
How long does it take?
Two visits about two weeks apart: one to prepare the tooth and take the impression, one to fit the finished crown. You wear a comfortable temporary in between.
Crown or onlay?
An onlay covers part of the tooth and removes less of it. In our experience ceramic onlays do not last as well as crowns, largely because of the cements they depend on, so for a tooth that has outgrown a filling we usually recommend a crown. Other dentists see it differently, and our page on inlays and onlays explains both views.
Will I need a root canal first?
Usually not. A crown is placed on a living tooth in the great majority of cases, and the tooth goes on working normally. A root canal is needed only when the nerve is already damaged, by deep decay or a crack, and we check for that before we start.
How long does a crown last?
We expect long service, often twenty years or more, and modern zirconia crowns are very hard to break. What limits a crown's life is the tooth underneath: it can still decay at the edge if plaque sits there. Floss it like any other tooth and keep your checkups, and the crown can serve for decades. Younger patients may eventually need one replaced.
What if the temporary comes off?
Call us and we will recement it, usually the same day. Keep it somewhere safe in the meantime and avoid chewing on that side. Sticky and hard foods are the usual cause, which is why we ask you to avoid them while the temporary is in.
