What are the other Names for the Procedure?
- Dental Crown Placement Procedure
What is Dental Crown Placement Procedure?
- When a tooth structure is damaged (typically the visible part) due to cavities or an injury, a synthetic dental crown (shaped like the tooth) is used to cap or crown the damaged tooth. This procedure is termed as Dental Crown Placement
- The dental crown is a prosthetic device made of ceramic or metal that is secured firmly to the remaining portion of the affected tooth. The procedure helps in improving teeth appearance and restores normal tooth function including biting and chewing
- Additionally, and importantly, it also helps protect the remaining tooth from further bacterial infection, decay, or damage
What part of the Body does the Procedure involve?
A Dental Crown Placement procedure involves the injured or broken tooth.
Why is the Dental Crown Placement procedure Performed?
A Dental Crown Placement procedure may be recommended by dentists for the following reasons:
- To protect teeth from further decay, damage, or fracture
- To hold a cracked or broken tooth together
- If the shape of the tooth affects the overall appearance
- When a large filling is dislodged and the tooth needs to be restored, but there is no much tooth left
- When the color of tooth is changed and makes it appear unattractive
- To attach a dental bridge or cover an implant
- For cosmetic purposes
- Protect teeth in children having high risk for decay, particularly when children are not capable of taking good oral care on their own (such as small children with disabilities)
- In children with certain disorders that involve the teeth
What are some Alternative Choices for the Procedure?
In many cases, there are no suitable alternatives to a Dental Crown Placement procedure.
What are the Recent Advances in the Procedure?
The advances in the field of Dental Crown Placement procedures are more to do with use of synthetic materials in making the crown.
What is the Cost of performing the Dental Crown Placement Procedure?
The cost of Dental Crown Placements procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Dental Crown Placements procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
https://www.animated-teeth.com/dental_crowns/t4_dental_crowns_steps.htm (accessed on 01/04/2018)
http://www.colgate.co.in/en/in/oc/oral-health/cosmetic-dentistry/bridges-and-crowns/article/what-are-dental-crowns-and-tooth-bridges (accessed on 01/04/2018)
Prior to Dental Crown Placement Procedure:
How is the Dental Crown Placement procedure Performed?
Dental Crown Placements may be undertaken by dental professionals in the following manner: (usually a minimum of two sittings is necessary)
- A visual examination of the tooth in concern is made. If necessary, an X-ray is taken to view the extent of injury
- Local anesthesia is applied to the region to numb the gums and tooth
- The injured, broken, or misshapen tooth is trimmed or shaped (on all sides) using special instruments, to receive the crown
- The shape of the remaining portion of tooth helps in giving a good grip and stability to the crown
- In some cases due to extensive damage, if the tooth stub (after trimming) is not sufficient to hold the crown, then it has to be first rebuild using a special cement and filling material
- Following the trimming and building-up of tooth (if necessary), an impression of the tooth is taken using a putty or paste (called impression material)
- The trimmed or reshaped tooth is washed and cleaned/dried and the impression putty spread around the region of interest
- After a few minutes, the composite material fuses and hardens to leave an impression of the teeth on that side of the jaw. Additionally, the biting jaw impression (jaw on the opposite side) is also secured
- The captured impressions are used to prepare a plaster cast, which in turn is then used to prepare the crown. The crown may be made of any of the following materials:
- Metal alloys (including gold)
- Stainless steel
- Resin-based material
- Porcelain with a metal base, or porcelain-fused to metal
- This process may take anywhere from 7-14 days. Thus, in the meantime, a temporary plastic dental cap (of same shade as the remaining teeth) is used to cover the trimmed tooth
- Once, the dental crown is ready, the temporary crown/cap is removed and the permanent crown fitted to the tooth stub and cemented firmly in place
- The dentist then checks the overall appearance of the new crown and the fit of the crown (whether it fits snugly in place), before it is permanently fixed using special adhesives
Note: In some specialized dental labs, an optical (digital) impression may be made using a camera, which is analyzed by CAD/CAM equipment. This can help generate a 3-dimensional picture of the region, which is used to design and fabricate the crown.
Where is the Procedure Performed?
Dental Crown Placements are usually performed in an out-patient surgery center facility, a dentist or an oral surgeon’s clinic or office.
Who Performs the Procedure?
A dental professional expert typically performs the Dental Crown Placement procedure.
How long will the Procedure take?
A Dental Crown Placement procedure may take anywhere from 30 to 90 minutes, depending on the extent of tooth cavity. It may be carried out over two or more sessions, based on the assessment of the dental professional.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Dental Crown Placement procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication, food items, or the filling material used in the procedure
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Dental Crown Placement procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Dental Crown Placement Procedure?
Before a Dental Crown Placement procedure, the patient may have to undergo certain tests such as:
- Visual examination of teeth
- Routine blood and urine analysis, as required
- X-ray of the mouth
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Dental Crown Placement procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Dental Crown Placement Procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia may be administered for the procedure.
How much Blood will you lose, during the Procedure?
Typically, no blood loss is involved during a Dental Crown Placement procedure.
What are the possible Risks and Complications during the Dental Crown Placement procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Dental Crown Placements include:
- Anesthetic complications
- Allergic reaction to the material used in filling
- Damage of tooth during the procedure
What Post-Operative Care is needed at the Healthcare Facility after the Dental Crown Placement procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Dental Crown Placement Procedure:
What are the possible Risks and Complications after the Dental Crown Placement procedure?
The possible risks and complications that may arise after a Dental Crown Placement procedure are:
- Bleeding from the gums
- The crown does not match the profile of the tooth
What is the Prognosis after the Surgery?
The prognosis after a Dental Crown Placement procedure is usually excellent, in a majority of individuals.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain or swelling around the gums and teeth
- Bleeding or fluid drainage from region
- Tooth sensitivity is observed
- The crown is shaky or wobbly, or fits loosely into the tooth
- Signs of an infection
- Fever, feeling sick
What Post-Operative Care is needed at Home after the Dental Crown Placement procedure?
At home, the following post-operative care is recommended after a Dental Crown Placement procedure:
- Avoid very hot or cold food items for a few days following the procedure
- Avoid hard food items for a few days after the procedure
- Avoid smoking or chewing tobacco
- Brush and floss regularly after taking food, or twice daily
How long does it normally take to fully recover, from the Procedure?
Generally, there is no recovery time involved and individuals are able to resume full function of their teeth within a few hours of the procedure.
What happens to tissue (if any), taken out during the Procedure?
Generally, the procedure does not involve the surgical removal of any tissue.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Usually, no tissue is sent for a pathological analysis.
Who will you receive a Bill from, after the Dental Crown Placement procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
- An anesthesiologist (if anesthesia was administered)
- A dental professional
The patient is advised to inquire and confirm the type of billing, before the Dental Crown Placement procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA