Crowns: Maintaining Your Crown(s)
As is true with your natural teeth and especially with teeth that have been restored with any dental material, you should avoid chewing on excessively hard or sticky foods after the crowns have been cemented. It is especially important not to bite down on hard foods with just one tooth. The porcelain material can fracture under extreme forces. Anything you chew that could break a natural tooth could break a crown!
Be sure to brush and floss daily as instructed. We also advise using a fluoride mouthrinse as part of your daily routine. Please be sure to return for your regular preventive care reservations at the time intervals we suggest.
After observing these types of procedures for many years, we note that the gingiva (gums) can recede from the crown margins and the surrounding tooth structure may become visible. This recession usually takes place over a period of several years and may require restoration replacements or a periodontal plastic surgery procedure to correct it.
Crowns: Provisional Crowns and Bridges
When a crown is being fabricated for you in an outside laboratory, the tooth or teeth treated will have a temporary restoration that is held in place by temporary cement. This is part of the treatment and does not warrant an additional fee. However, there are several instances when provisional crowns need to be made as a separate and intermediate procedure. Because of extra time and work involved, beyond that needed for a crown or bridge, there is a separate fee for the procedure.
One situation where a provisional crown warrants a separate fee involves a tooth or teeth that are severely decayed or broken, where the vitality of the nerve or the periodontal (gum) health is in question. It may be necessary to rebuild the tooth as soon as possible so that the health of the nerve inside the tooth, and the periodontal tissue surrounding the tooth, can be evaluated over time before proceeding with the final crown. When multiple teeth need this treatment, it is customary to place the provisional crowns on each at the same time. If each tooth is taken to completion individually before beginning the next tooth, there is too much opportunity for the remaining damaged teeth to deteriorate further, thereby complicating treatment and adding to the total cost. Provisional crowns may be in place for several months before further treatment is started on the tooth, after which time the tooth will need to have further preparation and a new provisional crown made.
When the nerve in the damaged tooth has a chance of dying, it is easier to save the tooth with root canal therapy if the final crown has not been placed. It often takes months for the health of the nerve to be determined. Despite using a long-term provisional crown, the nerve may die years after the final crown is placed. When that happens, the access for the endodontic treatment is made through the crown. With respect to the periodontal tissues, if they are infected or in poor health, they must be healed before final impressions are made. Periodontal treatment coupled with a well-fitted provisional crown will promote proper healing. After the periodontal tissue is healthy, its position with respect to the crown margins will change, and the tooth will be re-prepared and a second provisional restoration will be made.
Another reason for long-term provisional crowns to be placed is to stabilize loose teeth and determine the necessary support for the final crowns. When a tooth involved in support for a bridge or splint has a questionable prognosis, it is a good idea to make a provisional bridge first and let the tooth (or teeth) function together for some time to see how well they respond. If the tooth turns out to be hopeless, it can be removed. If teeth are restored in a quadrant at a time it may be necessary to do the opposing arch in long-term provisional crowns in order to establish the ideal biting relationships between the arches.
There are many and varied reasons why long-term provisional bridges might be needed. They might stay in place from months to years, especially in very complicated cases such as many teeth that are broken down and moderate to severe gum disease needing correction before the crowns are finally placed. In larger cases, financial limitations may dictate that treatment be phased over a longer time frame. Rather than let the teeth get worse during this time, long-term provisional crowns are made to hold things in place until the treatment can continue.
It is important that you understand why provisional crowns might be necessary for your dental health.