Crowns, bridges, onlays and inlays

Crowns, inlays, onlays are artificial coverings designed to improve the appearance of teeth and/or to restore badly broken down teeth. Bridges replace missing teeth using either crowns or metal discreet, hidden “wings” supported using the teeth on either side of the space. 

Crowns cover our teeth just like hats cover our heads in winter. Bridges are like the ones you see linking two banks on the river, where the supporting pillars are your own teeth, called by the dentists abutments, and the missing teeth are replaced by pontics. 

The forces we place on our teeth are immense and sometimes a filling in a tooth simply isn’t strong enough to withstand them. That is when your dentist will advise that a crown/onlay/inlay is placed on one or more of your teeth, because the tooth is weakened by extensive decay, or a large filling, following a root canal when the tooth is brittle, or for cosmetic reasons. Bridges are used to fill up small gaps in the mouth where teeth have been lost or removed.

Crowns and bridges are not usually provided for young patients until the teeth and jaws are fully developed. It is also important that the gums and supporting bone is healthy, therefore tooth brushing and the use of dental floss are essential before and following treatment. Your dentist and hygienist will advise you about this.

It is like building a new house. You can build the beautiful house furnished in the most tasteful way, but if the foundation is compromised… it will not withstand the function. By comparison – your dentist and dental technician can create an amazing, both technically and cosmetically job for you, but if your own teeth, the pillars, and the gums are unhealthy, the whole effort will be wasted. It is incredibly important that before considering any restorative or cosmetically driven dental work you follow your dentist and hygienist’s recommendation regarding maintaining the health of our gums

If you would like to read an article on gum and periodontal disease, then click here.

What are the risks of these treatments? 

The underlying tooth can still breakdown, or it may require root canal treatment before or after the procedure at additional cost.

How long do crowns and bridges last? 

As long as the teeth and gums are maintained by both, patient and dentist, crowns and bridges can last for many years. However, no absolute guarantee can ever be given and they may need to be replaced in time. Aesthetically, they tend to look their best for 10-15 years, during which time the gum shrinks a bit (gum recession), the margins of the crowns may be exposed, and you MAY (although you do not have to) decide to replace them simply for cosmetic reasons. 

If the tooth is badly broken down, or in very poor shape, there may be no alternative to a crown. Dentures or implants, instead of a bridge may replace gaps in the mouth.

What is the procedure like? 

You will usually need to have 2 appointments to complete crown / bridge work. 

The first appointment will be focused on the preparation and taking impressions. The dentist will discuss with you your wishes and needs, help you to choose the shape and the shade of your new crown, so it looks as good as a perfect natural tooth. 

It is incredibly important that you are honest and not at all shy expressing your wishes.  Please ask any question about the procedure, what is possible, what is not achievable, tell the dentist what you really want, express your worries and doubts. Please do not feel that you are ‘being vain’.

The dentist is trained to provide you with the best clinical solutions as well as the most aesthetically pleasing! We do want you to look your best. We want happy patients. We can customise the look of your smile to your liking. Do you like your teeth rounder? Squarer? Longer? Whiter? We can assist you with all your wishes, and advise you what is and what is not possible. We can do so much these days to create beautiful smiles. It is your mouth, your choice, your decision. 

Local anaesthesia may be necessary in order to reduce tooth structure without causing undue pain during the procedure. After numbing the tooth, the dentist gently and precisely grinds down the affected part of the tooth or an old filling to create the space for a new crown (a form of a cap covering the tooth just like a hat covers the head).

This is precision work, very technique sensitive, therefore requiring a lot of attention to detail. Your dentist will spend substantial amount of time on this activity to make sure that your crown will fit well on your prepared tooth. It has to be perfect! We can make it perfect, why compromise? There will be lots of water spray, and some noise from the instruments that your dentist and dental assistant use.

Making it easier and more pleasant for you

Ladies, get your lipstick ready to reapply after the procedure. Why not  bring your headphones and listen to your favorite music while we are working on making you even better looking ! If you forget your headphone, we offer video entertainment in our practices, to take your mind off the procedure you are undergoing.

Okay, so what next ?

After preparing the tooth, impressions will be taken. These are imprints of your teeth which are taken on small special plastic trays filled with colourful  material. Such trays filled with plastol-like material will be gently inserted into your mouth for a minute or two. Your impressions are now ready and the dental assistant will prepare them to be sent to our chosen dental laboratory to build the plaster model of your teeth.

A highly skilled dental technician will then use these models to build your precisely fitting ceramic crown ready to be checked and assessed and glued onto your tooth by your dentist. Nothing comes ready made off the shelf. It is all custom made for you. The laboratory will usually take several days to make the final fitting appliance so in the meantime you will have a temporary crown made by your dentist.

While you have this temporary crown you should be aware that it is made of plastic-like material meaning it is not as smooth as the final fit will be. You need to avoid eating sticky and hard foods and if your temporary filling is in the front of the mouth, please be aware that certain foods high in colour such as curries and spaghetti Bolognese, red wine can discolour it.

So if you stick to greek youghurt, cauliflower and white wine… you are safe! Ok, jokes aside, please be wary of colorful foods. If the temporary filling comes off, just contact the practice and arrange an appointment to get it cemented back on. If you are unable to get to us you can buy temporary cement from a pharmacy or use dental adhesive to keep it in until you are able to get to us.

The second appointment – fitting the crown or bridge

The second appointment is when your crown / bridge is ready to fit.

Sometimes local anesthesia may be necessary in order to reduce your sensitivity when we remove the temporary crown and rinse and dry your tooth. It’s a bit like going out to your garden in December in your T-shirt, when the temperatures plummet to -5 degrees… You will most likely be a little temperature sensitive.

Your dentist will gently remove your temporary crown (-s). She/He will clean and disinfect (remove bacterial film form the tooth and surrounding gum surface) the cavity, the tooth, and dry it. Now we need to make sure that the crown fits like a glove, and what is equally important – that you are happy with the appearance.

You will be given a mirror to see and assess the look of the crown in your mouth. Now that we are happy with the fit and the look, we can glue the crown onto your tooth. Your dentist will use a special dental cement to insert the crown precisely onto your tooth. He/She will then remove excess of the dental cement, check everything again, make some adjustments if needed, and you can enjoy the rest of the day smiling.

Okay, so what happens once the crown or bridge is fitted ?

On a rare occasion, after your final crown/onlay/inlay/ bridge is fitted, you may experience some of the following symptoms:

Sensitivity – Crown preparation is a n invasive procedure and where teeth are alive or ‘vital’, they may be irritated after the preparation.

Your tooth may be more sensitive to hot, cold or sweet foods. This is usually short lived. However pain lasting for a few minutes or more, or lasting for two or more weeks, or sufficient to keep you awake at night needs to be addressed. In such cases, the procedure may have been too irritating for the tooth and you will need to see your dentist who may suggest a root canal treatment if you elect to save the tooth, or extraction if you don’t. It is estimated that some 20- 25% of crowned teeth require a root canal after five years.

Crown feels too big and or too high – If you had a local anesthetic when your crown was placed, it is sometimes difficult for you to tell whether your crown is comfortable or not. If you feel that your crown is high when the local anesthetic wears off, then please arrange to see your dentist, who will ‘ease’ it. 

Breakage  Ceramic crowns may possibly chip, break or de-bond. Many factors can contribute to this situation such as chewing excessively hard materials, opening bottles using your teeth (!), changes in biting forces exerted, traumatic blows to the mouth, biting your nails, grinding at night or clenching your teeth etc. Unobservable cracks may develop in porcelain from these causes, but the crown may not actually break until chewing soft foods, or for no apparent reason. Breakage or chipping seldom occurs due to defective materials or construction unless it occurs straight after placement.

Pain – crowned teeth may require root canal treatment subsequently: teeth after being crowned may develop a condition known as pulpitis or pulpal degeneration. Usually, this cannot be predetermined. The tooth or teeth may have been traumatized from an accident, deep decay, extensive preparation, or other causes. It is often necessary to do root canal treatments in these teeth, particularly if teeth remain appreciably sensitive or painful for a long period of time following veneering.  The chances of this happening are around 20-25%. 

REMEMBER – crowns do not ‘bed in’ and failure to address a ‘high spot’ could lead to pain. Chipping of the porcelain may occur to prevent this happening especially if you clench & grind your teeth a bite guard should be made

Enlightened Dentistry

Dentistry is a complex art requiring expertise and experience to fulfill our patients’ expectations. At PJS Dental, we aim to deliver an exceptional customer experience that focuses on making our patients feel good about every interaction they have with us. We improve lives by giving our patients confidence in everything that they do.

If you you need advice about a Crown, Bridge or other dental treatment, get in touch to find out more.