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Ask the Dentist
I was recently told I need a crown on a tooth that does not seem to be giving me any trouble. Does this mean the tooth needs a root canal?
This is a great question! To answer, I will cover several points: What is a crown? Why do people need one? and How does it differ from a root canal( which is a separate procedure)? A crown, or“ cap,” simply put, is like a helmet for the tooth that protects it by covering the top and preventing splitting and cracking. It is important to mention that not all crowns are the same. There are various types( metal, ceramic, and combinations of those) and methods for making them. Furthermore, there is a wide price range for each.
The“ conventional” crowns have been around for centuries, as have the methods for making them. Usually two or more appointments are required. The dentist removes tooth from the top and sides to make room for the metal, ceramic or mixed-material crown. He / she then takes an impression, and makes a temporary crown to cover what’ s left of the tooth. Next, the dentist sends the impression to a lab that could be located anywhere from the local area to California, or as far away as China, which is becoming very popular for dentists. The final crown comes back to the office sometime between a few days and several weeks, at which time you will return to the dental office to get numb again and try the crown. If it fits and looks close enough to your other teeth, the dentist will permanently cement the crown. Otherwise, there will be new impressions, a temporary piece back on and another try whenever that crown comes back, and do it all over.
Another option is to use newer CAD CAM technology called CEREC. With CEREC there is no need to take goopy impressions or use temporary pieces. Instead, pictures are taken with an exceptionally accurate camera to give three-dimensional digital impressions. The digital impressions have proven to be up to 10 times more accurate than traditional methods. Then there is a specialized computer to design an ideal tooth based on the other teeth you have. We use
KEVIN PAWLOWICZ, D. D. S. LOGAN REITER, D. D. S.
VOTED BY PEERS AS ONE
OF PITTSBURGH’ S TOP DENTISTS 2008 – 2015
WWW. FOXCHAPELDENTISTRY. COM
a milling machine to create the crown. A porcelain oven is used to customize the restoration to match your other teeth. This procedure is complete in one visit, which eliminates multiple appointments and multiple injections to numb the area. We use only high-strength, highly aesthetic all-porcelain restorative material; no metal. When these crowns are bonded properly to your natural tooth, they can be stronger than if the tooth was bonded to itself. Unfortunately, less then 10 % of dentists have this technology. There are also“ kinda” CEREC machines, but they aren’ t CEREC— make sure to ask by name. If your dentist does not utilize CEREC technology, as the moderator for the CEREC study club in the area, I could put you in touch with one of our members who can help you.
Which brings us to the real question,“ Why do you need a crown?” One common reason for a crown is to reinforce a weakened tooth to prevent fracturing. A tooth can become weak from large fillings or cavities which diminish its strength. Some signs of a weak tooth include pain when biting or temperature sensitivity. However, these symptoms may not always be present until the tooth has cracked deep enough to affect the nerve of the tooth. Unfortunately, once it’ s gotten to this stage, nerve damage may require that the nerve be removed. The removal of a tooth’ s nerve is a root canal.
Root canal therapy is necessary when the nerve of a tooth dies or has been irreparably damaged. A root canal saves the tooth by removing the nerve from the inside of the tooth, subsequently removing any infection and then sealing the inside of the tooth to prevent any further problems. This procedure can be performed by a general dentist, depending on his / her training and comfort level; otherwise you would need to be referred to a specialist called an endodontist. It is important to understand that not all teeth that need crowns require a root canal, and with CEREC, that number is even less. However, all back teeth that have had a root canal should have a crown.
In summary, if the tooth is not giving you any difficulty it certainly does not rule out a problem. If your dentist recommends a crown on a tooth, he / she may be acting proactively rather than reactively; to prevent a potential problem that may require a root canal or possible loss of the tooth. As always, check with your dentist, call us here at Fox Chapel Advanced Dental Care, or log on to our website www. foxchapeldentistry. com where we have more information, as well as“ before and after” examples of CEREC crowns. Hope that helps! Dentally yours, Kevin
Top Dentist in 2015
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This Industry Insight was written by Dr. Kevin Pawlowicz.
Dr. Pawlowicz practices at Fox Chapel Advanced Dental Care on Old Freeport Road in Fox Chapel. He has trained at the Las Vegas and Seattle Institutes and is a member of the American Academy of Cosmetic Dentistry and the Academy of Laser Dentistry. You can learn more about Dr. Pawlowicz on his website, www. foxchapeldentistry. com.
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