Which teeth can be crowned and which cannot?

I recommend placing a crown on a living tooth if:

• Destruction of
  the crown part of the tooth
  more than 55%
  (trauma, caries, large chip, crack) with normal pulp condition.
• Intensive abrasion of enamel
  .
• The tooth serves as a support for attaching the bridge.

In addition, orthopedic structures using crowns are placed on loose teeth during the treatment of the underlying disease that caused tooth mobility. Sometimes it is possible to place crowns on severely crooked teeth.

Crown for a living tooth

When to place a crown on a living tooth

Stages of installing a crown on a living tooth

Types of crowns. Their pros and cons

When does pulp need to be removed?

Myths about dental crowns

The question of whether it is possible to put a crown on a living tooth has gathered many myths and prejudices and divided people into two camps. When you can put a crown on a living tooth, and when not, what are the pros and cons of both methods, we will consider in this article.

First, let's figure out what a living tooth means. A tooth is an organ consisting of a protective layer (enamel, dentin, cement) and a neurovascular bundle (pulp). A tooth is considered alive if the pulp is preserved, and dead if the pulp is removed - this procedure is usually carried out in the treatment of pulpitis and periodontitis.

Stages of the procedure

Based on the casts, a model of a permanent prosthesis is created in the laboratory from plaster. Since metal ceramics or zirconium dioxide are used for this, the manufacturing process can take several weeks.

Before finishing the work, the technician, together with the dentist, conducts two fittings:

• The first is to try on the crown frame.
• The second is when an almost finished prosthesis is tried on, when layers of ceramics and dyes are applied to the frame.

It is during the second fitting that the correct selection of the crown color and its shape is checked. Upon completion of the inspection, the structure is sent back to the laboratory, where the final manipulations for its creation take place - glazing and polishing.

At the next visit, the permanent crown is secured, but with temporary cement. This measure allows you to assess the level of comfort when wearing the structure, the correctness of its position in relation to neighboring units, and also eliminate the possibility of allergies.

If any problems are discovered or the patient makes complaints, urgent measures are taken to eliminate them. If no side effects are observed, the prosthesis is permanently fixed.

When to place a crown on a living tooth

A crown is a permanent cap-shaped structure that is similar in appearance to a natural tooth. Typically, a crown is installed on severely damaged teeth, when restoration with conventional filling materials is impossible or ineffective, since due to heavy loads, cracks may appear on the filling.

Indications for crown installation

• the tooth is destroyed by caries by more than 50%;
• the tooth is destroyed as a result of injury;
• the tooth has become gray or yellow, and stands out strongly against the background of other teeth.

Often, before installing a crown, the tooth is depulped, that is, the neurovascular bundle is removed from the root canals. However, in some cases this procedure is not carried out. The decision whether to perform depulpation or not is made by the doctor, based on clinical indications.

Cases when a crown is placed on a living tooth:

• the tooth is healthy, but due to destruction it cannot perform its functions;
• demineralization and fragility of enamel;
• using a tooth as a support for a bridge;
• destruction of the crown as a result of mechanical trauma;
• tooth loosening due to gum disease.

Why put a crown on a living tooth?

The neurovascular bundle (pulp) is the tissue that is located inside the tooth. It performs several functions: it delivers nutrients to the tooth and protects it from pathogenic microorganisms. After removal of the pulp, the tooth becomes fragile and vulnerable, as it is left without protection and does not receive nutrition, which leads to the destruction of enamel and the rapid development of caries. Therefore, preserving the pulp is a guarantee that the tooth can serve for many more years.

Sometimes after prosthetics, patients complain of toothache and swelling of the gums. This has nothing to do with the fact that the tooth was not pulpless. The main reasons are untreated diseases, incorrect technique when grinding down the enamel, and damage to the canals during preparation. If you experience these symptoms, you should make an appointment with your doctor.

Restoring part of a “dead” tooth with a filling

Before the restoration begins, endodontic treatment (canal treatment of the tooth) is carried out.

If the “nerve” was removed previously, the dentist will check the quality of the root canal treatment and, if necessary, perform re-treatment. We talk about the complexity of endodontic treatment in the article Why it is impossible to give a 100% guarantee for tooth root canal treatment.

If less than 50% of the crown part of the tooth is destroyed, the lost part can be qualitatively restored using composite filling materials.

Modern filling materials allow the dentist to accurately select the color and transparency of the part of the tooth being restored, to recreate the surface structure and anatomical shape, ensuring the correct bite and contact points with neighboring teeth.

Restoring a tooth with a filling requires the dentist to have a good knowledge of dental anatomy and the skill of a sculptor.

The filling will last 5–7 years

What affects the service life of a filling, when and why it will require replacement, you will learn from the article “Why change an old filling if everything is fine and the tooth is not bothering you?”

Stages of installing a crown on a living tooth

Installing a crown will require several visits to the dentist
Table 1. Stages of installing a crown on a living tooth

Some nuances

After depulpation, the tooth becomes fragile due to its “switching off” from the metabolic process. Excessive stress when eating food can also lead to premature loss. Due to these circumstances, prosthetics without depulpation has gained considerable popularity among patients.

The procedure itself is associated with certain difficulties. The main nuances of this process are:

1. The need to use a large amount of water when grinding the tooth surface. This technique will protect the pulp from overheating (excessive heat exposure).
2. Use of a special tip.
3. Use only new bur in the work. If the cutting part of the bur has already been used before, difficulties arise when grinding down the dentin, which will lead to rapid heating of the nerves, and as a result, their death.
4. Upon completion of the procedure, application of a protective coating to prevent infection from entering the neurovascular bundle.
5. The need to use special solutions containing antiseptics to improve the fixation of crowns.

Important! Failure to comply with these requirements may result in further complications and additional need for treatment.

In addition, upon completion of the preparation procedure, a temporary crown is necessarily attached to the tooth. This requirement solves several problems simultaneously:

1. Full preservation of chewing function.
2. Hiding an aesthetic defect, especially if reconstruction is planned in the frontal area.
3. Preventing the development of pain that the patient may feel if he chews on the problem area.
4. Providing psychological comfort.
5. Protection of the stump and periodontal tissues from pathogenic microorganisms.
6. Prevention of loosening and shifting of teeth after grinding due to loss of support in the form of a nearby element.
7. Preventing changes in gum shape.
8. Getting used to constantly wearing the future prosthesis.
9. Ensuring correct pronunciation of sounds.

Types of crowns. Advantages and disadvantages

Metal-ceramic crowns are rarely installed on a living tooth, since before installing such products, a significant layer of enamel must be removed. Therefore, metal-free structures are most often used: ceramics and zirconium dioxide.

Materials

The choice of materials for making a replacement crown is determined by both medical indications and the wishes of the patient. Today, clinics have a variety of options to choose from, among which the most popular are:

• Polymers - plastic is still an economical and affordable option, but its performance characteristics leave much to be desired;
• Ceramics is an aesthetic, but fragile material, the advantages of which include the lightness and hypoallergenicity of prostheses;

Zirconium dioxide is an option recommended by most clinics, characterized not only by its biological compatibility with oral tissues and a visually attractive structure, but also by its long service life.

When does pulp need to be removed?

Depulpation is not a mandatory procedure before prosthetics, but it cannot be avoided if there are the following indications.

• Advanced caries or caries at the very root of the tooth.
• Pulpitis or periodontitis.
• Partial exposure of nerves during grinding of enamel.
• Anatomically incorrect position of the tooth.
• Tooth injury, which may result in partial death of the nerves.
• Hypersensitivity.
• Low landing crown.

If there is a need to remove the nerve after the crown has been installed on a living tooth, then depulpation can be carried out without removing the crown. The doctor makes a hole, removes the nerve, and then fills the hole with polymer. After such a procedure, the prosthesis does not lose its performance properties.

Indications for removal

The more tissue that is removed during tooth preparation, the higher the risk of opening the pulp chamber. To avoid this, the nerve is removed before prosthetics. This is also done if:

• in the presence of a large cavity, due to which the dentin layer after preparation will become too thin to perform protective functions;
• when teeth move out or lengthen;
• when tilting, turning and abnormal positioning;
• in some cases in patients with periodontitis;
• with increased tooth wear of 2-3 degrees;
• when using large volume stump inlays;
• with increased tooth sensitivity that persists after treatment;
• when the neck of the tooth is exposed as a result of gum recession (loss).

In these cases, the pulp is removed even with healthy teeth. Also, manipulation is carried out in cases of root fracture, multiple caries and pulpitis (inflammation of the pulp).

Realities and myths

Most patients associate prosthetics, and especially if depulpation is excluded, with unpleasant sensations, pain and even fear.

This condition is explained by the need to remove part of the dental tissue, so many people refuse this method of tooth restoration, commenting on the following reasons:

1. A tooth covered with a crown deteriorates and rots faster. This phenomenon does occur, but only if the procedure is carried out incorrectly and there is no proper care for the oral cavity.
   Destruction is also possible due to inadequate preparation of the tooth for prosthetics, poor quality of the prosthetic product, or refusal to install a temporary crown.
2. To install a crown, a large amount of tissue will be removed from the tooth .
   Dentistry today is focused on maximizing the preservation of dentin layers. Modern equipment and tools make it possible to control the amount of fabric stitching, and to carry out this procedure more carefully and accurately. In addition, materials for prostheses have also changed. Thus, the metal-ceramics became thinner, which enabled more gentle grinding behavior.
3. After the crown is removed, the tooth will need to be removed . If the border of the prosthetic product has not dropped, and the preliminary grinding of the tooth is done as carefully as possible, then repeated prosthetics will be successful in a few years, i.e. without the need for removal.
4. Depulpation of a tooth that is to be covered with a crown is a mandatory procedure . Action is mandatory only if there are certain indications. Thanks to the introduction of innovative technologies in dentistry, attaching a prosthesis to a vital organ is not a problem.
5. If caries has developed under the crown, the disease cannot be cured. It is possible, but the treatment method depends on the severity of the pathology.
   In most cases, removal of the prosthesis and its subsequent replacement after completion of treatment is required. Often, caries can be eliminated in another way - without removing the orthopedic structure, treatment is carried out through the hole on the chewing surface.
6. Instead of a crown, it is better to put several fillings. From a financial point of view, filling is cheaper, but loses in efficiency. Fillings, even large ones, cannot withstand heavy chewing loads, which is why they split themselves and lead to the walls breaking off.

Important! The crown maintains uniform load distribution and protects tissue from destruction. If the tooth is severely damaged, fillings are not recommended.

All the considered reasons that underlie patients’ refusal to have crown prosthetics are misconceptions. It should be understood that only a dentist can offer the optimal treatment method, based on the results of the examination and visual examination.

From the video, find out the opinion of a specialist about whether it is necessary to kill the tooth under the crown.