What are crowns made of?
There are many different types of crowns but they all can be divided into one of three categories based upon the materials used. Crowns can be all metal, all ceramic/porcelain, or porcelain fused to metal. These categories can be further subdivided.

The most popular all metal crown is gold. Gold is the best material to use for a crown because it can last the longest and is most compatible as far as wear and hypoallergenicity.

Crowns can also be made of other metals with lower gold or no gold content. Generally speaking, if you want a metal crown only insist a one with a high gold content. Porcelain fused to metal crowns are very common and used as standard because they have been around for awhile. Most people ask for a ceramometal (porcelain fused to metal) crown because they don't want yellow gold showing. A ceramometal crown has porcelain baked on to high noble alloy shell (high gold content).

The last category is the ceramic/porcelain crown. These crowns have no metal and depending upon the type of crown can be either cemented or bonded to the tooth. The most esthetic ceramic crown is the porcelain jacket crown. This type of crown is more esthetic because it is bonded to the tooth, has greater depth of color and is opalescent. Porcelain veneers are very similiar in character to a porcelain jacket crown.

How is a crown placed?
To prepare the tooth for a crown, it is reduced so the crown can fit over it. An impression of the teeth and gums are made and sent off to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown in made. On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.

Will it look natural?
Yes. The dentist's main goal is to create crowns that look like natural teeth. That is why dentists take an impression. To achieve a certain look, a number of factors are considered, such as the color, bite, shape and length of your natural teeth. Any one of these factors alone can affect your appearance.

If you have a certain cosmetic look in mind for your crown, discuss it with your dentist at your initial visit. When the procedure is complete, your teeth will not only be stronger, but they may be more attractive.

Why crowns and not veneers?
Crowns require more tooth structure removal; hence, they cover more of the tooth than veneers. Crowns are stationary and are customarily indicated for teeth that have sustained significant loss of structure, or to replace missing teeth. Crowns may be placed on natural teeth or dental implants.

How should I take care of my crowns?
To prevent damaging or fracturing the crowns, avoid chewing hard foods, ice or other hard objects. You also want to avoid teeth grinding. Besides visiting your dentist and brushing twice a day, cleaning between your teeth is vital with crowns. Floss or interdental cleaners (specially shaped brushes and sticks) are important tools to remove plaque from the crown area where the gum meets the tooth. Plaque in that area can cause dental decay and gum disease.

Who should get a bridge?
If you are missing any teeth and are committed to maintaining good oral hygiene practices, you may be a good candidate for a bridge. A bridge is the most natural choice to fill the space in your mouth left by missing teeth. This space can cause the surrounding teeth to drift out of position and can cause teeth and gums to become more susceptible to tooth decay and gum disease that can cause further tooth loss. Fixed bridges not only correct an altered bite, improve your chewing ability and speech, but they also safeguard your appearance by preventing the collapse of your facial features that can cause premature wrinkles and age lines.

What types of bridges are there?
Besides traditional bridges, another popular design is the resin bonded or "Maryland" bridge, primarily used for the front teeth. This is usually the most economical choice when the abutment teeth are healthy and don't contain large fillings. The pontic is fused to metal bands that can be bonded to the abutment teeth with resin cement and hidden from view, reducing the amount of preparation on the adjacent teeth.

A cantilever bridge may be used if there are teeth on only one side of the span. This involves anchoring the pontic to one side over one or more natural, adjacent teeth. If there are no adjacent teeth to act as anchors, you dentist may recommend an implant - a metal post that is surgically imbedded into the bone and capped with a crown as an abutment. In some cases where the span is large, your dentist may recommend a removable partial denture or even an implant-supported prosthesis.

What procedures are involved?
For a traditional fixed bridge, the first appointment consists of the dentist reducing the adjacent abutment teeth that will act as anchors. Impressions are made, from which a metal framework, including the pontic, is created. By the second appointment, the final bridge is fitted over the teeth.

The total treatment time is usually between two and four weeks, depending on the type of bridge. However, because it is often difficult to match the natural shade of your teeth, the treatment time may be longer.

How do I care for a bridge?
With a bridge, it is more important than ever to brush, floss and see your dentist regularly. If you do not control the buildup of food debris and plaque - the sticky film of bacteria formed from acids in foods - your teeth and gums can become infected, requiring further treatment and resulting in possible loss of the bridge. Your dentist may also recommend using floss threaders that help remove bacteria from hard to reach spaces between the bridge and adjacent teeth and gums.

If you maintain optimal oral hygiene care, you can expect your fixed bridge to last as many as 8-10 years, or even longer.

Who needs a denture?
Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

What happens when you get a denture?
A dentist can make a full conventional denture when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments; the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient's final denture is placed, following any minor adjustments.

New denture wearers need time to get accustomed to their new "teeth" because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days or a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers often notice a slight change in facial appearance, increased salivary flow, or minor speech difficulty.

How do you care for a denture?
A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpaste. Never use harsh, abrasive cleansers, including abrasive toothpastes, because they may scratch the surface of the denture. Don't sterilize your denture with boiling water because it will cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth.

When not is use, soak it in a cleanser solution or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.

Should a denture be worn at night?
While you may be advised to wear your new denture almost constantly during the first two weeks - even while you sleep - under normal circumstances it is considered best to remove it at night. Research has shown that removing the denture for at least eight hours during either the day or night allows the gum tissue to rest and allows normal stimulation and cleansing by the tongue and saliva. This promotes better long-term health of gums.

Continue seeing your dentist regularly
It is important to continue having regular dental checkups so that a dentist can examine oral tissues for signs of disease or cancer. As you age, your mouth will continue to change as the bone under your denture shrinks or recedes. To maintain a proper fit over time, it may be necessary to adjust your denture or possibly remake your denture. Never attempt to adjust a denture yourself and do not use denture adhesives for a prolonged period because it can contribute to bone loss. When in doubt, consult your dentist.

Reprinted from AGD.