crown and bridge

Many people, especially the elderly, lose their teeth for one reason or the other. Missing teeth in the mouth bring a lot of difficulties like interference in speaking, biting, or chewing adequately. A practical solution to fix the problem of missing or damaged teeth is crown and bridge. Crown and bridge treatments are restorative procedures that utilize a fixed unit of prosthetic devices to treat damaged teeth and restore the gap created by a missing tooth.

Moreover, the crown and bridge help to redefine your smile in the most natural way possible. In a dental bridge unit, the crowns act as a supportive cover or cap which is cemented on the teeth on either side of the missing tooth space. Both the crowns are connected to one or two false teeth. The false teeth are known as pontic, which fill the space and allow proper chewing motions in the mouth.

A dentist can use several types of crown and bridges. The choice of material depends on the patient’s aesthetic requirements. Let’s read further to understand more about this unique prosthetic appliance. We will also look at the cost factors and procedures of crown and bridges.

What do you mean by crown and bridge?

A crown is a single restorative dental prosthesis which is used to cover the entire tooth surface. It typically strengthens a weak or damaged tooth, maintains the alignment of the tooth in the arch, and improves the appearance of the smile. (1)

fixed partial denture dental crown replacement

A dental bridge is a fixed dental prosthesis which is used to treat damaged teeth and fill the missing tooth space in the mouth. This device consists of a unit with false teeth attached to supportive crowns on either end. The crowns on both the ends can be cemented on an existing tooth or an implant. A dentist can only remove crown and bridge units in case of an underlying tooth or gum infection.

What are the benefits of using crown and bridge?

Both dental crown and bridge are considered superior to tooth fillings as they have better aesthetic value and durability. Unlike dentures or any other removable appliances, crown and bridge are fixed restorative solutions. Let’s check out the benefits of both crown and bridge –

Benefits of using a crown

  • Complete coverage and protection of the tooth – dental crown provides the best possible protection to damaged, fractured, or poorly shaped tooth. Moreover, it gives a 360-degree coverage to dental implants, weak root canal treated tooth and tooth with large fillings.
  • Superior aesthetics – in addition to the physical strength and protective quality, dental crowns offer an excellent esthetic advantage. Often, the color of the crown is matched to the adjacent teeth. The crowns are custom made to replicate the ideal shape, size, and color of a particular tooth in the mouth.

Ceramic and zirconia crowns are the best type of crowns to provide a completely natural look. Moreover, these crowns have high strength as compared to other dental materials used for crown fabrication.

  • Durability – dental crowns can last for a lifetime. However, the strength depends upon the oral hygiene and eating habits of the patient. Compared to a tooth filling, dental crowns last longer because of their high quality and durable material.

Benefits of dental bridge

  • Equal force distribution – usually the space created by tooth loss often interferes with eating and chewing. Moreover, it puts a lot of load on the adjacent teeth. A dental bridge restores the gap and equally distributes the biting force to the supporting teeth.
  • Functional restoration – one of the most significant advantages of using a dental bridge is that it restores dental functionality. This means that it makes chewing and eating more relaxed and comfortable. Additionally, the dental bridge improves the clarity of speech that may have been affected due to tooth loss.
  • High aesthetic value – like a dental crown, the bridge also has high aesthetic value. Tooth-colored materials like ceramic and porcelain provide a natural look to the smile.
  • Durability – as mentioned above for dental crowns, the bridge also tend to last longer than any other type of tooth restorations, for example, removable dentures.

What are the risks associated with crown and bridge?

Although the crown and bridge have many advantages over other restorative treatments, there are a few risks associated with them. Some of the risk factors of crown and bridge are listed below –

A detachment of crown and bridge from the tooth surface

Several reasons can lead to detachment of dental crown and bridge from the supporting teeth. One of the most common reason is biting down on hard and sticky food substance. (2) Other causes of crown and bridge detachment may include –

  • Old and worn out prosthetic units
  • Washing out of dental cement from under the crown

Sometimes, loose crowns caused by dissolution of the underlying cement can allow bacteria to penetrate the space and cause tooth decay. In such situations, it is essential to contact your dentist immediately. In case, the crown and bridge fall off, never try to reattach the crown and bridge by yourself. Usually, the dentist assesses the situation and provides the best possible solution. If the prosthesis is not damaged ad all the supporting teeth are healthy, the crown can be re-cemented.

The detachment of partial veneers

Sometimes, a dental bridge is fabricated in connection with a partial veneer. Partial veneers only cover the front surface of a tooth and have less strength as compared to the crown and bridge. This increases the risk of veneer detachment in one piece or with a fractured part of the bridge. The treatment depends on the type of detachment an evaluation by the dental professional –

  • If the veneer has detached in one piece, it can be reattached by the dental professional.
  • If the veneer fractures the bridge unit, the dentist will have to fabricate a new group for the patient. Re-fabrications should ideally be done with a slightly superior dental material as compared to the one fractured. In most cases, porcelain and zirconia are considered the best due to high strength and aesthetic quality.
  • Another economical solution to repair veneer detachment is to reconstruct the fractured area with tooth-colored composite veneer. However, this is considered as a temporary fix; the patient must think about replacement of the prosthesis with a new bridge unit.

Post-treatment sensitivity or discomfort

Some patients experience tooth sensitivity, pain, and discomfort for a few days after the new restoration has been cemented permanently. Some of the possible reasons for this situation may include –

  • Presence of a high point which increases the biting load on the opposing healthy tooth. Often the tooth, lower jaw, and muscles also get affected. This can be treated by simple bite adjustment.
  • If the supporting tooth is not root canal treated, an underlying periapical infection may lead to progressive pulp inflammation. Such conditions have to addressed immediately and treated with root canal treatment followed by crown placement.

Gum irritation

Typically two factors can cause harm to the gingival health of the patient –

  • Insufficient margins of the crown – such prosthesis exposes the tooth root and produces an unsightly image. Moreover, it increases the risk of plaque accumulation and food impaction in the space.
  • Overextended margins of the crown – usually, this can be identified as a dark line around the gums in units that have a base metal frame. Such prosthesis continuously irritates the gingival tissue and can initiate gum recession around the tooth.

In general, crowns attract dental plaque that can be difficult to remove. Improper oral hygiene and failure to keep up with regular dental check-ups can lead to severe complications such as gum disease and inflammation.

Chipping of ceramic or porcelain

Often, crown and bridge made from porcelain can chip and expose the underlying metal frame. Such situations occur when the patient bites down on a hard piece of food. The treatment, in this case, depends upon the extent of chipping –

  • Small chips can be restored by using tooth-colored composite resin. Many dental offices are equipped with ceramic repair kits, which consist of a specific gel that bond composite to the metal frame.
  • Significant cracks or chipping of porcelain may require replacement of the entire prosthesis. (3)

What are the different types of crown and bridge?

Based on material used

Some of the popular dental material used for fabrication of crown and bridge include –

  • Base Metal – this is a non-noble metal which is highly corrosion resistant and has excellent strength in withstanding the biting forces.
  • Porcelain fused with metal – porcelain fused metal units as the name suggests, it consists of a base metal frame on which the porcelain is coated to improve the aesthetics of the prosthesis. This unit gives a more natural look and is exceptionally durable. (4)
  • All-ceramic – all-ceramic restorations are usually preferred for front teeth because of its high-end aesthetic quality that matches the natural tooth color.
  • Gold alloy – this material is a mixture of gold, copper, and other metals which provide improved strength and durable bonding capacity with the tooth. The high wear resistance protects the nit from fracturing. However, gold-alloy is capable of wearing away the opposing tooth structure.
  • Resin – resin crown as the most natural-looking and economical choice among all other types. However, it is not as durable as ceramic restorations and can crack or fracture easily.
  • Zirconium – zirconia is an advanced dental material which has bee recently added to the list of cosmetic smile designing. Some of the properties of zirconia include durability, high-end aesthetics, and minimal tooth preparation. (5)

Based on the location

A dental bridge can be categorized into following types –

Standard bridge

This is a traditional bridge which consists of two supporting crowns on either end of the unit. The crown is cemented on the abutment teeth on either side of the missing tooth space. Space is filled with pontics or false teeth attached to the crowns. (6)

Maryland bridge

This unique bridge consists of one pontic with wings of metal, resin or porcelain. The wing bonds to the abutment teeth on either side of the missing tooth space. This prosthesis is usually used in front teeth restorations as they lack maximum chewing force. (7)

Cantilever bridge

A cantilever bridge is fabricated in cases of single tooth support. This prosthesis is not very common for restoring teeth at the back of the mouth. Cantilever bridge cannot withstand biting forces. Moreover, they are not preferred by dentists because of insufficient support.

What is the procedure for crown and bridge placement?

For fabrication of a crown and bridge, the tooth must be reduced in size to compensate the width of the material. The dentist performs crown cutting procedures to reduce the size of the crown and takes an impression to provide a mold for the lab technician.

Shade matching is done for ceramic, resin, porcelain or zirconium restorations. Ideally, the shade is matched with the adjacent and opposing teeth. While the impression is sent to the lab for fabrication of dental prosthesis, the dentist may cover the prepared tooth with a temporary crown and bridge.

What is the cost of crown and bridge treatment?

Usually, a single tooth crown may range from $800 – $1700 depending on the type of material used. The cost of a dental bridge relies on the kind of bridge –

  • Standard or traditional bridge and cantilever bridge usually cost around $2000 – $5000 for a three-unit prosthesis. This device replaces a single missing tooth.
  • Maryland bridge costs around $1500 – $2500 for a three-unit framework.
  • Implant-supported bridge costs around $5000 – $15000 for a bridge with two dental implants spanning three or four teeth.

Take away message

Crown and bridge are one of the most effective and standard procedures performed to treat decayed or damaged teeth and restore the missing tooth space. A dental crown can be used as a single restorative unit, or it can be attached to the bridge to act as a support. Benefits of crown and bridge mainly include functional restoration, durability, and aesthetics. A dentist performs crown and bridge treatments; the choice of the prosthesis may depend upon the patient’s needs and requirement.

Often front teeth are restored with ceramic, porcelain, resin or zirconium restorations because of the natural-looking appearance. However, back teeth that are not usually visible can be restored with metal frameworks. It is essential always to discuss all the possible benefits and risks associated with the different types of crown and bridge prosthesis. This will help you to have a long-lasting and natural-looking smile.