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Dental Crowns Marielaina Perrone DDS

Not All Dental Crowns Are Created The Same!

Dental crowns are a type of dental restoration which completely covers and protects a tooth or a dental implant. Dental crowns are often necessary when a large cavity has destroyed  a good portion of the tooth, leaving it easily fracturable. Dental crowns will restore its shape, strength, and improve its cosmetic appearance. Dental crowns are typically bonded to the tooth using a specialized dental cement (in dental implants they are sometimes screwed in place). Crowns can be made from many different types of materials. Dental crowns are generally custom fabricated using indirect methods.

 Types Of Dental Crowns

Permanent dental crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal (also called a PFM crown), all resin, or all porcelain.

-Stainless steel. These short term use dental crowns are  pre -formed metal shells.They are used on permanent or primary teeth generally for a few years, or as a temporary. The temporary crown protects the tooth or filling while a permanent crown is made from another material. For children’s teeth, a stainless steel crown is commonly used to fit over a  tooth that’s been prepared to fit it. The crown covers the entire tooth and protects it from further breakdown. This type of dental crown also serves another purpose, to hold space in the mouth for the permanent teeth to move into. When the primary tooth eventually falls out of the mouth, the crown comes out with it.

-Metal Alloy. These dental crowns can include crowns made of gold , other precious alloys (for example,platinum, palladium), or a base-metal alloy or non-precious (for example, nickel or chromium). Purer gold is the softest yet easiest to get ideal fit, while non precious crowns are variable in hardness and strength. Non precious dental crowns tend to make the underlying tooth black as,over time, metals leach into the tooth, they may also have a very metallic taste.  Metal dental crowns can be made very thin. This allows for minimal tooth structure to be reshaped in preparation for the crown. Another advantage is, that metal crowns are not as hard as porcelain. This “softness” causes much less wear on the opposing tooth. Metal dental crowns do not break or chip and tend to withstand biting forces well over time. However, metal crowns are not very cosmetic, can wear through, and generally are reserved for the areas not visible in the smile line.

Dental Crowns Marielaina Perrone DDS-Porcelain-fused-to-metal (PFM). These dental crowns are the most widely and commonly used. They have the benefit of good fit and underlying strength from the metal.The underlying metal alloy may be any combination of precious or non precious as mentioned above. These dental crowns are more cosmetic, and are fabricated to match the color of the surrounding teeth. However, the porcelain outer layer will cause more wearing to the opposing teeth than a metal crown. The porcelain portion of the crown can also chip or break off over time. PFM dental crowns can be highly esthetic and look just like your natural teeth when prepared properly. Over time, with gum recession, a dark line may become visible at the gumline. This is the underlying metal of the crown. Depending upon where it is in the mouth, it may become a cosmetic problem. These dental crowns are able to be used for any teeth in the mouth.

-All ceramic, all porcelain, all resin. These dental crowns are the ultimate in cosmetic crowns. These provide better natural color match than any other crown type. These are also a good choice for patients with metal allergies of any kind. However, some are not as strong (example, Belle Glass) as porcelain-fused-to-metal crowns, some are stronger (example, Bruxzir crowns). These dental crowns tend to wear down opposing teeth more than metal crowns would. Because of the lack of metal, there will never be a black line to worry about.  All porcelain crowns are the perfect choice for front teeth cosmetics, or any teeth that will be easily seen when smiling.

Dental Crown Tips

So, you have been told you need a crown to restore a tooth? The following are some things to ask or check on with your dentist to ensure you are receiving the highest quality care that will last over the long term:

American Made? Many dentists  save costs by resorting to using dental laboratories overseas in places like Costa Rica and China. They tend to be made with cheaper materials and lower quality recycled dental metals and porcelain. Ask your dentist where your crown is being fabricated, along with the laboratory slip to tell how much gold content or type of porcelain is being used.

How long should it last? Is there any warranty for breakage? Dental crowns generally last between 10-15 years with proper oral hygiene, if a dental crown is madeDental Crowns Marielaina Perrone DDS with inferior materials you can expect breakdown in half that time. Some labs will warranty a crown for up to a year. Especially important if you have chosen a ceramic, resin, or porcelain type crown. ask your dentist about this.

Lab Created Provisional Dental Crowns. Sometimes to help you make decisions especially in a cosmetic area, a dentist may have a dental laboratory make a trial or provisional crown. This type of dental crown is generally made if there is healing required before the final processing of your new crowns. With lab created temporaries, you can literally see what your permanent crown (shape and color) will look like and whether it blends well with your smile. It also helps you determine if it is compatible with the health of your gum tissues and whether or not you can eat and talk normally. With a provisional crown (as opposed to a routine temporary crown), all the details are worked out ahead of time. There usually is an additional charge for this extra step as there will be a laboratory fee involved as well as extra chair time with dentist. Once you approve, your final crown is custom made to match the blueprint provided by the provisional, except that the final materials are stronger, of better quality, and look far more natural.

Always ask to see the crown before it is placed permanently in the mouth! This should be something most dentists do anyway but not all will. You want to ensure shape and color are to your liking before it is placed in permanently. If the color is off or does not feel right voice your concerns. If you truly are not happy with something that cannot be adjusted chair side ask for the crown to be remade. Crown aesthetics can be very subjective, and their beauty is very much in the eyes of the beholder. Both your input and your dentist’s professional experience should come together in giving you the smile you want.

Conclusion

Each and very dentist has a professional responsibility to treat to the standard of care for a particular dental procedure. Even if some dentists may use inferior products or dental laboratories they are still responsible that the dental crown fits properly and functions as it should.

Not all dental crowns are made the same,and not all dentists, or their labs, have the same skill, training, or experience. A well trained dentist will have no problems preparing and inserting a good functioning dental crown. It takes a skilled dentist and lab to make it look natural, without anyone knowing you even have a crown in your mouth. Dentistry ultimately is an art and choosing the right dentist for you will create a happier, healthier smile.

 

Tooth eruption is a process in tooth development in which the teeth erupt into the mouth and becomes visible.

The arrival of a new tooth, or tooth eruption is a big event for most of us! As a baby, tooth eruption allows for introduction of new foods with more substance. Later on, many parents and kids look forward to a visit from the tooth fairy, and for their new “grown up” teeth to come in. It is an exciting time for parents and children alike and losing baby teeth is an important milestone in most kids and parents lives. It means they are growing up, getting bigger, and taking on more responsibility for themselves at home and school.

Tooth Eruption Facts

Humans have two sets of teeth, primary (or baby) teeth and then permanent teeth. These teeth develop in stages. The schedule is different but the development and tooth eruption of each of these sets of teeth is very much the same. Following are a few facts about tooth eruption:

Tooth eruption tends to happen in parallel. This means that the bottom molar tooth on your left side should erupt into your mouth at about the same time as the bottom molar tooth on the right side.

-Primary tooth development begins during the 2nd trimester of a woman’s pregnancy. Primary teeth are place holders for permanent teeth.

-Loss of primary teeth due to extraction or loss of space due to breakdown of baby teeth, makes a child susceptible to malocclusion and more likely to need orthodontic treatment.

-The crown of a tooth is the first to begin forming. The roots continue to develop and lengthen even after the teeth have come through the gums.

-There are 20 primary teeth. These are usually fully erupted by age 3, and remain until around 6 years of age when they begin to fall out to make room for your permanent teeth.

-Adult teeth usually begin to erupt into the mouth between 6 and 12 years of age. Most adults have 32 permanent teeth.

-Permanent teeth are larger and take longer to erupt than primary teeth.

Tooth Eruption – Types of Teeth

A person’s teeth will vary in size, shape, and their location. Each tooth in your mouth has a job to do and that is why it is shaped the way it is and where it is located. Tooth eruption follows a definite pattern.  There are 5 types of teeth:

1) Incisors. Incisors are the eight teeth in the front of your mouth (four on top and four on bottom). These teeth are used to take bites of your food. Incisors are usually the first teeth to erupt. Primary incisors erupt at around 6 months of age.Permanent incisors should come in at  6 and 8 years of age.

2) Canines. We have four canines in our mouths. These are the next type of teeth to erupt. Canines are your sharpest teeth and are used for ripping and tearing food apart. Teeth eruption for primary canines usually occurs between 16 and 20 months of age, with the upper canines coming in just before  the lower canines. The order is reversed for permanent teeth. Lower canines erupt around age 9, with the uppers erupting at about 11-12 years of age.

3) Premolars. Primary molars are replaced by premolars. Premolars (also called bicuspids) are used for chewing and grinding of food. You have four premolars on each side of your mouth, two on the upper and two on the lower jaw. The first premolars appear around age 10 and the second premolars arrive about a year later. Premolars are generally the teeth that may need to be removed during orthodontic treatment to create space.

4) Molars. Primary molars (replaced by the permanent premolars) are also used for chewing and grinding food. Teeth eruption for these happens between 12 and 15 months of age. The first permanent molars erupt around 6 years of age while the second molars come in around 11-13 years old.

5) Third Molars. These are also referred to as “wisdom” teeth. These are the last teeth to erupt into the mouth and do not typically erupt until age 18-21 years of age. Some

Tooth Eruption Issues - Peg Laterals - Marielaina Perrone DDS

Tooth Eruption Issues – Peg Laterals

people never develop third molars at all. These molars may cause crowding and need to be removed. Other times they develop in the jaw but never erupt into the mouth. When this happens it is referred to as impacted.

Tooth Eruption Issues

-Supernumerary teeth.  Extra teeth may form and make normal tooth eruption more difficult, delayed or impacted. This happens most often in the wisdom tooth area. Another type of extra tooth is called a mesiodens. This is an extra small tooth growing right between the two upper front teeth and needs to be removed surgically. There is also Gemination, or twinning of a tooth, wherein, a double tooth forms.

Malformed  Teeth. Tooth eruption is not always perfect. Sometimes genetics, medications etc. can cause malformed teeth. Examples are peg laterals (very small lateral incisors), mulberry molars (a molar

Fused Tooth - Marielaina Perrone DDS

Tooth Eruption Issues – Fused Tooth

that has a raspberry like appearance), Fused teeth (two different teeth which form conjoined into one tooth such as a lateral and canine),  Dens in dente (a tooth growing completely inside of another tooth).

If a tooth does not form in the primary dentition (for example a child never forms a front baby tooth), there will never be a permanent tooth to replace it. Also, tooth eruption in the lower arch in front can sometimes erupt behind the primary teeth. This is quite normal but may necessitate the need of removal of the primary teeth to aid tooth eruption.

If teeth are not erupting properly, have your dentist take an x ray. Sometimes there are developmental or genetic issues causing malformed teeth, extra teeth or lack of tooth development. It is important to monitor tooth eruption as it happens. The earlier these issues are detected, the better you can prepare for future treatment needs.

 

Primary Tooth Eruption Chart

Tooth Eruption Chart - Marielaina Perrone DDS

Tooth Eruption Chart

 

Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.