Are Dental Crowns Really Necessary
Tooth crown when and why?
If more than half of the natural tooth crown is destroyed, it would have recently been advised to crown the broken tooth. With new filling materials and treatment techniques, crowning is much less necessary.
Reasons for crowning defective teeth:
- Dental caries has led to such extensive destruction of the natural tooth crown that the remaining tooth cannot withstand chewing pressure despite modern adhesive fillings.
- Because of a tooth gap, a bridge should be made, which requires a crowning of one's own teeth adjacent to the gap for attachment. Alternatively, however, an implant can now be placed for the missing tooth.
- A tooth that has been treated with a root canal - dead tooth - is as brittle as a living tooth and turns dark in color. To prevent breakage of the tooth crown, the tooth is covered and stabilized with an artificial tooth crown for reasons of stability.
- A simple denture needs to be fixed with brackets. The clasp tooth is covered with a protection to protect against attacks by the clasp. This reason for crowning is only provided for in "health insurance" and is never medically meaningful.
- So much tooth substance has been lost in an accident that only a crown is a guarantee of success. In the visible area there is an aesthetically disturbing misalignment of the teeth.
- Orthodontic regulation is out of the question, the alternative could be crowning. By grinding, the natural teeth have lost so much substance that filling - also because of the grinding - is no longer sufficient and only crowning makes sense.
The partial crown largely corresponds to the fully cast crown. Only the entire tooth is not included in the restoration, but healthy tooth surfaces are left intact. The processing of the tooth and the production of the partial crown require more effort than that of the fully cast crown.
Partial crowns are made instead of full crowns to protect the tooth substance, the gumline and also for cosmetic reasons. Usually the part of the tooth that is visible to the outside is not ground. Depending on how many areas are later covered by the partial crown, a distinction is made between half crown, three-quarter crown and four-fifth crown; but a partial crown always covers the chewing surface of the tooth. A demarcation of the partial crown from an onlay, overlay or inlay (inlay filling) is often difficult because there are always flowing transitions. In general, one thinks that with an onlay all the tooth cusps are still present (only the cusp tips are covered), with a partial crown at least one natural cusp is missing. This dispute, which is senseless in itself, is only of importance because the statutory health insurance companies in Germany only pay a fixed allowance for partial crowns, but not for onlays or inlays, which are considered to be fillings and are practically not subsidized.
Absurdly, the whole thing is exactly the other way around with private health insurances: Here the inlay is often 100 percent paid for - it counts as “tooth preservation” - while the partial crown as “denture” requires an additional payment from the private patient, albeit a small one.
The partial crown usually ends with its edge above the gums (supragingival). Partial crowns are useful in teeth that are not susceptible to caries, as the risk of marginal caries is considerably greater than with a full crown.
The metal-based crown can be made of a high-quality gold alloy, a gold-reduced alloy, titanium or a non-precious metal alloy (NEM). With the cheaper gold-reduced alloys, the addition of less noble metals, such as palladium, can lead to allergies or discoloration of the oral mucosa. This is why today, in addition to the expensive high gold alloys, non-precious metal alloys or titanium are used as an inexpensive alternative to the gold crown.
The metal-based crowns can be manufactured as unveneered full cast crowns, partially veneered crowns or fully veneered crowns. The veneering material can either be a composite-based veneering plastic or, better yet, ceramic (veneering metal-ceramic: VMK). Because of the high firing temperature (800-900 ° C), the latter require special firing alloys that form an oxide layer that promotes bonding during the firing process. Ceramic veneering is more complex, but compared to plastic veneering it has the aesthetic advantage of better color stability and greater resistance to abrasion. This can rarely be a disadvantage because its enormous hardness prevents even abrasion (natural grinding) and the opposing teeth are severely chewed off. The result can be TMJ problems.
Full cast crown
It consists entirely of a dental alloy that is silver or gold in color depending on its composition. The standard is the gold crown with high gold content or, less so, the titanium crown. For reasons of cost - increased gold prices - a reduced gold alloy or non-precious metal alloy (NEM) is often used. In the non-visible area, this crown may represent a sensible restoration for patients with severe teeth grinding.
Galvano gold-based dental crowns
Crowns with galvanically separated basic frameworks occupy an intermediate position. These are made electrochemically from pure gold at room temperature and veneered in the color of the tooth. They combine very good body compatibility, accuracy of fit and high aesthetics, but are more prone to processing errors and not very stable.
Ceramic crowns with metal framework
Ceramic crowns that are reinforced inside by a metal framework are called composite metal-ceramic crowns (VMK) or veneered crowns. Until recently, veneer crowns were the standard way of rebuilding a massively damaged tooth and achieving a beautiful aesthetic result. With a composite metal-ceramic crown (VMK), the ceramic is reinforced by a metal framework. This framework is mostly an alloy with a high gold content. In rare cases, this alloy can also cause allergic reactions. Above all, alloys containing nickel should be avoided, as nickel has a high allergy potential.
VMK crown (partially veneered):
The basic structure corresponds to the fully cast crown. In the "outside area", a tooth-colored ceramic veneer is attached for aesthetic reasons. The chewing surface remains as a metal occlusal surface. This crown corresponds to the standard care in the visible area (upper jaw up to tooth 5, lower jaw up to tooth 4).
VMK crown (fully veneered):
The inner framework corresponds to that of the fully cast crown. A dental ceramic is burned onto the entire visible outer surface so that the entire tooth is "white". Due to its multiple positive properties, this type of crown has established itself as the standard, especially in the visible area. Since the occlusal surfaces are also veneered, adapting and manufacturing requires increased effort.
A composite metal-ceramic crown is more useful than an all-ceramic crown if:
- The prepared tooth is darkly discolored and would show through the all-ceramic crown.
- Limited space prevail.
- When the patient is constantly grinding or clenching their teeth
The stability gained by the metal framework has aesthetic disadvantages. The composite metal-ceramic crown appears less lively under certain light conditions in the anterior region. In everyday life, however, there is hardly any difference between an all-ceramic crown and a composite metal-ceramic crown at speaking distance. In the case of composite crowns in which the metal inner jacket is pulled to the edge of the crown, there is a further disadvantage. You can see the metal shimmering darkly through the gums. If the gums recede for any reason, you can see the metal edge.
Full ceramic crown the most beautiful of all ceramic crowns
The most aesthetically demanding and high-quality solution for a crown restoration is the all-ceramic crown, because ceramic can be ideally adapted in color and shape to natural teeth and looks very natural. Thanks to a special layering technique, this ceramic crown can be modeled in such a way that the ceramic looks like natural teeth in terms of color brilliance (coloring) and transparency. For this reason, all-ceramic crowns are the best choice, especially for the anterior region. In the posterior region, the ceramic-veneered metal framework is still justified for reasons of stability. Finally, all-ceramic crowns have a ceramic core instead of a metal framework, which is then burned over. The core can be machined from a block on a boring and milling machine or pressed from liquid ceramic at a high temperature. As a rule, all-ceramic crowns are cosmetically very beneficial and particularly biocompatible because of their transparency.
If you consider the treatment steps for an inlay and the work in the dental laboratory, it is understandable why a tooth crown causes considerable costs. For patients with statutory health insurance, the costs for a crown are only partially covered (50%, 60%, 65% or 100% - hardship) and only for a simple steel crown.
They receive a fixed subsidy from their health insurance company, which assumes that a simple steel crown would have been sufficient and economical for the care of the carious tooth. The statutory insured pays the difference in costs to a ceramic crown himself.
Private patients are partially fully reimbursed for the cost of dental crowns, depending on the insurance conditions.
Fixed subsidy of the health insurers different price in the dental technology laboratory
The cost of dental crowns varies from case to case. The size, the material and the position of the tooth to be treated are factors that are reflected in the costs.
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