Crown (dental restoration)

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

The most common method of crowning a tooth involves taking a dental impression of a tooth prepared by a dentist, then fabricating the crown outside of the mouth. The crown can then be inserted at a subsequent dental appointment. This indirect method of tooth restoration allows use of strong restorative material requiring time-consuming fabrication under intense heat, such as casting metal or firing porcelain, that would not be possible inside the mouth. Because of its compatible thermal expansion, relatively similar cost, and cosmetic difference, some patients choose to have their crown fabricated with gold.

Computer technology is increasingly employed for crown fabrication in CAD/CAM dentistry.

Crowns are indicated to:

Traditionally, it has been proposed that teeth which have undergone root canal treatment are more likely to fracture and therefore require cuspal protection by providing occlusal coverage with an indirect restoration like crowns. This led to routine prescribing of crowns for root-treated teeth. However, recent review of literature reveals that there is no strong evidence to show that crowns are better than other routine restorations to restore root-filled teeth. The general advice is that dentists should use their clinical experience in view of the patient's preferences when making the decision of using a crown. As a rule of thumb, the use of crowns and other indirect restorations for root treated teeth is justified when the surface area of the access cavity exceeds one third of the occlusal surface of the tooth, when the lingual or buccal walls are undermined or when the mesial and distal marginal ridges are missing.

In order to ensure optimum condition and longevity for the proposed crowns, several factors need to be explored by conducting a thorough and targeted patient history and clinical dental examination. These factors include:

The choice(s) of crown restoration can be described by:

These restorations are a hybrid between an onlay and a full crown. They are named based on the estimated wall coverage of the walls of the tooth; e.g. the 3/4 crown aims to cover three out of the four walls, with the buccal wall being usually spared, thus reducing sound tooth tissue to be prepared. They are normally fabricated in gold. Grooves or boxes are normally added to the preparations as close to the unprepared wall as possible to increase retention of the crown. Despite its advantages of reducing sound tooth preparation, these crowns are not commonly prescribed in practice because they are technically difficult and have poor patient acceptability due to the metal showing through in their smile.