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Gain More Crown
August, 12, 2018

At Direct Pay Dental Care, we crown teeth. 

For our high-risk patients, we have a standard Crown protocol.  This protocol has helped to prevent the following common problems people have as a result of poor dental care management:

1. Cracked teeth

2. Recurrent decay and  repeated restorations

3. Nerve problems (need of root canal therapy)

4. Bone problems associated with crack teeth and nerve problems

5. Tooth, gingiva, and bone loss

 

For each high-risk patient our Goal is the following:

1.  Crown all high risk teeth.  At Direct Pay Dental Care high-risk teeth are classified as all molars and premolars with MOD surface restorations.  All molars with MO or DO restorations.  All anterior teeth with the restorations including the incisal angle and edge.

2. No unopposed teeth.

3. Identify all caries and plan for short-term and long-term management.  Treat or do not treat.  If treat, then question treat now or later.

4. Treatment enables and promotes good function for speaking, chewing and smiling.

*  Our protocol is a guide for our staff and patients and does not supersede professional or patient judgement.  Nor does it apply to those who are at low risk for dental problems.  It is a platform to identify and bring attention to teeth which have high risk of dental issues.

 

Pros and Cons to our Crown protocol:

Pros: 

-Better maintenance of dental positioning for crowned teeth and uncrowned teeth.  If a crowned tooth has caries, nerve, and/or bone problems, typically this provides a better environment for treatment since positioning is preserved, catastrophic cracks are unlikely and in the event of tooth loss, space has been maintained for replacement.

-Lower incidence of tooth replacement

-Lower incidence of pulpal (nerve) problems over time

-Less dental cracks which affect the nerve and periodontium over time.  This translates to less need of root canal therapy, and tooth replacement.

-Better preservation of dental arch integrity for future treatment.  This benefits those who need extensive dental reconstruction by preserving the space between opposing and same dental arches.

Cons:

- Displacements:  Crowns become uncemented and displaced.  Of the crowns we install,  lower than 5% become displaced over a 6 year period.  After this point, chance of displacement goes down with each individual crown.  Displacement is evidence of instability or a compromised starting point which is common.  Although inconvenient, displacements typically require re-designing of the crown preparation or recementation of the existing crown if preparation dimensions are all satisfactory.  At times more treatment is involved to establish better mechanical patterns in the dentition.

- Post-operative sensitivity:  Crown treatment removes most if not all of the top tooth structure.  This produces nerve sensitivity.  In teeth with a normal nerve and bone support, sensitivity subsides over days to a couple weeks.  In teeth with symptoms and/or extensive restorations, the sensitivity response to treatment can be unpredictable and more extensive.  We try to prevent as much sensitivity by pulpal testing all suspicious teeth and using disinfectants and desensitizers such as GLUMA on vital teeth.   In people with large nerves as seen radiographically, crown procedures may be delayed until a later age.  However, the need of a crown is translated to the patient.