Crown, Bridge, and Veneer

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crown

A crown refers to the placement of an artificial crown on a tooth. It acts as a ‘cap’ that fits over the tooth which mimics a real crown of tooth

Purpose

To restore the original shape and function of teeth.
To improve the esthetics of teeth, such as shape, size and colour.
To fix a bridge onto the teeth.
A fixed bridge is supported by crowns on either/both side.
To protect teeth from fracture.
Tooth that has undergone root canal therapy and with a large filling is more brittle. It can be protected from fracture when a crown is placed.

Materials

Porcelain

– Properties

Esthetic-the colour and translucency can match the natural teeth
The material is not easily stained
Hard and high in wear resistance

– Disadvantage

Brittle and may fracture under heavy biting force
Certain amount of tooth substance has to be removed in order to achieve sufficient thickness for the strength of porcelain veneer

– Application

Tooth veneer or crown
To restore teeth with high esthetic requirement, especially the front teeth.

– Procedures for porcelain laminate veneer

Remove a small amount of enamel from the facial surface of the tooth.
Take impressions of the upper and lower teeth and record the bite.
Fabricate the veneer in the dental laboratory.
Clean the tooth surface before bonding the veneer.
Etch the tooth surface and treat with diluted acid such as 30% phosphoric acid.
Cement the veneer onto the tooth.

– Procedures for porcelain crown

Remove a layer of tooth substance.
Take impressions of the upper and lower dental arches and record the bite. Construct a temporary crown to protect the prepared tooth.
Fabricate the porcelain crown in the dental laboratory.
Remove the temporary crown and clean the tooth surface.
Cement the crown onto the tooth.

Metal alloy

– Properties

Durable
High wear resistance
Metal alloy crown can be quite thin — only a small amount of tooth substance needs to be removed to accommodate it

– Disadvantage

Metallic colour, poor esthetics

– Application

Used at high stress bearing area where good esthetics is not a must. For example, posterior teeth

– Procedures for metal alloy crown

Remove a thin layer of tooth substance on all surfaces of the crown.
Take impressions of the upper and lower teeth and record the bite. Construct a temporary crown to protect the prepared tooth.
Fabricate the metal alloy crown in the dental laboratory.
Remove the temporary crown and clean the tooth surface.
Cement the crown onto the tooth.

Porcelain fused to metal

– Properties

Esthetic — colour of outer surface is similar to natural tooth
Strong and durable because of the metal alloy base
Hard

– Disadvantage

Relatively more tooth substance needs to be removed from the facial surface of the tooth.

– Application

Used on anterior teeth

Before treatment

After treatment

– Procedures for porcelain fused to metal crown

A thin layer of the tooth is removed
Take impressions of the upper and lower teeth and record the bite. Construct a temporary crown to protect the prepared tooth.
Fabricate the porcelain fused to metal crown in the dental laboratory.
Remove the temporary crown and clean the tooth surface.
Cement the crown onto the tooth.

Stainless steel

– Properties

Stainless steel crown is not custom-made. It is preformed into certain sizes.
Since the crown is not custom-made, the procedures of fitting are simple and the time taken is relatively short.

– Disadvantages

Silvery colour, unesthetic
Non-stress bearing, not lasting
Causes tooth decay and gum disease easily — since the crown margin is not closely adapted to the tooth, the margin is prone to accumulation of dental plaque

– Application

Used on molars of deciduous teeth
As temporary crown before the permanent crown is ready for use

– Procedures for stainless steel crown

Remove a thin layer of the tooth surface structure.
Choose the right size stainless steel crown and try it in the tooth.
Trim the crown according to the contour of the tooth.
Clean the tooth surface.
Cement the crown onto the tooth.

Bridge

A bridge is a fixed prosthesis that is used to replace one or more missing teeth.

Before treatment

After treatment

Purpose

To replace missing teeth in order to prevent the drifting of neighbouring teeth into the tooth space, which will result in tilted teeth or abnormal bite.
To restore the functions of teeth, including mastication, speech and esthetics.

Mechanism

A bridge is being anchored by the teeth on either side of the tooth space; it can also be fixed by a metal wing extending from either side of the bridge.
A bridge can be used together with crowns.

Material

Porcelain fused to metal alloy

Types

Conventional Bridge

– Mechanism

The crowns on both ends of the bridge act as anchors and hold the bridge in place.

– Properties

Suitable for stress bearing area
Bridge can be relatively longer

– Procedures for conventional bridge

Grind the neighbouring teeth on both sides of the tooth space into appropriate shape according to the design of the bridge.
Take impressions of the upper and lower dental arches and record the bite.
Fabricate the bridge in the dental laboratory.
Try in the finished bridge in the patient’s mouth and make adjustments if needed.
Cement the bridge onto the prepared teeth.

Cantilever Bridge

– Mechanism

The bridge is only supported or fixed on one neighbouring tooth.

– Properties

Suitable for low stress bearing area
Can only replace one missing tooth
(For example, replacement of a lateral incisor by a cantilever bridge anchored by the central incisor

– Procedures for cantilever bridge

Grind the neighbouring tooth of the missing tooth into appropriate shape according to the design of the bridge.
Take impressions of the upper and lower dental arches and record the bite.
Fabricate the bridge in the dental laboratory.
Try in the finished bridge in the patient’s mouth and make adjustments if needed.
Cement the bridge onto the prepared tooth.

Maryland Bridge

– Mechanism

The bridge is anchored by metal wings extending from both ends, and bond to the neighbouring teeth by cement.

– Properties

Only suitable for low stress bearing area
The teeth used to support the bridge should have enough enamel structure

– Procedures for Maryland bridge

Grind the inner surfaces of neighbouring teeth of the missing tooth into appropriate shape according to the design of the bridge.
Take impressions of the upper and lower dental arches and record the bite.
Fabricate the bridge in the dental laboratory.
Try in the bridge in the patient’s mouth and make adjustments if needed.
Complete processing the bridge in the dental laboratory.
Bond the bridge onto the prepared teeth with cement.

Laminate veneer

Laminate veneer is a technique that involves bonding of a veneer onto the tooth surface by cement. It requires just very little removal of tooth surface structure.

Purpose

To improve the esthetics of teeth, such as shape, size and colour
To close up space between teeth
To cover discoloured teeth
To restore the strength of teeth

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