A crown is a porcelain cap that replaces the broken or decayed portion of a tooth when more structure has been lost than can be replaced with a filling. In these cases, the damage to the teeth has reached a point that the tooth has lost its natural strength and integrity and a crown is needed to replace the missing tooth structure and hold everything together to allow normal function without further breakage. A bridge is a procedure used to replace a missing tooth or teeth. In this case, a special prosthetic is made that has two crowns on opposite ends with one or two false teeth permanently attached in between that “bridge the gap” where you are missing teeth.

Crowns and bridges are not bad options, in fact in many cases it’s the best option for restoring badly broken or decayed teeth. The issue with crowns and bridges is how they have traditionally been done. A regular crown or bridge, as performed by standard dentists, involves cutting a tooth down to the gum line.

The reason for this is twofold. The first reason is that standard crowns have a weak bond that requires more surface for the crown to hold onto. The second reason is to avoid having a visible horizontal seam where the crown or bridge meets with your remaining natural tooth. Doing a crown this way makes it easier for a dentist to ensure the crown will stay in place and that you won’t have a visible seam, but it also removes a significant amount of healthy tooth that could have been saved. The less remaining tooth structure you have, the smaller the chances are that the tooth can be saved should you have recurring decay or the crown fails.

My goal is to preserve as much of your natural tooth structure as possible. Dentists can remove tissue, but we can’t regenerate it, so it’s always best to preserve as much as we can, since this leaves more material to work with in the future if needed. This means that I leave all healthy tissue intact and do not cut down to the gum line unless there is a reason to. 

In some cases, I won’t even do an entire crown, I will instead fabricate a partial crown called an onlay or inlay. This partial crown is a carefully sculpted piece of porcelain that fits like a perfectly shaped puzzle piece where your previously decayed tissue used to be. But what about those ugly seams I mentioned?

Well, as a Biomimetic dentist, with training in aesthetic dentistry, I use special materials and bonding techniques that leave you with a beautiful seamless restoration that looks just as good as a complete crown, but with the added benefit of leaving significantly more of your natural tissue intact. This means you will have greatly reduced post op sensitivity and it also reduces the need for a root canal, which is frequently done with a traditional crown because of trauma to the nerve from aggressive drilling and tissue removal.