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MESSAGES TO

Crowns, Bridges & Veneers

A DxD Session with Dr Steven Soo


Ended on Wed Mar 20 2019
Ended

Top Answers


Crowns, bridges, and veneers are different types of prosthetic solutions.

Crowns cover the whole tooth to strengthen and improve the appearance (colour and shape), bridges replace missing teeth and often consist of several crowns linked together attached to the teeth either side of the gap.

Veneers cover only the front of the tooth to improve the appearance and occasionally strength. All of them are made of porcelain and are provided for different reasons. 

  Crowns Bridges Veneers
Purpose
  • Strengthen tooth
  • Allows significant improvement in color or shape
Replace missing teeth 
  • Allows improvement in colour
  • Allows minor changes in shape
Amount of trimming needed Significant amount – only on the tooth that needs to be crowned Significant amount – on two teeth at either side of the gap Small amount – only on the front side of the tooth
Strength Strong and durable Strong and durable Strong but brittle
Coverage Covers the entire trimmed tooth  Covers entire teeth that were trimmed, including gap Covers the front of the tooth
Material Porcelain or metal (gold/silver) Porcelain  Porcelain 
Cost $700 to $3,000 $700 to $3,000  $700 to $3,000

 

11 Sep 2018

Hi Gui Fang, 

The treatment options available depends on the size of your gap. A small gap can be closed using braces or white (composite) fillings. A medium gap can be closed with braces, white fillings or crowns. A large gap (the size of a tooth) can be closed with braces and perhaps an additional tooth in the form of a bridge or an implant.  

To give you some background, a space or gap between two teeth is a diastema. It can be caused by various factors such as:

  • Teeth and jaw discrepancy
  • Oversized labial frenum (a piece of soft tissue that extends from center of upper lip to the middle of the two upper front teeth)
  • Habits such as thumb-sucking or tongue swallowing reflex
  • Periodontal (gum) disease
  • Transition from primary teeth to permanent teeth (children) 

If necessary, the underlying cause will be treated first before proceeding with the treatment to close the gap.

During your consultation with your Prosthodontist/dentist, they will examine your dental condition clinically and radiographically before advising on an appropriate treatment plan.

11 Sep 2018

Providing a crown is generally a two visit procedure. 

The first visit will take approximately one hour to prepare the tooth and make an impression.

  • During preparation of the tooth, you will be given some local anaesthesia to numb your tooth and gum tissue around it. The natural tooth is then trimmed away to allow sufficient space for the dental crown.
  • Next, a dental impression is taken either with a hand-held scanner or with an impression tray. The dental impression is then sent to the dental laboratory to fabricate the definitive (final) crown.
  • A temporary crown is provided on the same visit to protect the tooth and to allow patients to leave the clinic with a complete smile.
  • Lastly, your Prosthodontist/dentist will go through the shade guide with you to select an appropriate colour shade for your new dental crown.

The second visit is generally two weeks later, for about 30 minutes. This is when the final crown is issued and cemented.

  • Your Prosthodontist/dentist will check the fit and appearance of the crown.
  • Once both of you are happy with the new dental crown, the crown will be cemented in place.
11 Sep 2018

Crowns should last approximately 10 years if maintained well and not abused (i.e. biting very hard things). Therefore, it is important to take good care of them so that they can last as long as possible. Refer to this question for tips on how to care for your dental crowns and bridges.   

Like everything, they will be subject to some wear and tear and will require replacement eventually. Here are some cases when it will be necessary to replace the dental crowns with new ones:

  • Cracked or broken crown
  • Excessive wear resulting in holes (perforation) found on the crown
  • Recurrent tooth decay underneath the crown
  • Gum recession resulting in the edge of the crown being visible (eg. dark line)
11 Sep 2018

Here are two simple tips I give to all my patients with regards to caring for their dental bridge/crown:

1. Treat it as if it were your own natural tooth. Brush two times a day for at least two minutes each, floss at least once a day and visit a dentist two times a year. 

It is essential to continue with these oral care routine as a dental bridge/crown is equally susceptible to decay along the gum line. If you are unsure of how to floss effectively, ask your dentist so that he/she can guide you. 

2. Try not to bite very hard things. For example: ice, nuts, crusty bread, dried fruit. You should also refrain from using your dental bridge/crown as a tool to open a bottle or crack open seafoods. These can cause the bridge to chip or break.

Debonding or chipping on fracture can occur due to other reasons but regular checks by your dentist can help predict any failures and help develop a solution.

11 Sep 2018

Hi Qing Ying, 

There are two basic types – gold or porcelain (ceramic). Gold is very hard wearing and good for patients who have a partially heavy bite or habit to grind their teeth. Unfortunately, the colour is not to everyone’s liking.

Zirconia (ceramic) crowns are tooth coloured and also very hard wearing. More than 99% of crowns are made from ceramic.

11 Sep 2018

Providing a crown necessitates some tooth preparation by drilling. As the tooth has a nerve, this can cause transient pain/sensitivity. However, if the discomfort is more severe and longer lasting, you are recommended to call your prosthodontist/dentist for an evaluation. 

One of the possible cause of pain from a new dental crown is nerve inflammation. In the event the tooth’s nerve becomes very inflamed or even infected, root canal treatment (RCT) is needed to treat the infection. It is indicated by the following symptoms:

  • Severe pain from chewing/biting
  • Pain after consuming hot/cold drink
  • Swollen or tender gums
  • Dental abscess (collection of pus) 

Other reasons that may cause your crown to hurt include the crown not fitting well or if you have the habit of bruxism.

11 Sep 2018

In Singapore, the cost of dental crowns generally ranges from $700 to $3,000. 

The cost varies widely depending on material, laboratory costs, clinician chosen and clinical time spent. The fees from a Prosthodontist (crown specialist) will be naturally higher to reflect the expertise and experience of a specialist. 

As every patient has different dental conditions and requirements, it is difficult to compare the fee between crowns and it is not a simple like for like comparison.

11 Sep 2018

Medisave can be used for certain surgical procedures only. As crowns, veneers and dental bridges do not require involve surgery, patients are unable to use Medisave to cover part of their treatment fee.

11 Sep 2018

The various types depend on many factors such as:

  • number of teeth to be replaced
  • condition of adjacent teeth
  • age of patient
  • position of missing tooth

These clinical factors are considered alongside the choice of material for the bridge to arrive at the best option for you. Ultimately replacing missing teeth may be better done with an implant. Your dentist can advise the most suitable restoration.

11 Sep 2018

Firstly, a clinical examination of your dental condition will be carried out. This is when we check on the condition of the teeth and gums.

Secondly, a radiographic examination is done to check on the condition of the underlying bone and any other condition that may not be seen during the clinical examination.

Thirdly, a consultation is done to explain any dental issues that need to be fixed, along with each treatment option’s pros and cons for patient’s consideration.

If patient chooses to proceed with a dental bridge, it is possible to start the process during the same visit if there are no other serious dental concerns (e.g. gum disease). Tooth preparation is done and a dental impression is taken, followed by the issuing of a temporary bridge.

We know how daunting it can be to be without a teeth for some, hence the temporary bridge is in place to protect the tooth and to allow patients to leave the clinic with a complete smile.

However, if other dental issues such as gum disease is present, then we will need to treat that first so that there is a good foundation for the dental bridge. This is done through scaling and root planing (also known as deep cleaning), where the plaque and tartar above and below the gum line are removed. Depending on the severity, this may require more than one visit.

Lastly, when the definitive (final) bridge is ready for issue, the fit and appearance of the bridge is checked. Once both your clinican and you are happy with how it looks and feel, cementation is done and you get to enjoy your new dental bridge.

11 Sep 2018

A Prosthodontist specialises in the replacement of teeth using crowns/bridges, dentures and dental implants. Several general dentists can also provide this treatment but a prosthodontist’s training is specifically for this type of treatment. 

A recognised Prosthodontist in Singapore needs to receive additional three to four years of training, build up clinical cases (and experience) and sit for the Prosthodontic Specialist Exit Exam.

Personal recommendation is a good start, while qualifications and experience are important things to consider. With these information, you are recommended to go for a dental consultation to see for yourself if you are comfortable with him/her to proceed with treatment.

11 Sep 2018

It is often said that veneers are minimally invasive and do not involve much preparation of the teeth. Whilst this is true, veneers are not totally reversible.

In fact, it is considered permanent because the outer layer of your enamel needs to be removed to give way to the veneers, changing the original structure of your teeth.

There may be an alternative to improving the appearance such as orthodontics and teeth whitening. It is important to be informed of all the treatment options available as well as the pros and cons of each option so that you can make an informed decision.

11 Sep 2018

Porcelain veneers by the nature of the material can chip and break when encountering hard foods. Treat them gently and they can last a long time.

The treatment is not inexpensive so one must look after them well. That includes brushing two times a day for at least two minutes each, flossing at least once a day, visiting a dentist two times a year and also avoidance of hard foods.

11 Sep 2018

Gum disease is a separate issue from veneers but with all dental restorations, it is advisable to make sure the foundations are healthy before improving the appearance.

A crown is like a house, and our gums are like the foundation. If the gums are not healthy, the foundation is not stable and it will not be ideal to build the “house” (crown) on it. Hence, it is crucial to ensure that all active gum disease is removed before having any cosmetic work done.

With the presence of gum disease, it increases the failure rate of not only veneers, but also crowns, bridges and dental implants.

11 Sep 2018

Top Questions


A dentist has recommended for my wife to have both dental crowns on her molar and pre-molar removed and replaced. I understand that dental crowns can sometimes be repaired and fix. I would like to find out when do dental crowns need to be removed and replaced, as opposed to repaired?