Dental crowns and bridges

A crown covers a damaged tooth completely, restoring its shape, strength and appearance. Where a filling rebuilds part of a tooth, a crown replaces the whole outer surface — which is why it is the restoration of choice once a tooth has lost too much structure to hold a filling reliably.

When a crown is recommended

• After root canal treatment on a back tooth. Root-treated teeth become more brittle and take heavy chewing loads; a crown splints the remaining structure so it is far less likely to split.
• A cracked tooth, or one with a crack line that is causing pain on biting or release.
• A heavily filled tooth where the remaining walls are thin. Each time a filling is replaced the cavity gets larger; at some point another filling simply becomes a bigger hole.
• A broken or badly worn tooth, including severe wear from grinding.
• On top of a dental implant, as the visible replacement tooth.
• Cosmetic correction where a tooth is misshapen or badly discoloured and a veneer will not provide enough coverage or strength.

If a tooth can be restored well with a filling, we will recommend a filling. A crown involves removing more tooth structure and costs considerably more, and it should be recommended for a reason you can understand.

Crown or filling?

The honest test is how much sound tooth remains. A filling relies on the surrounding tooth to support it. Once the walls are thin, a large filling acts like a wedge under chewing forces and the tooth can fracture — sometimes below the gum, where it cannot be saved.

A crown does the opposite: it wraps and holds the tooth together. The trade-off is that preparing for one means reducing the tooth on all sides.

Your practitioner should show you the tooth on the intra-oral camera or radiograph and explain which way it falls. Ask, if they do not.

The option in between: onlays

An onlay covers only the parts of the tooth that need covering — typically the weakened cusps — while leaving sound tooth walls intact. It sits between a large filling and a full crown, and where a tooth qualifies it is the more conservative choice because less tooth is removed.

Onlays are made in the laboratory from ceramic or gold and bonded into place, so the appointment sequence is the same as a crown. Not every tooth suits one: where decay runs below the gum or several walls are already gone, a full crown is more predictable. Ask whether an onlay is possible before agreeing to a crown.

What is involved

First appointment. Under local anaesthetic, the tooth is shaped to make room for the crown and any decay or failing filling is removed. Where a large amount of structure is missing, a core is built up first. Impressions or a digital scan are taken, along with a shade match, and a temporary crown is fitted. Allow around an hour to ninety minutes.

Laboratory stage. Your crown is made by a dental laboratory to the records taken. We use local Australian laboratories — shorter turnaround than overseas fabrication, and materials to Australian Standards.

Fitting appointment. The temporary comes off, the crown is tried in and checked for fit, bite, contact with the neighbouring teeth and appearance, then cemented. Say something at the try-in if the shade or shape is not right; it is straightforward to adjust before cementation and troublesome afterwards. Usually half an hour.

Typically two visits over two to three weeks.

What it feels like

The preparation appointment is done under local anaesthetic and should not hurt, though you will feel pressure, water spray and vibration. Tell your practitioner if anything is sharp; more anaesthetic can be given.

Afterwards the tooth can be sensitive to cold and tender to bite on for a few days to a couple of weeks. That usually settles. Sensitivity that is getting worse rather than better, or pain that wakes you, should be reported rather than waited out — occasionally a prepared tooth turns out to need root canal treatment.

Living with a temporary crown

Temporaries are held with a soft cement so they can be removed easily. Avoid very sticky foods on that side, chew carefully, and clean around it by pulling floss out sideways rather than snapping it up. If a temporary comes off, keep it and call us — it is not an emergency, but the tooth should not be left uncovered for long because the neighbouring teeth can drift and the crown may then not seat.

Materials

All-ceramic crowns, including zirconia and lithium disilicate, give the best appearance and are the usual choice for front teeth. Modern ceramics are also strong enough for most back teeth.

Porcelain fused to metal has a metal substructure for strength with a ceramic outer layer. Reliable, though a dark line can show at the gum if the gum recedes.

Gold and precious alloys remain excellent for back teeth where appearance matters less — exceptionally durable, kind to the opposing tooth, and requiring less tooth removal than ceramic. Read more about why gold is still used.

After the crown is cemented

• Avoid chewing anything hard on that side for the rest of the day while the cement reaches full strength
• The bite may feel slightly unfamiliar for a day or two. If it still feels high after that, come back. A crown left high causes pain and can crack the tooth
• Clean the margin where crown meets gum as carefully as a natural tooth. This is where problems start
• Floss normally, but if the floss shreds consistently in one spot, tell us

How long do crowns last?

Many years, commonly a decade or more, and often considerably longer with good care. What shortens that is decay at the margin where crown meets tooth, gum disease around the tooth, or fracture from grinding.

A crown does not decay. The tooth underneath it still can. Brush and floss the margin as carefully as you would a natural tooth, and keep your six-monthly examinations so we can check it. If you grind, an occlusal splint protects the investment.

What can go wrong

• The crown comes off. Usually the cement has failed rather than the crown. Keep it, do not superglue it, and call us. Often it can be re-cemented
• Decay at the margin. The most common reason a crown eventually needs replacing. Caught early it is a small repair; caught late the tooth may not be restorable
• The tooth needs root canal treatment later. Preparation is a stress on the nerve and a small proportion of crowned teeth eventually need it. A crown can usually be accessed through and repaired rather than replaced
• Fracture of the ceramic. More likely in grinders, which is why splints matter
• Gum recession exposing a margin, which is cosmetic at the front and a decay risk anywhere

Bridges

Where a tooth is missing rather than damaged, crowns on the neighbouring teeth can be joined to a false tooth to span the gap — a bridge.

The main trade-off is that a bridge requires preparing the teeth either side, even if those teeth are perfectly healthy. Where they already carry large fillings or crowns, that cost is low. Where they are untouched, an implant is usually the more conservative choice because it leaves the neighbours alone.

Cleaning under a bridge is not optional. The false tooth sits on the gum and plaque collects beneath it, so a floss threader or interdental brush under the span, daily, is what keeps the supporting teeth healthy. A bridge lost to decay in an abutment tooth usually means losing two teeth instead of replacing one.

The designs and the full comparison against implants are on our dental bridge page.

Cost and claiming

Crown fees include the laboratory work and vary with the material chosen. Where a core build-up or root canal treatment is needed first, those are separate items. You will receive a written treatment plan with every cost before we begin.

What drives the figure: the material, the laboratory fee, whether a core build-up is needed, and whether the tooth needs root canal treatment first.

We claim on the spot through HICAPS — bring your card and pay only the gap. Crowns fall under major dental on most extras policies, so annual limits and waiting periods apply, often twelve months; we can obtain a quote from your fund before you commit. Afterpay and Zip are available. See payment options.

Questions we are asked

Can I have it done in one day? Some practices offer same-day milled crowns. We use laboratory-made crowns over two visits, which allows a try-in stage and a wider choice of materials.

Will it look like my other teeth? Shade and shape are matched, and ceramic at the front is very convincing. Tell us at the try-in if it is not right.

Does the tooth underneath still need cleaning? Yes, and more carefully than before, because the margin is the vulnerable point.

What if I grind my teeth? Have a splint made. Grinding is the most common cause of a fractured crown.

Can a crown be whitened? No. If you are planning to whiten, do it before the crown is made so the shade can be matched to the final colour.

Is a crown better than an onlay? Not automatically. An onlay removes less tooth. Ask which your tooth suits.

Book a consultation

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145

Phone (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · closed weekends and public holidays

Book online at any hour.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.