What affects the Success of my Crown?
Lots of different things will influence the success of your dental crown] and ultimately how long long it will last. We have been discussing such factors in detail throughout this series of articles and I hope by now that you have an appreciation for everything the dentist must take into consideration. A great outcome and successful crown comes down to a combination of the dentist, tooth, crown, technician and let us not forget the part that you yourself play!
Here’s a bit of a summary of the elements within each of those areas that will contribute to the success of your crown:
- The quality and strength of the core
- The amount of good solid natural tooth remaining
- The state of the nerve
- The quality of the root canal treatment; if the tooth has one or needs one
- The quality of the post ;if it has one or needs one
- The periodontal condition of the tooth (amount of good bone support)
- The bite- how your teeth come together… Do you have missing teeth which will mean the tooth takes extra pressure? Do you clench or grind your teeth?
- Their experience
- The quality of the preparation- the height, margins, taper, shape and ability to achieve a ‘ferrule’- this is a band of 1-2mm of natural tooth at the base of the core that helps protect the tooth against fracture from sideways forces due to chewing.
- The accuracy of the impression
- The quality of the cementation procedure.
- The type of crown (material)
- The cement used
- The quality of the temporary crown.
The Technician (lab)
- The communication with the dentist- shade, material specifications and design
- The experience of technician
- The quality of the materials used
- The fit of the crown- margins (where the crown meets the tooth) and contact points (where the crown contacts the tooth next door).
- Your oral hygiene
- Your diet
- Regularly seeing a dentist to check everything is OK
- Your age
- Your activities.
You and the dentist should always be looking to the future and thinking- what can we expect the condition to be like in 10 years or 20 years and even longer. This allows you to plan more effectively and to be realistic about the outcomes. Dentist are not miracle workers… though some of them do like to think so.
It also is very different when you are considering a young person compared to an older person. Full porcelain crowns on someone in their twenties, will need to be replaced a few times over the course of their life and may see them missing a number of teeth by the time they are 50 if complications are experienced! The same treatment on a 60 year old is more likely to last a lifetime.
There are no definite answers only ‘treatment plans’ that can best address an individuals unique situation.
What are Your Expectations?
A big reason for developing and writing this website, was to give you some honest independent information so that you would have realistic expectations about what can be done and what to actually expect from the various dental treatments available today.
Not just for now, but for the future too. Of course there are going to be good and bad extremes, but having a genuine realistic appreciation is important for you to make a proper informed decision and if things do go wrong (as they do) then it will not come as an utter shock, because you were aware of the risks and potential problems of say having crowns for example.
‘How things ‘look’ is one of the biggest areas where both yourself and your dentist need to be on the same page. A careful open discussion is always needed in this respect!
As a dentist I am asked occasionally to perform treatment that is not ideal. Sometimes it will possible to attempt the request and other times I have to gracefully decline and suggest they seek treatment elsewhere- if that is the only thing they are prepared to accept.
To give you an example, if a tooth had fractured very low down under the gum and you really didn’t want it extracted, I may be able to attempt saving the tooth as long as you were realistic about the prognosis and understood what would happen if it didn’t work. It could last 6 months or a year, perhaps longer but I couldn’t say. Are you prepared to pay for this knowing how limited it maybe?
If I felt however, that it was so far under the gum that any kind of treatment I could perform would be of little benefit and was unlikely to last even a month, it would probably be wrong of me to even attempt it, despite you saying you understand the chance of it failing.
It’s a difficult grey area, in which there is often no right or wrong, and which a requires a fully honest and open discussion of risks, prognosis and alternatives.