How does a dentist remove a crown to replace it?

Step 1: Evaluating the Crown

During a comprehensive dental examination, your dentist will thoroughly assess the condition of the existing crown, tooth, and surrounding tissues using visual inspection and x-rays. Decay at the crown margins, cracks in the porcelain, looseness of the crown, or excessive wear underneath are all signs that replacement may be required.

Here are some signs and considerations when planning crown replacement:

• Age of the Crowns – Over time, older crowns can weaken and potentially crack, making them prone to food particle accumulation and decay. If your crowns have persisted for over ten years, it’s crucial to undergo a dental examination to assess their condition.
• Wear and Tear – Porcelain crowns, widely used for their durability and stain resistance, can show signs of wear due to teeth grinding or clenching (bruxism). If you have this habit, it could expedite crown wear. In cases of persistent teeth grinding, some individuals may need crown replacement within as little as five years to maintain optimal functionality.
• Tooth Decay – Cracks and imperfections in crowns can lead to the infiltration of food particles beneath the crown. This creates a breeding ground for bacteria, triggering tooth decay and subsequent sensitivity and pain. Addressing this issue may involve a root canal treatment followed by crown placement.
• Pain and Swelling – Broken or extensively worn crowns can cause persistent toothaches and heightened sensitivity.
• Receding Gum Line – Damaged crowns can contribute to plaque and bacteria buildup along the gum line, potentially leading to gum infections and subsequent recession.
• Cosmetic Concerns – Discolored crowns that do not match the color of adjacent teeth can impact your smile’s appearance.

Step 2: Preparing for Crown Removal

Proper preparation before crown removal is essential for a smooth and secure procedure, which involves the successful extraction of the old crown while minimizing potential complications.

Complications arising from improper crown removal include damage to the underlying tooth structure, discomfort, and prolonged procedure time. Careful planning helps prevent these issues, promoting the overall well-being of the patient.

During the crown removal process, specialized tools and equipment are employed. Dental drills and burs delicately disengage the crown from the tooth, while a dental dam safeguards surrounding areas.

This comprehensive approach prioritizes patient safety, tooth preservation, and effective crown extraction, reinforcing the significance of professional expertise in dental procedures.

Step 3: Removal of existing crown

• Numbing the Tooth – The dentist will first administer local anesthesia like lidocaine to numb the tooth and surrounding gumline. This prevents any discomfort during the procedure.
• Removing the Old Crown – The dentist will use a dental drill to grind away at the cement holding the porcelain or ceramic crown on the underlying tooth, taking care to avoid damaging the healthy tooth structure. This drilling slowly loosens the old crown.
• Wiggling Off the Crown – Once adequately loosened from the cement, the dentist will use special pliers or levers to gently wiggle or pry the crown off in one piece. The original tooth preparation below is now exposed.
• Cleaning the Tooth – The tooth surface and surrounding area will be cleaned thoroughly to remove any remaining bits of old cement or grime before a new crown is placed.

Step 4: Taking Impressions and Temporary Restoration

• Precision Impressions – Impressions of the prepared tooth will be taken and sent to the dental laboratory team to fabricate the patient’s custom-designed replacement crown.
• Temporary Restoration for Protection – While the permanent crown is being fabricated, a temporary restoration will be placed to protect the tooth and maintain function and aesthetics until the final crown is ready.

Step 5: Fabricating and Placing the New Crown

• Intricate fabrication – The customized crown will be fabricated in a dental lab with consideration of the fit, alignment, and a natural appearance that seamlessly blends with surrounding teeth. This process may take up to 4 weeks.
• Removing temporary restoration – When the replacement crown is ready, you’ll have to schedule an appointment to remove the temporary restoration and install the new crown.
• Trying on the New Crown – The dentist will have the patient bite down to ensure proper fit of the replacement crown on the prepared tooth. Minor adjustments are made as needed.
• Cementing New Crown – The interior of the new crown will be coated with permanent dental cement, which adheres it to the prepared tooth. Excess cement is removed before it hardens.
• Checking Fit and Bite – Once securely cemented, the dentist will have the patient test the bite with the new crown in place. Additional adjustments can be made to the crown for optimal comfort and function before sending the patient home.

Step 6: Aftercare

After the crown replacement procedure, taking diligent care of your newly restored tooth is pivotal for its longevity and your overall oral health. This includes:

• Dietary Considerations – Be mindful of your diet in the initial days following the procedure. Avoid chewing on hard or sticky foods that could potentially stress the crown and disrupt its stability. Opt for softer options that minimize the pressure on the newly placed crown, allowing it to settle securely.
• Oral Hygiene Excellence – Uphold your oral hygiene routine with dedication. Brush your teeth gently, using a soft-bristle toothbrush to avoid putting undue pressure on the crown. Floss carefully, ensuring you navigate around the crown without causing any damage. Maintaining oral cleanliness prevents the accumulation of harmful bacteria and helps your crown stay problem-free.
• Caring for Sensitivity – Sensitivity to temperature changes and pressure may be experienced initially. This is normal and should gradually subside. If tooth sensitivity persists or worsens, contact your dentist for guidance.

Step 7: Scheduled Follow-Up Appointments

Your journey towards optimal oral health doesn’t end with crown placement; it involves consistent monitoring and timely interventions:

• Essential Check-Ins – Follow-up appointments are thoughtfully scheduled to assess the stability and functionality of your new crown. These appointments provide your dentist with the opportunity to ensure that the crown is integrating seamlessly into your oral structure and that any potential issues are caught early.
• Proactive Issue Resolution – Timely follow-ups allow your dentist to identify and address any emerging complications promptly. Be it minor discomfort or changes in fit, addressing these concerns swiftly contributes to the long-term success of the crown. This commitment to proactive care reinforces your dentist’s dedication to your well-being and the integrity of your crown.

Final Thoughts

Dental crown replacement is a vital step to maintain oral health and ensure long-term functionality. By adhering to care guidelines and attending appointments diligently, you play a central role in nurturing the health of your crown and ensuring your continued comfort and confidence in your smile.