Why does my tooth need a crown?

Basically when a tooth is missing sufficient tooth structure , filling it with a simple composite or amalgam restorative is not a good way of protecting it. This can be true for a few different reasons. First of all if the walls of the tooth are not strong enough, a filling may not offer sufficient protection from chewing forces  and may be prone to developing cracks or even tooth fracture  These  can cause pain, infections and even tooth loss.

Teeth with large fillings can become symptomatic and a patient will come in complaining on pain when chewing or sensitivity to hot or cold. Sometimes the x-ray of the tooth shows no pathology but a small black or white line can be seen adjacent to the tooth's filling. After removal of the tooth's filling the line can still be seen on the floor of the preparation that held the filling and is evidence of a cracked tooth. Teeth with cracks in them often need crowns to protect them since complete removal or repair of the crack is not possible. If after crowning the tooth is still bothersome the tooth may require a root canal to devitalize the tooth and make it comfortable.

 Crowns , when properly made help distribute the occlusal load better and make a fracture less likely. If a tooth already has a crack, crowning it may keep the crack from propagating further and if it hasn't yet developed a crack, the crown may keep it for developing one in the future.

A second  reason for crowning a tooth is that there is too much tooth missing for a dentist to place a direct filling and still be able to establish good adjacent contacts with both adjacent teeth.  Some large fillings end up with "open contacts" that can help trap food. Over time food impaction can lead to periodontal problems or recurrent decay. Since a crown is made indirectly by the lab on a model, good contacts can be designed in  the fabricated crown and if made properly, a patient will end up with the sort of tight contacts that make food impaction less likely and  the crown can help preserve the tooth in a way that a very large filling may not.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/12/why-does-my-tooth-need-crown.html - http://lspindelnycdds.blogspot.com/

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