Dental Crown: The Complete Guide

Medically reviewed by Dr. Sam Wood

A dental crown is a custom-made cap that covers a damaged, decayed, cracked, or root-canaled tooth to restore its shape, strength, and appearance. Crowns are made from porcelain, zirconia, metal, or a combination, and in the US cost $1,000 to $2,500 per tooth before insurance. Getting a crown typically takes two visits over two to three weeks, or a single visit at offices with in-house milling, and a well-made crown lasts 10 to 15 years or longer.

When you need a crown

A filling repairs a hole in a tooth. A crown is for when there is not enough sound tooth left to hold a filling, or when the tooth needs protection from splitting. The common reasons:

• A large cavity or a failing large filling where the remaining walls of the tooth are thin
• A cracked tooth, to hold it together and stop the crack from spreading
• After a root canal on a back tooth, which becomes brittle without a crown (see our root canal guide)
• A broken or badly worn tooth, from an injury or from grinding
• Covering a dental implant (the crown is the visible tooth on top of the post)
• Anchoring a dental bridge, where crowns on the neighboring teeth hold the replacement tooth
• Cosmetic reasons, to cover a severely discolored or misshapen tooth

Dentists sometimes propose an onlay instead of a crown. An onlay covers only the damaged cusps and preserves more natural tooth. It is a good option when the damage is contained to part of the tooth.

Types of crowns and what they cost

The price spread within each material reflects geography and the lab. A crown from a high-end lab with hand-layered porcelain costs more than a milled crown from a large commercial lab and looks better on a front tooth; on a back molar, the difference is invisible.

Dental insurance typically covers crowns as a major service at 50 percent after the deductible, up to the annual maximum of $1,000 to $2,000. Many plans require that the tooth have significant damage, and some impose a waiting period on new policies. Ask your dentist’s office to submit a pre-treatment estimate to your insurer so you know your share before starting.

The procedure

Visit one (60 to 90 minutes). The tooth is numbed. Decay and old filling material are removed. If needed, the tooth is built up with a core of filling material to give the crown something to hold. The tooth is then shaped, reduced on all sides by about 1 to 2 millimeters, so that the crown fits over it without being bulky. An impression or digital scan is taken, along with the shade for matching. A temporary crown, usually acrylic, is cemented on.

Between visits (1 to 3 weeks). A dental lab fabricates the crown. The temporary is not strong; avoid sticky and hard foods on that side, and floss by pulling the floss out sideways rather than lifting it.

Visit two (30 to 45 minutes). The temporary is removed, the permanent crown is tried in, the fit and bite are checked and adjusted, and it is cemented permanently.

Same-day crowns. Offices with a milling machine scan the tooth, design the crown on screen, and mill it from a ceramic block while you wait, typically in about two hours total. No temporary, no second visit. The materials are strong and appropriate for most teeth, though a lab-made crown may still be preferred for a highly visible front tooth.

Does it hurt?

Preparing the tooth is done under local anesthetic and is not painful. Afterward, some sensitivity to cold and pressure for a few days to a couple of weeks is normal, especially if the tooth has not had a root canal. Persistent pain when biting after the permanent crown is placed usually means the bite is slightly high and needs a quick adjustment. Pain that worsens over weeks, or a tooth that becomes sensitive to heat, can mean the nerve is dying and a root canal is needed; this happens in a small percentage of crowned teeth.

How long crowns last

Most crowns last 10 to 15 years, and many last 20 to 30. What determines it:

• Decay at the margin. The crown itself cannot decay, but the tooth underneath can, right at the edge where crown meets tooth. This is the most common reason crowns fail. Brushing and flossing at the gum line matter more with a crown, not less.
• Grinding. Bruxism cracks porcelain and wears through crowns. A night guard is cheap insurance.
• Material. Gold and zirconia are the most durable; layered porcelain chips more easily.
• Fit. A crown with an open margin traps bacteria and fails early. This is where the dentist’s and lab’s skill show.

Caring for a crown

Treat it as a tooth. Brush twice daily, floss daily paying attention to the gum line around the crown, and keep regular checkups so the margins can be checked. Avoid chewing ice, hard candy, and pens. If the crown feels loose, comes off, chips, or the gum around it bleeds, see a dentist; a crown that has come off can often be re-cemented if you keep it and act quickly.

When to see a dentist

See a dentist if a tooth cracks, if a large piece of tooth or filling breaks away, or if you have pain on biting that does not settle in a day or two; these are the situations where a crown is often the answer. After a crown is placed, see a dentist if sensitivity lasts more than a few weeks, if the bite feels high, if the crown loosens or falls off, or if the gum around it is sore, swollen, or bleeding. A crown that has fallen off exposes a prepared tooth that can become sensitive and decay quickly, so do not wait.

Frequently asked questions

Sources

• American Dental Association (MouthHealthy) – Crowns
• Cleveland Clinic – Dental crowns
• American College of Prosthodontists – Crowns
• National Institute of Dental and Craniofacial Research – Tooth decay

This article is for general information only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult a licensed dentist about your specific situation.