Crowns and bridges are laboratory-made restorations that fit over your natural teeth like a thimble after the teeth have been prepared to a peg shape. A crown is an individual restoration whereas a bridge is a multi-tooth restoration with false teeth supported by the crowns cemented onto the anchor teeth which must all be prepared parallel to each other.

Deterioration of the pulp can express itself as increasing hot and cold sensitivity that will not go away, progressing possibly to a toothache. In most cases, the solution would be a root canal procedure for the tooth that has been crowned. The pulp contents are removed through a small hole made in the back of the crown. A small reinforcing post would then be placed in through the hole, which would then be sealed over afterwards. While making a crown, during tooth preparation, a judgment is made as to the likelihood of the need for a root canal procedure on the tooth. If needed, the root canal procedure would be best done before the completion of the crown. The problem with a root canal procedure is that in a very small percentage of treated teeth, some residual sensitivity to pressure may remain, the teeth may be weaker and more prone to root fracture and post loosening when compared with intact natural teeth crowned with no root canal and post. Root canals and posts also introduce additional costs. It is obvious therefore that there are advantages and disadvantages in going both routes, which are all considered when making recommendations. In general, the more heavily filled the tooth and the more strategic the restoration, the more likely it is that root canal procedures and posts would be recommended before the crown is made. Teeth showing significant symptoms would also receive root canal treatment before crowning.

It is against the code of ethics in most professions to “guarantee” ones work or results. Because mouths (as other parts of humans) have so many variables, giving a guarantee implies that the dentist has more control over a situation than is clinically possible.

It is impossible to say how long a specific restoration will last. Rarely, a patient may have a crown last for 30 years or more! Although these are the longest-life restorations dentistry has to offer, statements such as “lasting a life time” are not accurate. The average life span reported for crowns reported in the dental literature, depending on the study you read, ranges from 8-15 years with some lasting much longer. The life span for a bridge is related to the size and complexity of the bridge. Long span bridges involving six or more teeth may be expected to last about 8 - 10 years, while 3 - 4 unit bridges may last 10 - 15 years or more. Many factors influence the life of a crown such as decay rate, control of any periodontal disease, grinding habits, etc. Dental decay is particularly significant and you should keep the gum crevice around the crowns as clean as possible for that is where the microscopic seams between the crown and the tooth (margins) are located. Crowning a tooth does not protect the root beyond the crown from decay, even if the tooth has a root canal. Decay can still recur around a crown so normal hygiene measures are still required. Dry mouth, especially common with many medications, can make plaque sticky and aggressive. High decay rates can occur quickly. Patients requiring large amounts of crown work in this situation are often counselled to have the roots extracted and place the crown work on dental implants.

If the underlying tooth and root are sound the crown can be cut off and a new one made. If the underlying tooth is compromised, extraction and placement of a dental implant would possibly be suggested to support the replacement crown.

Crown and bridgework is technically difficult to do well and it also carries significant laboratory costs in particular when made of exotic materials. The fees applicable relate to the volume on a “per tooth” basis. In general, an implant supported crown with straight forward surgical phases costs significantly less than a fixed bridge alternative. A one piece full-arch fixed bridge costs significantly less than a full arch of individual crowns. A detailed estimate will be provided before you decide to proceed.

The implant exam and consultation will be used to evaluate your mouth with a clinical exam and an x-ray exam in order to determine your potential for implants. This exam will also be where you can discuss what type of implant replacement will work best for you. The x-ray exam will be able to show how much bone is present in the locations where you will need implants placed. This will aid in evaluating the need for grafting in advance if necessary.

Different long-term research studies have shown that implants, which have been placed in good bone, can last for a patient's lifetime. However, some implants can fail if the quality of the bone wasn't good, if there was too much bite stress for too few implants or implants which weren't long enough for the demands of a given case. The prosthetic superstructures (Crown and bridgework) may occasionally require repair or replacement. This may be due to changing esthetic issues, clenching and grinding wear, trauma, or changes in overall treatment planning.

There is the need for the implants to attach to the bone by a process, which was originally described as osseointegration. The length of time for this waiting period varies with the quality of bone that is present where the implants were placed. The upper arch takes to heal than the lower as the quality and quantity of bone there is usually inferior.

There should be no pain when the implants are placed. In most cases, a local anaesthetic is all that is needed. In large cases sedation or general anaesthesia is used.

Patients have feeling that ranges from discomfort to pain. The variation depends on the number of implants placed, their location as well as a patient's predisposition for swelling and tolerance for pain. It is unusual to require more than Ibuprofen after the anaesthetic wears off.

Post-surgical swelling may interfere with wearing a full or partial denture immediately after the surgery or until after the swelling has gone done. Each case varies and therefore, this should be discussed with your implant surgeon. It may be necessary to leave the denture out for a week or so if the bearing area is over the implants. Soft liners may be necessary.

Yes! If you don't clean around the implants, they can get gum disease. Gum disease can lead to the failure of the implants if it is not treated before too much bone has been destroyed. Experience suggests that bone loss and susceptibility to periodontal disease around natural teeth doesn’t necessarily imply the same with dental implants.

When implants fail, there will be some bone loss, which accompanies the loss of the implant or implants. If there is still adequate bone left, additional implants can be done. However, there are cases where additional implants can't be easily done after previously placed implants have failed due to the fact that there is not enough bone present anywhere which would allow for more implants. In these cases grafting procedures would be required to allow the placement of future implants.

Each case varies regarding how many implants are needed for the demands of replacing the missing teeth. If the implant surgeon is limited regarding the length of implants that can be placed, more implants will be needed. The length of the implants is determined by how much bone you have present. A good consideration is to have enough implants built upon that if one implant fails, there are enough implants left which will prevent the failure of your whole implant reconstruction. "An implant failure should not mean a case failure".

The cleaning demands vary depending on the type of implant reconstruction that you had. You definitely need to clean daily around the implants. Brushing with a toothbrush, as well as flossing are important. There may be the need for a prescription mouth rinse (chlorhexidine) that can further help you keep your implants healthy. Electric toothbrushes, such as the Oral-B 3D Excel, can also be helpful for cleaning around implants. Other cleaning aids, such as interproximal brushes, may be recommended where the specific needs of your case require them.

Yes. It is important to have a professional cleaning done around the implants. The interval will vary with the individual patient’s needs.