Dental crowns: Making the right treatment decision

If you have a healthy tooth with a cavity, your dentist will drill it and fill it. If a tooth is beyond repair or restoration, your dentist will extract it. But what if your tooth is damaged or diseased but not so far gone as to require extraction? That’s when your dentist may recommend a dental crown. This article can help you make the right treatment decision by telling you about:

• What is a dental crown

• Which type of crown to choose

• What’s involved in getting a crown

• How much crowns cost, and insurance coverage

• Ways to save money on a crown

What is a dental crown?

A dental crown is a tooth-shaped cap that is placed over a tooth that is misshapen or damaged due to decay, a damaged tooth, a weak tooth, a decayed tooth, a broken tooth, a cracked tooth, a misshapen tooth, or a tooth that has undergone a root canal procedure. When cemented into place, the crown fully encases the entire visible portion of the tooth above the gum line. Crowns are designed to protect and save the tooth, mimic its natural appearance, and restore chewing and speaking function.

There are different types of dental crowns

If your dentist says you need a crown, you should think about which kind of crown to get. There are several different types available, each made from different materials, with their own advantages and drawbacks:

• Porcelain and ceramic crowns: These provide a very natural look, closely matching the color and shape of natural teeth. They are ideal for front teeth and are metal-free, making them suitable for people with metal allergies. However, they are less durable than metal.

• Metal crowns: Made of gold, silver, or other metal alloys, they are durable, rarely chip, resist chewing forces, and require minimal tooth removal. They are usually used for back teeth due to their metallic appearance.

• Porcelain-fused-to-metal (PFM) Crowns: These crowns have a metal core for strength with a porcelain exterior for a natural look. They offer a balance between durability and natural appearance. That said, they may show a dark line at the gum line over time.

• Zirconia crowns: Made from zirconium dioxide, they combine strength, durability, and a natural appearance. They are more cost-efficient than metal crowns and less prone to chipping, but due to their strength, they may wear down opposing teeth.

• Composite resin crowns: These are usually the least expensive option. They look like regular teeth but aren’t extremely durable and are prone to wear and discoloration. They may require replacement sooner than other crowns.

• Stainless steel crowns: The preferred choice for pediatric dentistry, stainless steel crowns are known to be durable, cost-efficient, and easy to install. In addition, they are very effective in protecting teeth at high risk of damage or decay, particularly children's back teeth.

The type of crown which is most appropriate for you (or your child) will depend on the location of the tooth, aesthetic considerations, durability needs, and your own personal preferences. Your dentist can help you make the best possible decision.

Dental Crown Types: Pros and Cons

The procedure for getting a dental crown

Getting a dental crown installed usually takes 2-3 dental visits, although dentists with access to the very latest technologies may be able to complete the entire process in one session. Typically, the procedure involves:

• Initial examination: The dentist examines the damaged tooth to determine if a crown is appropriate and checks for other issues, such as decay.

• Tooth preparation: The dentist numbs the tooth and surrounding area with a local anesthetic and then removes a small amount of enamel and any decay to shape the tooth for the crown.

• Impressions: An impression or digital scan of the prepared tooth and surrounding teeth is taken to create a model for your crown. This ensures the crown fits perfectly and matches your bite.

• Temporary crown placement: A temporary crown is placed on the prepared tooth to protect it while the permanent crown is being made in a dental laboratory, which takes 1 to 3 weeks.

• Permanent crown placement: Once ready, the temporary crown is removed, the tooth is cleaned, and the permanent crown is cemented onto the tooth. The dentist makes any necessary adjustments to ensure a proper fit.

• There is typically little or no discomfort: The dental crown procedure is generally pain-free due to the use of local anesthesia, which numbs the tooth and surrounding area when the tooth is being shaped or filed. That said, some mild sensitivity or discomfort may occur after completion as the tooth adjusts to the permanent crown. This sensitivity is usually temporary and can be managed with over-the-counter pain relievers.

Costs and coverage

Like other major dental procedures, getting a crown can be expensive. According to a recent report from Guardian, average costs are approximately $1,399 for a porcelain crown, $1,114 for a porcelain and metal crown, and $697 for a temporary crown made of resin.¹ However, it’s important to note that the actual price you pay will be influenced by factors such as your location, dentist’s expertise, materials used, and any additional procedure costs.

Dental insurance can help

If you want to use dental insurance to help cover the cost of dental crowns, there are a few things to consider.

• Type of plan: Lower-cost basic plans typically just provide coverage for routine treatment like exams, cleanings, and (potentially) basic fillings. However, more comprehensive full coverage dental insurance is available that can cover at least a portion of the cost for dental crowns. Also, you'll likely have lower out-of-pocket expenses with an HMO plan (which limits the number of dentists you can see) compared to a PPO plan, which lets you see virtually any dentist. Finally, since bridges are often considered ‘major care,’ it’s important that you compare levels of major care coverage when choosing a dental plan.

• Medical necessity: Dentalinsurance plans (and even medical insurance plans) are more likely to cover procedures deemed medically necessary, rather than just cosmetic. Dental crowns are considered medically necessary in many situations, such as if the tooth was damaged due to traumatic injury, treatment for other medical conditions (including chemotherapy), or if the patient is suffering from secondary health impacts like GERD or loss of function.

• Coverage levels: Many full-coverage dental plans may cover 40-50% of crown costs after deductibles, up to the annual plan maximum. However, if you’re signing up for a plan and already have some symptoms, the crown may not be covered for at least 6-12 months because plans typically limit coverage for pre-existing conditions and/or have waiting periods before they will cover major procedures like dental crowns[KY3] [DA4] . Plus, some plans have a ‘missing tooth clause’ which treats pre-existing tooth loss as a non-covered condition, and allows insurers to deny claims for bridges, implants, dentures, or crowns needed to replace such teeth.

• Waiting periods: All types of dental insurance plans typically include waiting periods to receive non-preventative treatment. For example, you can usually have an oral exam and cleaning as soon as coverage starts, but you may have to wait a few months until procedures like cavity fillings are covered. If covered, major dental work, including crowns, may require longer waiting periods of up to 12 months. So it’s important to sign up for coverage before you actually need it.

• Your estimated expense: The actual out-of-pocket cost for implants can vary dramatically based on the extent of work needed, type of insurance, and even factors like geography, because treatment costs more in some parts of the country than others. Be sure to look at:

  • Estimated out-of-pocket costs for different procedures in your zip code.

  • Waiting periods for both minor and major restorative care.

  • The percentage of coverage for specific conditions, procedures, and treatments.

  • Policy factors such as deductibles, co-pays, and annual maximums can affect how much you spend.

  • Whether preexisting conditions would disqualify you from coverage for certain conditions.

Tips to help make dental crowns more cost-efficient

Try using these strategies to help make dental crowns more cost-efficient and get the most out of your coverage:

• Check your medical insurance coverage, as some health insurance plans may cover medically necessary crowns needed due to certain causes of tooth damage.

• If you are eligible for at least some coverage through multiple dental and/or health insurance policies, look into coordinating benefits and increasing your potential coverage around lifetime maximum limits.

• Time procedures strategically around annual maximum limits or deductibles of your dental coverage.

• If a procedure is denied (or you can't get preapproval), talk to your dentist about how to appeal the denied claims.

• Work with your dental provider to discuss discounts. And since providers have different rates, consider getting a second opinion and/or new quotes for at least some of the work needed.

• Leverage healthcare credit cards and savings accounts, including HSAs and FSAs, in order to make coverage more accessible.

Finally, you may want to ask your dental provider to submit the proposed treatment plan to your insurer to obtain a pre-determination of benefits. Pre-determinations provide the most accurate estimate of coverage and patient responsibility before the service is performed.

How long does a dental crown last?

Now that you know how much dental crowns can cost, here’s some good news. Most dental crowns last between 10 and 15 years, and with excellent oral hygiene and regular dental check-ups, some crowns may last significantly longer, up to 30 years.² The lifespan of a dental crown depends on:

• The material used: Metal and zirconia crowns can last 15 to 20 years or more, while porcelain and ceramic crowns tend to last 10 to 15 years. Resin crowns generally last 5 to 10 years.

• Oral hygiene and care: Good brushing, flossing, and regular dental check-ups help extend crown life.

• Patient habits: Teeth grinding (bruxism) or chewing hard foods can shorten crown life.

• Tooth location and vitality: Crowns on back teeth (posterior) tend to last longer than on front teeth (anterior); crowns on root canal-treated teeth may be more prone to failure.

Caring for a dental crown

Proper care for a dental crown is similar to proper care for your natural teeth: brushing the crowned tooth twice a day with a soft-bristled toothbrush and fluoride toothpaste, flossing once a day around the crown to remove plaque and food particles, and scheduling regular dental check-ups. Also, watch for warning signs such as a loose crown, sensitivity, cracks, or sour taste around the crown, and seek prompt dental care if they occur.

As we’ve noted, with proper care, crowns can last 10-15 years or longer. However, lack of proper care can lead to progression of tooth decay, structural damage, tooth fractures, and tooth loss. Ignoring crown care may also lead to bacterial infections, periodontal disease and other oral health issues.

Are there alternatives to getting a dental crown?

While crowns are among the most common dental solutions for damaged or diseased teeth, there are some alternatives that your dentist may want to discuss before making a treatment decision. These treatments often preserve more of the natural tooth structure and are less invasive:

• Dental veneers: Thin shells bonded to the front surface of teeth mainly for cosmetic improvements such as covering stains, chips, and minor misalignments.

• Inlays and onlays: Sometimes called partial crowns, these restorations fit into (inlays) or onto (onlays) the tooth to repair moderate damage without needing a full crown.

• Composite bonding: A quick, less invasive procedure where tooth-colored resin is molded onto the tooth to fix chips, cracks, or discoloration. It is cost-effective and usually completed in one visit, but it is less durable than crowns.

• Dental implant: When a tooth is severely damaged and cannot be saved, it can be extracted and replaced with a dental implant, which serves as a replacement root for a crown. This is a more extensive procedure but offers a sturdy, permanent replacement.

• Resin Crowns: Temporary or short-term options made from resin, typically used to buy time before a full crown is placed.