Appointment 1:
1- Numb the tooth.
2- Take the shade of the tooth.
3- Take a preliminary impression for a temporary crown.
4- File the tooth about 1.5 to 2 millimeters around the tooth in every direction.
5- Remove any remaining decay.
6- If the tooth has a root canal, place a buildup with or without a post.
7- Take an impression of the filed-down tooth.
8- Make a temporary crown.
9- Send the impression to the dental lab.

Appointment 2:
10- Try in the crown.
11- Ensure the crown meets all the correct specifications.
12- Cement the crown to the tooth.
13- Remove excess cement around the tooth.

There are a couple of objectives when filing a tooth for a dental crown. First, you need to file down the tooth 1.5 to 2 mm minimum around the tooth's circumference and off the top of the tooth. The more tooth you drill away, the thicker you can make the crown. A thick crown will resist fractures and hide the color of the underlying natural tooth. However, the more tooth you drill away, the more likely the tooth will become sensitive or loosen in time. Therefore, keeping the drilling depth right around 2 millimeters is best unless more space is needed.

When drilling on a tooth you must keep in mind the retention of the future crown. Crowns can loosen the more you chew on them, but with sufficient retention, they likely will not. The more parallel the remaining walls of the underlying tooth, the more retention it will have. However, the closer they are to parallel, the less likely a crown will fit. The walls of the remaining stump should therefore converge at about 5 to 10 degrees for the best retention possible.

The weakest point of the future crown will be where the tooth and crown meet. This is called the margin, where decay can find its way back under the crown. An exposed margin will be visible and can make a crown unsightly. Luckily, the margin can be hidden under the gums if the dentist drills under the gums. However, the further the margin is below the gum level, the more temporary soreness the patient will have and the more difficult it will be to get a detailed impression of the margin. If the lab that makes the crown cannot see the margin in the impression, there will likely be an open margin susceptible to decay. Therefore, I prefer to place the margin far below the gum level and use a technique that still picks up an accurate impression of the margin.

Once we get the final crown back from the lab, then we arrive at the final appointment where we try in the permanent crown. When we slip on the crown over the remaining tooth, we check five criteria for an acceptable crown. We will also make necessary adjustments so the crown will pass all those checkpoints.

First, we check how well the adjacent teeth contact each other. If floss snaps through the crown and adjacent tooth nicely, it will also likely prevent food from getting trapped between the teeth when chewing. If the contact is open, the dentist must send the crown back to the lab to add material for adequate contact. If the connection is too tight, the crown won’t sit down all the way, and the dentist will adjust it until it touches adequately.

Second, we check the internal of the crown. If something is high or off internally, the crown will rock and loosen in time. Therefore, any high spot should be adjusted so that it is stable.

Third, we check the margin where the tooth and crown meet. The margin needs to be flush and not catch my explorer when I feel the margin. If the margin is open or overhanging, the lab will need to remake the crown because it will trap food, and decay will start here.

Fourth, we check the bite. Before making adjustments, the bite is commonly off when it comes back from the lab. The dentist will file down high spots until the tooth feels like it bites evenly. If biting down hits this tooth before other teeth, it can become sore over time and even cause jaw problems.

Fifth, we check the cosmetics. If the patient and I are happy with how it looks, it is ready to be cemented. Most of the time, the cosmetics are exceptional on the first visit. Therefore, we will typically achieve the desired cosmetic outcome for even our most particular patients. However, sometimes, it requires sending the crown back to the lab for improvements. Nevertheless, as you can see from our cosmetics gallery, we can arrive at very cosmetic results for every dental crown procedure.