What is meant by crown
Dental crown: types, treatment & cost
What is a tooth crown?
The dental crown is a popular and effective solution for replacing an injured or missing tooth. The most important requirement for the insertion of dental crowns is the presence of a tooth root. This tooth root can be from the original tooth or it can be implemented as an artificial tooth root. A crown is usually placed on the remaining part of the damaged tooth. Metal crowns and veneer crowns are mostly attached with a medical cement. For ceramic crowns, on the other hand, a plastic adhesive is used. In the case of very badly damaged teeth, a pin tooth can also be used. The post is taken when the tooth stump is so damaged that it no longer offers enough support for the crown. The pen itself is usually made of metal or fiberglass and is then attached with a special plastic.
As a rule, statutory health insurance companies do not fully cover the provision of a dental crown. Insured persons have to bear part (around 50 percent) of the mostly quite high dental bill themselves. With a private dental insurance, the costs can be completely covered.
When is a dental crown necessary?
If the natural crown of the tooth has been destroyed by caries or an accident to such an extent that it can no longer be supplied with a simple tooth filling or an inlay, the dentist usually recommends a crown. The dental prosthesis supplements the missing parts of the remaining tooth and largely reproduces the original shape of the tooth. The fitting with an artificial crown is sometimes also recommended if a misalignment of the teeth has to be corrected or the tooth lacks the support zone.
Additional findings for a crown are loose, discolored, or missing teeth. Because even if an implant was anchored in the jaw after the complete loss of a tooth, a crown must then be made that covers the protruding metal pin of the implant and serves as a chewing surface. Dental crowns are also often used to anchor a dental prosthesis. Teeth with dead dental nerves or strongly tilted teeth, on the other hand, should not be crowned.
Dental crowns: this is how the treatment works
The restoration of a tooth crown takes place in several steps. At the beginning, the dentist examines the functionality of the tooth nerve and the stability of the tooth root. As part of the preliminary examination, an X-ray image of the affected tooth is sometimes taken and evaluated.
In order to be able to provide a tooth with a crown, the tooth must first be prepared. Unfortunately, up to 60 percent of the partially healthy hard substance must be removed for this. A high level of professionalism and care on the part of the dentist are required for this important treatment step.
The first appointment: taking the impression
In order for the new tooth crown to fit seamlessly into the patient's teeth, an impression of the teeth must be taken with an impression material (usually silicone-containing). When the impression material has hardened, the dental technician uses it as the basis for shaping a custom-made tooth crown. With the help of a true-to-original model of the dentition, the precise interaction of the upper and lower jaw on the crown can be ensured. This is very important because the smallest irregularities on the bite surfaces are extremely annoying and can hinder chewing.
As additional information, the dentist determines the individual shade of white of the neighboring teeth so that the finished tooth crown adapts to the immediate surroundings as inconspicuously as possible. During the manufacturing process, the patient is given a temporary plastic crown to protect the tooth stump.
The second appointment: inserting and gluing
The insertion and bonding of the tooth crown is then carried out under local anesthesia at a follow-up appointment at the dentist. After the temporary restoration has been removed, the dentist thoroughly cleans the remaining tooth stump. The new tooth crown is fitted and fixed. If necessary, small readjustments can be made to the dentures afterwards. The dentist can also use this opportunity to determine whether the crown is causing pressure or pain. A routine check-up usually takes place a few weeks after the crown has been inserted.
Take out additional dental insurance for crowns
These types of dental crowns exist
Depending on the function, area of application and special requirements, very different types of crowns are recommended. Basically, the patient must first familiarize himself with the new bite feeling of an artificial tooth crown. But often a relatively short time to get used to it is enough for the dentures to be perceived as a natural part of the natural set of teeth.
Classification of tooth crowns according to functions:
The type of tooth crown used is very different. Basically, crowns can be classified according to their function, size and extent, the material used and the type of anchoring on the tooth.
The so-called replacement crown is probably the best-known crown - it is used in the event of a large tooth damage to replace the natural tooth crown.
Another type of tooth crown is the protective crown. This is used when the hard and firm enamel has been lost on the tooth. The protective crown then protects the exposed, soft dentin.
Another variant is the anchoring crown. As the name suggests, it is primarily used to anchor dentures.
Classification of tooth crowns according to size and extent:
A partial crown covers z. B. only the damaged chewing surface. A partial crown is useful if a full crown has not yet been attached. Advantage: A lot of healthy tooth substance remains.
The full crown, on the other hand, not only covers the damaged chewing surface, but also the entire crown of the tooth, reproducing the natural tooth as closely as possible.
Classification of the tooth crowns according to the material used:
When choosing the material, various factors such as the degree of stress and aesthetics play a role.
A veneer crown is mostly used in the visible area, i.e. on the incisor or in the front area of the molars. The veneer crown is made of metal - but is then partially or completely covered with a tooth-colored layer. Ceramic or plastic is almost always used for this veneering of the crown.
Advantages (plastic veneer crown):
+ Completely or at least partially covered by a tooth-colored layer
+ Is particularly suitable for the visible tooth area
+ Can be easily repaired in the mouth
+ Slightly cheaper than a ceramic veneer crown
Disadvantages (plastic veneer crown):
- Plastic is more susceptible to dental plaque or plaque
- temperature sensitivity
- Discoloration possible after long periods of wear
- Allergic reactions possible
Metal and cast crown
The metal or fully cast crown made of metal is mostly used in the invisible area (e.g. molar). Since this type of tooth crown is made of metal or a gold alloy, it is particularly durable and very break-resistant.
+ Consists of metal alloy and is therefore also called a gold crown or metal crown
+ Applies to the standard tooth crown
+ Made of mouth-resistant material and therefore very durable / long-lasting
+ Well tolerated in terms of the material Rather inexpensive as there is no great dental effort
- As it is visually very conspicuous, it is not particularly suitable for the visible tooth area
- Temperature sensitivity possible as metal conducts temperatures well
- Taste disorders or corrosion from neighboring teeth with z. B. Amalgam fillings
Mantle and full ceramic crown
The all-ceramic crown or mantle crown surrounds the tooth in a mantle-shaped manner. The crown is made entirely of ceramic. There is a small disadvantage: Since these crowns are not as break-resistant, more material has to be used and thus more of the natural tooth has to be ground off.
+ Usually made of ceramic materials (jacket crown)
+ Surrounds the tooth crown in a jacket-like manner
+ Can hardly be distinguished from a natural tooth, even for an expert
+ Is used in the visible tooth area
+ Cosmetically perfect solution
+ Very good tolerance
+ Good temperature insulation
- Elaborate preparation, irritation possible
- When preparing the tooth, a lot of (also healthy) tooth substance is used
- Very expensive
Full plastic crowns
All-plastic crowns serve more as long-term temporary restorations and not as full-fledged dentures. Prefabricated blanks can be used or an individual full plastic crown can be milled.
You can find more information about the different types of dental crowns in our dental lexicon.
Classification of the tooth crowns according to the type of anchoring on the tooth:
Cemented or glued crowns
In the cemented method, an abutment is screwed onto the implant. The crown is then cemented onto this abutment with a medical cement.
Pin tooth (pin crown)
In the case of a completely damaged tooth, a pin must be implanted in the tooth stump to hold the crown in place. This pin tooth then serves as an anchor or base for the tooth crown.
Which material is the right one?
When deciding which material to make the crown of, the advice of the dentist is crucial. Because every tooth is exposed to different loads and therefore a certain material is recommended in each case. The presence of an allergy also plays an important role in the choice of material. For aesthetic reasons, surfaces that stand out from the tooth color should not be used for visible teeth. Last but not least, the choice of material is also a question of cost. Because there are considerable differences in the amount of the necessary additional payment.
The fully cast metal crown is very durable, relatively inexpensive and particularly resilient. Because of its striking color, it is usually used for the less visible area of the molars. Due to the relatively thin walls of the cast crown, a higher proportion of the natural tooth substance can be retained. In the case of sensitive teeth, the high thermal diffusivity may become a problem. Fully cast crowns are available as gold crowns or as crowns made from non-precious alloys, for example with chrome and cobalt.
All-plastic crowns are well tolerated and inexpensive. However, they tend to discolour over time, are pressure-sensitive and do not last long. The all-plastic crown can therefore hardly be considered as a full-fledged denture.
All-ceramic crowns are also well tolerated and insulate sensitive teeth better against cold and heat than, for example, a metal crown. Electrochemical reactions cannot occur in the mouth either. On the other hand, the durability of this tooth crown usually does not quite reach the level of a metal crown. Another strength of the all-ceramic crown is its ability to adapt well to the shade of the natural neighboring teeth. A significant disadvantage is the high cost.
The veneer crown consists of a metal substructure with a tooth-colored veneer either made of plastic or ceramic. Their durability is very good. The aesthetic effect is convincing apart from a small visible metal edge on the gums. However, the additional veneer results in thicker crown walls and thus a higher loss of healthy tooth substance. In the case of plastic veneers, discoloration is possible over time. The cost burden for the patient is in the medium range. Veneer crowns in the visible part of the dentition are part of the standard care provided by health insurance companies.
These are the advantages and disadvantages of dental crowns
A crown can often save severely damaged teeth and protect them from renewed caries formation. But there are also disadvantages. In order to attach the crown, part of the natural tooth substance must first be ground. The tooth nerve can be damaged during this work. Caries formation occurs even more frequently if the crown was not made to fit perfectly. Incidentally, a tooth crown only has a limited shelf life. This means that after a few years it has to be replaced - but then the tooth has to be regrinded again. In the end it can happen that the crown can no longer be properly attached and ultimately the tooth has to be extracted.
Proper care is of course very important for the long life of the crown. The edge of the tooth crown, which hits the gums, is particularly sensitive and needs special care. You can also take good care of the spaces between the teeth with dental floss and an interdental brush. With proper oral hygiene, a tooth crown will last 10 to 15 years.
How long does a crown last?
Dental crowns have an average shelf life of five to fifteen years. However, factors such as regular teeth cleaning and thorough oral hygiene play a significant role here. The special area of application of the respective crown also ensures differences.
The veneered crown is the most common type of artificial crown. Well-maintained veneer crowns can last for more than twenty years. Ceramic veneers are generally more resilient and have a lower tendency to discolour than plastic veneers.
Full cast metal crowns are also extremely durable and long-lasting. This applies to both base metals and gold alloys.
All-ceramic crowns, including mantle or jacket crowns, do not quite reach the service life of a metal crown with or without veneer. Only all-ceramic crowns made of zirconium have a comparable durability.
All-plastic crowns have a poor durability and tend to wear out a lot. They are more suitable as long-term temporary restorations and not as full-fledged dentures.
These advantages and disadvantages / risks exist with dental crowns
With a crown, badly damaged teeth can often be saved and protected against renewed caries formation. But there are also disadvantages. In order to attach the crown, part of the natural tooth substance must first be ground. The tooth nerve can be damaged during this work. Caries formation occurs even more frequently if the crown was not made to fit perfectly. Incidentally, a tooth crown only has a limited shelf life. This means that after a few years it has to be replaced - but then the tooth has to be regrinded again. In the end, it can happen that the crown can no longer be properly attached and the tooth ultimately has to be extracted.
Proper care is of course very important for the long life of the crown. The edge of the tooth crown, which hits the gums, is particularly sensitive and needs special care. You can also take good care of the spaces between your teeth with dental floss and an interdental brush. With proper oral hygiene, a tooth crown will last 10 to 15 years. The supply of an artificial tooth crown is part of the routine of a dental practice. Nevertheless, the procedure is associated with certain risks.
The following complications can occur:
- Allergies or intolerances
- Infections of the tooth or gums
- Nerve injuries during treatment
- Dental nerve inflammation
- Loosening or damage to the tooth crown
- Discomfort when biting
- Sensitivity to cold and heat stimuli
- Scarring of the gums
- Poor aesthetics
Pain under the crown of the teeth
A crowned tooth can also cause pain. This does not only apply in the period immediately after a new crown has been inserted. Even many years later, pain can arise under a previously completely inconspicuous tooth crown. If the tooth root still has an active tooth nerve, the pressure of the tooth crown can cause discomfort. An incorrectly set bite on the tooth crown can also cause pain. Despite the protective crown, penetrating bacteria can inflame the nerve roots painfully. Many people grind their teeth at night without even knowing it. This excessive strain, not least on the tooth crown, can also lead to pain.
To reduce the risk of pain under the tooth crown, careful dental care, regular teeth cleaning at the dentist and the use of antibacterial mouthwash help. The stress caused by grinding teeth is relieved by a dental splint that is worn during sleep and has to be individually made by the dentist.
The exact causes of long-lasting toothache should be clarified by your dentist. He can check the correct bite and localize and eliminate irregularities in the bite surfaces.
To treat a possible root infection and inflammation of the tooth nerve, the doctor may need to remove the crown. This can mean a high treatment effort, because the old crown can often not be reinserted and a new tooth crown has to be made.Therefore, if possible, the dentist will drill a hole in the crown and perform a root canal treatment in this way.
What costs do you have to expect with a tooth crown?
The labor and material costs for dental crowns are very high. Dental crowns are reimbursed as part of the standard care, so that the health insurance company pays a good 50 percent of the costs. The patient has to pay the remaining costs out of his own pocket. It becomes even more expensive if the patient with the health insurance system wants a similar but visually more attractive supply. In this case, the dentist may bill according to the private fee schedule and demand up to 3.5 times the rate.
In general, one can say that the co-payment for dental crowns varies between 300 and 1,000 euros. For a crown that is not made of precious metal, you have to reckon with an own contribution of 300 to 500 euros. A partial ceramic crown costs between 400 and 600 euros. In the case of a gold crown, an own contribution of 500 to 700 euros is due. It gets really expensive with an all-ceramic crown. This can hardly be distinguished from the natural tooth and the cost of this high-quality solution is particularly high at 700 to 1,000 euros.
Amount of the own share of the costs for the various types of crowns
The costs for the supply do not depend solely on the material used. The size of the tooth defect and the place where the tooth is damaged also influence the cost. This results in clear differences, so that only an approximate cost framework can be given here.
- Fully cast crown (not veneered) 250 - 400 €
- Base metal alloy crown 300 - 500 €
- Crown with partial veneer 400 - 600 €
- Partial ceramic crown 400 - 600 €
- Gold crown 500 - 700 €
- Double crown for dentures 600 - 800 €
- Full ceramic crown 700 - 1,000 €
In order to protect yourself from high additional payments for dental crowns, we strongly recommend that you take out additional dental insurance. The DFV-ZahnSchutz Exklusiv 100 is particularly powerful and reimburses up to 100% of the personal contributions for dental crowns. The tariff of the German family insurance was awarded the absolute top grade VERY GOOD (0.5) from 234 tested supplementary dental insurances by Stiftung Warentest Finanztest (05/2019).
Is there a hardship rule for the cost of dental crowns?
Statutory insurance companies have to bear part of the cost of dentures themselves, as the health insurance companies only cover the so-called fixed allowance.
There is an exception for low-wage earners through the so-called hardship rule: Those who earn little can submit an application to their statutory health insurance company to cover up to 100 percent of the costs of standard care. If the corresponding hardship criteria are met, insured persons incur lower costs or even no costs at all for the provision of medically necessary services. The usual personal contribution is then often completely omitted.
The following can benefit from the hardship regulation:
- Single people whose gross monthly income does not exceed EUR 1,274.
- Insured persons who live with a relative and whose gross family income does not exceed EUR 1,751.75 per month. (For each additional family member an additional 318.50 euros.)
- Students who receive benefits under the BaFöG
- Welfare recipients
- Hartz IV recipient
- Recipients of war victims' welfare
- Recipients of basic security in old age or with reduced earning capacity
- Insured persons who live in a home and whose costs are covered by a social welfare agency or the war victims' welfare organization.
If the monthly gross income only slightly exceeds the specified limit values, an increased fixed allowance is also possible. The so-called sliding hardship rule applies. The amount of additional cost relief depends on the individual load limit.
Insured persons who are exempted from the additional payment for drugs and remedies are not automatically considered as hardship cases when it comes to questions about the cost of dentures. This must be requested separately.
What does the GKV take over for a dental crown treatment?
There is a fixed subsidy system for the provision of dentures. The statutory health insurance companies pay a subsidy towards the actual costs for crowns, bridges and prostheses. The health insurances cover 50 percent of the average costs for the so-called standard care (a sufficient, necessary and economical standard therapy). From October 1, 2020, the fixed allowance for dentures will increase to 60 percent. Patients can choose their dentures freely, but the amount of the fixed allowance does not change. You have to pay your own contribution for your dentures yourself. That is the difference between the cost of the dental treatment and the fixed allowance from the health insurance fund.
This subsidy increases if a patient attends the regular check-ups at the dentist and has this confirmed by a stamp in the bonus booklet. If the bonus booklet has been kept for five years without gaps, the fixed allowance increases by 20 percent. After ten years, the insured person benefits from a 30 percent higher fixed allowance. At the same time as the increase in the fixed subsidy from October 1, 2020, the assumption of costs including bonuses increases to 70 or 75 percent.
Patients who only have a low income can submit a separate application to their health insurance company, which falls under the so-called hardship rule. Then it is possible to receive the double (basic) fixed allowance, but at least the costs for the standard care.
From October 1st, health insurance companies will also take over the bonus payments in individual cases if the seamless “efforts to keep teeth healthy” have not been complied with. - Provided that the insured person has regularly cared for his teeth and only neglected to attend the regular check-up at the dentist once in the ten years before the treatment.
The following example shows how the bonus currently (January 2020) affects the fixed grant:
- Fixed subsidy for one crown - without bonus: 161.95 euros
- with a 20 percent bonus: 194.34 euros
- with a 30 percent bonus: 210.54 euros
What does the DFV do for a dental crown treatment?
The four-time Stiftung Warentest test winner DFV-ZahnSchutz pays up to 100% of all costs that you incur at the dentist. Of course, this also includes pre- and post-treatment as well as all anesthetic services and other services for eliminating pain.
Best test winner services for dentures
The six-time Stiftung Warentest test winner, DFV-ZahnSchutz, will reimburse up to 100% of the costs for your high-quality and long-lasting tooth crown!
- Up to 100% reimbursement for dentures
- Free choice of dentist
- Without a health issue
- Without waiting
FAQs on the subject of dental crowns
When do you need a dental crown?
The production of a tooth crown is inevitable if the tooth is so badly damaged by accident or caries that it can no longer be supplied with a filling. Even if a tooth had to be extracted and replaced with an implant, an artificial tooth crown must be inserted. In addition, a crowning of the neighboring teeth is necessary for the secure attachment of some dental prostheses.
How long does a dental crown usually last?
The lifespan of a tooth crown depends heavily on how carefully the teeth are cared for. Regular checks and professional tooth cleaning in the dental practice also extend the maximum useful life. The veneered crown, the most frequently used type of crown, can, in the best case, last 15 to 20 years. However, if the crown is exposed to extraordinary stress, it is possible that it will have to be replaced after about five years. Crowns with plastic veneers tend to discolour over time and are therefore sometimes also replaced earlier.
What does a health insurance patient have to pay for his or her crown?
The additional payments for the supply of a dental crown can be substantial. The health fund pays a fixed subsidy, i.e. only part of the total cost of the treatment. That is 50 percent of the so-called standard supply. Patients with a bonus booklet that has been kept without gaps for at least five years receive an additional grant. The all-ceramic crown is the most expensive variant. Up to 1000 euros can be due for statutory health insurance patients if they opt for this type of treatment. On the other hand, veneer crowns and full cast crowns, some of which are part of the standard health insurance coverage, are much cheaper. Here the patient has to reckon with an own contribution of 250 to 600 euros.
Which tooth crown for the molar?
In the area of the molars, the tooth crown is exposed to greater pressure when chewing. This is where cast metal crowns show their strengths. They are particularly durable and withstand great loads. Because the walls of the crown can be kept comparatively thin, only a small amount of healthy tooth substance has to be ground down in order to fit the new crown. The disadvantage of the cast crown is usually its dark or golden color. However, crowned molars are hardly visible due to their position, so that the color difference to the natural teeth is not noticeable here.
Is it possible to reinsert a failed tooth crown?
This is only possible in exceptional cases. Most of the time, a newly manufactured tooth crown has to replace the fallen out or loose crown. As a fixed denture, the artificial crown has to fit perfectly on the real tooth. If the natural tooth has changed or the previous tooth crown is defective, a new crown usually has to be made and fitted.
- Gernet Wolfgang et al: Dental prosthetics (ZMK-Heilkunde), Georg Thieme Verlag, 4th edition 2011
- Weber, Thomas: Memorix Zahnmedizin, Georg Thieme Verlag, 5th edition 2017
- Dental lexicon: www.zahn-lexikon.com (accessed January 7, 2020)
- DocMedicus Verlag: www.zahngesundheit-online.de (accessed January 7, 2020)
- Additional dental insurance test: www.test-zahnzusatzversicherung.de (accessed on January 8, 2020)
- Dentnet: www.dentnet.de (accessed January 9, 2020)
- Finanztip, www.finanztip.de (accessed: January 8, 2020)
- Bundesvereinigung Lebenshilfe, www.lebenshilfe.de (accessed: January 8, 2020)
- National Association of Statutory Health Insurance Physicians, www.kzbv. (Access: January 8, 2020)
- finanzen.de GmbH, www.finanzen.de (accessed: January 8, 2020)
- beta Institute non-profit GmbH, www.betanet.de (accessed: January 8, 2020)
- AOK, www.aok.de (accessed: January 8, 2020)
- Barmer, www.barmer.de (accessed: January 9, 2020)
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