Crowns

Dental procedure
Overview
Core buildup with pins used to rebuild a badly damaged or decayed molar tooth prior to placing a crown.

Teeth which have sustained heavy damage to the visible part of a tooth (natural clinical crown) can often be repaired with filling material and placement of structural pins. The combination of modern dental adhesives and pin retention can produce a durable restoration; however ideal tooth shape and improved strength, and superior fracture resistance may be achieved by placing a crown or onlay on the tooth.

The (natural clinical) crown of a tooth is the portion of the tooth which is covered with tooth enamel and projects through the gums into the mouth. It is the part of the tooth you can see, as compared to the tooth root which is generally below the gumline. When a dentist mentions a “crown” as an option for repairing a tooth, they are talking about a prosthetic crown.

If a tooth has been extensively decayed, chipped or cracked, and cannot be restored to its proper shape, function and appearance another way, the dentist may recommend placement of a prosthetic crown.

Crowns are most often made in a laboratory by a skilled dental technician, and the process is very detailed. Use of computerized milling devices to make ceramic crowns is becoming more common, but they may not be appropriate in all applications.

The tooth is first prepared for a crown by removing any decay, and filling in any voids. It is then reduced in shape to a tapered stump, which the new crown will slip down over.

Crowns for baby (primary) teeth differ significantly from crowns for permanent teeth, from the shape of the prepared tooth stump, to the way the crowns are made and the materials they’re made of.

The process

Before the procedure

When you have invasive dental procedures like crowns done, the dentist will review your health history. If you have replacement joints (for example, total knee replacement, hip replacement, etc.), you may be pre-medicated with antibiotics for the procedure. If you have certain types of heart murmurs or replacement heart valves, you may also need to take an antibiotic pre-medication prior to the procedure.

If you are anxious about dental procedures, your dentist may recommend sedating you for the procedure. There are several methods of relaxing patients for dental treatment, including oral anti-anxiety pills like Valium®; inhaled anti-anxiety medication like nitrous oxide; and intravenous anti-anxiety medication, such as Versed®. Your dental plan may not pay benefits toward sedation.

The following describes the typical crown preparation and laboratory process (if applicable) in detail. Your procedure may vary a bit from the procedure described.

Anesthetic

The tooth to be crowned is usually numbed by injecting local anesthetic around the nerve(s) that supply sensation to the tooth. Discomfort from the injection can be minimized by use of a topical numbing gel for a minute or two prior to the injection.

Pre-impression

Frequently, a preliminary impression (mold) is made of the teeth before they are altered. The material used most for crown impressions is polyvinyl siloxane, a dimensionally stable and extremely accurate elastomer (meaning it’s stretchy, but returns to the shape it takes when it cures after a minute or two). Other materials may be used. The preliminary impression can be made of silicone or other elastic materials. It can be used to make a temporary crown for the tooth while the final crown is being made in a laboratory, a process that can take a couple of weeks.

Shade matching

If the tooth is to be crowned with a tooth-colored crown, a shade matching guide will be used to determine the shade of your natural teeth. The shade is generally matched in natural lighting, also called “full spectrum” lighting. Fluorescent lights can make teeth appear blue to grey; Incandescent lights can make them appear too yellow. Dental porcelains and resins available today can produce a stunningly precise match for the shade and optical properties of your natural tooth enamel, allowing a single crown to be made that matches your teeth nearly imperceptibly.

Isolation

The tooth is isolated from mouth structures like the tongue and cheeks to prevent injuries from instrumentation used to prepare the tooth. An isolation barrier known as a rubber dam or dental dam is frequently used, but there are other retraction devices in use. Some dentists may simply use cotton rolls and cheek shields.

Core preparation

Molar tooth crown preparation showing high speed handpiece, cooling spray, metal core material and crown margin.

The preparation margin is a ledge that is shaped into the tooth, against which the crown (or onlay) will seal.

The tooth is prepared by removing old restorative materials (if necessary), removing any decay, and (if necessary) filling in any deep holes or missing corners of the tooth. It may be necessary to place small metal (normally titanium) pins in the tooth to rebuild the portion of the tooth that will be covered by a crown. The dentist may use any of a variety of filling materials to rebuild the tooth, including composite resin, glass ionomer, and silver amalgam.

Core buildups are considered a separate billable procedure from crowns. A distinction is made between buildups that involve all or a substantial portion of the core of the tooth, and those that require only a small amount of filling material in the core to build out a minor chip (called “basing to proper contour”). It’s a good idea to know in advance whether a complete core build-up is likely to be required, to avoid unexpected costs.

Crown preparation

Preparation of a damaged tooth for a crown or onlay is done with a tapered diamond bur using large amounts of cooling spray.

Preparation of a badly damaged or decayed tooth for a crown or onlay is done with a tapered diamond bur (shaping point), which spins in a high speed dental handpiece using large amounts of cooling spray to avoid overheating the tooth.

The outer surface of the tooth is reduced in all dimensions (biting surface and sides) by 0.75mm to 3mm to make room for the crown that will be placed on the tooth. The walls of the preparation are tapered to allow the crown to be slipped down over the tooth. A ledge (margin) is created around the circumference of the tooth against which the crown will be tightly sealed.

Impression of the prepared tooth

An impression of the prepared tooth and the teeth that bite against it is made, taking care to gently reflect the gum tissue away from the prepared tooth. Often, the dentist will place retraction cord
in the trough between the gums and prepared tooth prior to making the impression. The cord will be removed after the impression is made. This technique allows the crisp outline of the prepared tooth to be recorded in the impression, so that a precise fit can be achieved between the crown and tooth.

Temporary crown (if needed)

If the crown is not going to be made by a computerized milling device in the office (often the case), the impression that was made prior to preparing the tooth can now be used to make a temporary crown. This is done by filling the pre-impression with a gooey tooth-colored resin material, having the consistency of thick syrup, and placing it over the prepared tooth. The resin material will gel in about a minute (in the shape of the un-prepared tooth), and the impression can be removed from the mouth. The temporary crown completely hardens in another minute or two. Once hardened, it will be trimmed to proper fit, polished, and cemented onto the tooth with temporary cement.

Lab work and final crown seat

Porcelain crowns are cosmetic dental procedures to make teeth youthful and attractive.

Solid ceramic crowns being made on a stone cast replica of the prepared teeth. Note how the teeth to be crowned have been reduced to tapered stumps (lower left and right frames). The crowns will be permanently cemented onto the stumps after they are evaluated for fit, function and cosmetic attributes.

Although some dentists now have computer-controlled milling machines for making ceramic crowns in their offices, a more common scenario is that the crown will be made in a dental prosthetics laboratory. Essentially, the lab work involves the following:

Cast fabrication

The impression of the prepared tooth and the teeth that oppose it is poured with lab plaster and allowed to harden.

Articulation

The stone casts of the teeth are assembled into a hinged jaw simulation device known as an “articulator” in their proper bite relationship.

Die Preparation and fabrication of a wax pattern

The cast of the prepared tooth (working die) is inspected closely for undercuts and any other irregularities. The technician will create a crown from wax using sculpture techniques. This wax pattern will be used in any of a variety of ways to produce the final crown, depending on whether the crown is to be made of ceramic, metal, or a combination of those.

Production of the actual crown

Full gold crown for broken molar tooth is being finished on dies in the dental lab.

Full gold crown being made on a cast of the prepared tooth. Other materials, including various metal alloys, composite resin, and porcelain fused to gold, titanium or zirconium (a white metal), can be used to make crowns. Your dentist can help you decide which material is most appropriate for your needs.

Depending on which type of crown is to be fabricated, the crown may be cast from a variety of metal alloys, pressed from ceramic, or made of ceramic fused to the metal alloy.

Finishing

Depending on which type of crown is made, it may require metal finishing and polishing, or other staining and glazing procedures (tooth colored crowns) to make the tooth match the patient’s natural teeth as closely as possible.

Delivery of final crown

When your final crown is ready, a second visit is necessary to remove the temporary crown and replace it with the permanent crown. About half of the time, a patient will ask to be anesthetized for the second visit, to avoid any discomfort associated with removing the temporary crown and cleaning the temporary cement from the prepared tooth. Teeth which have been endodontically treated (i.e. root canal) generally do not need to be anesthetized for the delivery of a permanent crown, although many dentists prefer the patient to be numb for the crown preparation due to the potential for
discomfort associated with soft tissue management (gum retraction, etc.).

Adjust and Polish

The occlusion (i.e. functional biting relationship) of the crown may need to be adjusted slightly, and the crown re-polished. This should take just a minute or two under normal circumstances.

Advantages and benefits
Tooth colored dental crown for molar shown transparent to illustrate the amount of tooth reduction taken in the preparation.

Tooth colored crowns can be made from solid porcelain, porcelain fused to metals (for example, gold), porcelain fused to ceramometals (for example, zirconium — a white metal), and composite resin. More tooth structure needs to be removed for all of these materials than for solid metal crowns, in order to have sufficient durability to withstand chewing forces.

  • Since they are made outside of the mouth, it is easier to rebuild the ideal contours of the natural tooth with a crown than it is with large fillings. It is also easier to achieve contact with adjacent teeth, so food won’t collect between the teeth afterwards.
  • Crowns can prevent cracks from spreading through a tooth.
  • Porcelain crowns can restore the tooth to its natural contour, function, and appearance.
  • Metal crowns will not generally chip, and provide the tooth with a surface that is durable.
  • Porcelain fused to metal crowns offer a good combination of durability and esthetics.
  • Porcelain fused to zirconium (white metal) crowns arguably offer the best combination of durability and esthetics.
Disadvantages and risks
  • Compared to fillings, onlays and crowns are relatively expensive. However, they generally afford better protection against tooth fractures, and can make it more predictable to achieve contact with adjacent teeth (versus leaving a gap). It may also be easier to sculpt an ideal tooth shape working outside the mouth.
  • Traditionally, onlays and crowns require two visits to complete. Often, this means being “numb” at both appointments. Computer-milled inlays, onlays and crowns, which are delivered the same day the tooth is prepared, eliminate the need for a second appointment; however, these may not be appropriate for all teeth, and are still not widely available.
  • Preparing a tooth for an onlay or crown involves reducing the sides of a tooth and its biting surface. Depending on how thick the remaining walls of the prepared natural stump are, the tooth itself can be weakened, reducing its long-term prognosis.
  • Inflammation and/or infection from the preparation procedures can occur, and may be more likely with ceramic onlays and crowns, because it is necessary to remove more natural tooth structure than for metal ones. This is because porcelain must be thicker than metal to have comparable strength. Studies aiming to quantify the risk of tooth abscess following crown preparation have shown an abscess rate of about 10%.
  • If the tooth being prepared is alive (vital), it will normally be numbed with local anesthetic. Local anesthetic has disadvantages of its own, which are generally considered minor compared to the advantages of having the procedure performed comfortably.
  • Fillings, inlays, onlays and crowns can fall out and be lost, requiring replacement. Modern bonding adhesives and cements used in dentistry have significantly reduced this risk.
  • Ceramic and composite resin inlays, onlays and crowns can chip, requiring repair or replacement. This is particularly true in patients who grind (brux) their teeth, or use them inappropriately (e.g. chewing ice, popcorn kernels, etc.).
  • Leakage can occur along the interface between an inlay, onlay or crown over time, and the prepared tooth (margin), leading to sensitivity and decay. Poor oral hygiene is often a significant factor in such cases.
  • All dental procedures can produce lip dryness, chapping and cracking. Some patients develop cold sores following dental treatment. Some degree of post-operative discomfort frequently accompanies tooth preparation, including tenderness to biting and cold which is normally temporary. Some studies have shown prolonged sensitivity over a year in certain patients. Such cases are relatively rare.
Other care that may be needed

Core buildup

Silver amalgam dental filling material used to base a crown preparation to full contour is not the same thing as a core buildup with pins or posts.

Filling material used to build out (base) a crown preparation to its full contour is not the same thing as a core buildup with structural pins or posts, and is generally not billed the same. A base is merely used to replace a corner of the tooth that has been damaged or decayed.

This procedure involves removing any decay and weakened tooth structure, and rebuilding the damaged contours (core) of the tooth with filling material, prior to protecting the tooth with a crown or onlay. Pins may be necessary, especially if the core buildup material is not bonded in place with dental adhesives. If most or all of the clinical crown of the tooth is gone, it may be necessary to place a structural post in the tooth’s root canal. Doing so generally requires the tooth to be endodontically treated (i.e. to have root canal therapy).

Posts can either be pre-fabricated from fiberglass, stainless steel or titanium; or they can be custom cast in a laboratory from a gold alloy. Core buildups are distinguished from basing to contour, in which a small chip or void in the tooth is filled in prior to preparing the tooth for the crown. Basing to contour does not constitute a core buildup for purposes of separately billing the procedure. Diagnostic photographs showing how much damage there is to a tooth can be useful in communicating the need for a core buildup.

Root canal (endodontic) treatment

Preparing a tooth for a crown can result in inflammation of the tooth’s pulp (the blood vessels and nerve tissue inside the hollow center of the tooth). Because teeth are poorly equipped to deal with inflammation, the problem may not resolve on its own without intervention in the form of root canal treatment. Teeth that are badly broken down or extensively decayed may also become infected, requiring root canal treatment to eliminate the infection.

A tooth which has been prepared for a crown may need endodontic treatment at any time—before, around the time of, or long after a crown is placed. Whether a tooth will need this treatment depends on many factors, including the extent of the damage/decay to the tooth and the age, health status, and tooth habits (for example, grinding the teeth, chewing ice, etc.) of the patient. Some studies have estimated the number of teeth requiring root canal therapy following a crown preparation at 10%.

Crown lengthening surgery

If an insufficient amount of the tooth is left protruding through the gums to hold onto a crown; or if the interface between the crown and tooth (margin) would need to be located far below the gums near the bone level, the tooth may require crown lengthening surgery. This procedure involves elevating the gums back from the tooth, exposing the underlying bone, removing a few millimeters of bone around the tooth, and re-positioning the gums over the newly re-contoured tooth-supporting (alveolar) bone. The result is that the tooth protrudes out of the gums far enough to prepare it for a solid crown with margins appropriately away from the bone.

It may be possible to produce an equivalent crown lengthening result by orthodontically or surgically extruding the tooth by a few millimeters, rather than removing bone from around it.

Other treatment options

Fillings

Fillings can often be a viable option to onlays and crowns, when appropriately bonded into the tooth with modern dental adhesives, and/or stabilized with pins. They can help stabilize fractures, and (within limits) rebuild the tooth to its normal contours. They can restore function and esthetics for a significant length of time (even years in appropriate cases), although a crown, inlay or onlay may be the best long term solution. Your dentist is the most qualified person to help you understand the limitations of fillings, and when another type of restoration would be more appropriate for your needs.

Provisional Crowns

Provisional crowns can be semi-customized to your tooth, providing an interim restoration while dental procedures are completed on other teeth, or to plan for the expense of a more permanent crown. Your dentist is also the most qualified person to help you understand if this type of solution might be appropriate for you.

Onlays

Onlays are a type of dental restoration that provides protection against cracks, while sparing tooth structure. They can be made of metal, ceramic or composite resin.

What if I do nothing?

If you have a badly broken down, decayed, chipped, or cracked tooth in need of a crown, and decide not to have it fixed, the tooth can break apart further, to the point where it may not be possible to save it.

A crack may spread through the tooth into the pulp, the hollow inside of the tooth where the blood vessels and nerve are located. Bacteria can get into the pulp, causing an infection that may require root canal (endodontic) treatment. In rare cases, the tooth may not be savable. If the tooth is lost, problems associated with missing teeth may occur.

These include shifting of the adjacent teeth, a change in the way your teeth fit together, increased forces on the remaining teeth, a reduction in lower face height, shortening of the chewing muscles (which can result in greater muscle forces), increased stress on the jaw joints (TMJs), and the potential for jaw joint problems (temporomandibular joint dysfunction, or TMD).

Author: Thomas J. Greany, D.D.S.
Editor: Ken Lambrecht
This page was reviewed by members of our review board.

This page was last updated on June 17, 2016.

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Background information

A Six Year Evaluation of Cracked Teeth Diagnosed with Reversible Pulpitis: Treatment and Prognosis
Krell, Keith V., DDS, MS, MA and Rivera, Eric M., DDS, MS
Journal of Endodontics
2007 33 (12): 1405-1407

Ongoing Changes in Fixed Prosthodontics, 2007
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2007 138: 1257-1259

Update on the Adaptive Immune Responses of the Dental Pulp
Hahn, Chin-Lo, MS, PhD, DDS and Liewehr, Frederick R., DDS, MS
Journal of Endodontics
2007 33 (7): 773-781

Is the wide range in crown fees justifiable?
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2006 137: 1297-1299

Contact stomatitis due to palladium in dental alloys: A clinical report
Garau, Valentino, DDS, MS, PhD, et al.
The Journal of Prosthetic Dentistry
2005 93 (4): 318-320

Short-term clinical evaluation of a resin-modified glass-ionomer luting cement
Yoneda, Sumie, DDS, PhD, et al.
Quintessence International
2005 36 (1)

The advantages of minimally invasive dentistry
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2005 136: 1563-1565

Universal Paradigms For Predictable Final Impressions
Vakay, Rena T., DDS and Kois, John C., DMD, MSD
Compendium of Continuing Education in Dentistry
2005 26 (3): 199-209

Incidence of Endodontic Treatment: A 48-Month Prospective Study
Boykin, Michael J. DMD, MS, et al.
Journal of Endodontics
2003 29 (12): 806-809
Editor’s notes: Abstract states that in this Florida Dental Care Study, conducted over four years, 2% of all services were endodontic, and 94% of endodontic procedures performed were for conventional root canal therapy. Those were approximately evenly distributed between anterior, bicuspid and molar teeth. Re-treatment and apicoectomies each accounted for 3% of the endodontic procedures.

Minimally invasive dentistry
Murdoch-Kinch, Carol Anne, DDS, PhD, and McLean, Mary Ellen, DDS
The Journal of the American Dental Association
2003 134: 87-95

Incompletely fractured teeth associated with diffuse longstanding orofacial pain: diagnosis and treatment outcome
Brynjulfsen, A., et al.
International Endodontic Journal
2002 35 (5): 461-466

An Inexpensive Device for Transillumination
Liewehr, Frederick R., DDS, MS, FICD
Journal of Endodontics
2001 27 (2): 130-131

Principles of biocompatibility for dental practitioners
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2001 86 (2): 203-209

Tooth preparations for complete crowns: An art form based on scientific principles
Goodacre, Charles J., DDS, MSD, et al.
The Journal of Prosthetic Dentistry
2001 85 (4): 363-376

Type and incidence of cracks in posterior teeth
Ratcliff, Steve, DDS, et al.
The Journal of Prosthetic Dentistry
2001 86 (2): 168-172

Biocompatibility of dental casting alloys: A review
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2000 83 (2): 223-234

Clinical Evaluation of a New Resin Composite Crown System to Eliminate Postoperative Sensitivity
Suzuki, Shiro, DDS, PhD
The International Journal of Periodontics & Restorative Dentistry
2000 20 (5): 499-509

Cracked tooth syndrome—incidence, clinical findings and treatment (PDF, 123K)
Homewood, C.I. (Kip), BDSc DDS, LDs, FRACDS
Australian Dental Journal
1998 43 (3): 217-222

Does the cycle of rerestoration lead to larger restorations? (PDF, 2704K)
Brantley, C. F., et al.
The Journal of the American Dental Association
1995 126 (10): 1407-1413

Crown lengthening and restorative treatment in mutilated molars
Parashis and Tripodakis
Quintessence International
1994 25 (3): 167-172

Are endodontically treated teeth more brittle?
Sedgley, Christine M., BDS, MDSc, FRACDS and Messer, Harold H., MDSc, PhD
Journal of Endodontics
1992 18 (7): 332-335

Changes in the pulpal vasculature during inflammation
Takahashi, Kazuto, DDS, PhD
Journal of Endodontics
1990 16 (2): 92-97

Cracked Tooth Syndrome
No author specified
Colgate World of Care web site
Last viewed: 9/23/2010
Editor’s notes: Manufacturer’s web site. Reviewed by the faculty of The Columbia University College of Dental Medicine.

Information you may wish to read before making a decision on treatment

An Evaluation of Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Pulpal Anesthesia for Mandibular First Molars
Jung, Il-Young, DDS, MSc, PhD, et al.
Journal of Endodontics
2008 34 (1): 11-13
Editor’s notes: This article describes a potentially useful technique for getting lower molars numb, which may be more comfortable than traditional methods.

Clinical Performance of Class II Adhesive Restorations in Pulpectomized Primary Molars: 12-month Results
Zulfikaroglu, Burcu Togay, et al.
Journal of Dentistry for Children
2008 75 (1): 33-43

Preformed metal crowns for decayed primary molar teeth
Innes, NPT, et al.
Cochrane Database of Systematic Reviews
2008 1

A Comparison of Fixed Prostheses Generated from Conventional vs. Digitally Scanned Dental Impressions
Henkel, Gary L., DDS, MAGD
Compendium of Continuing Education in Dentistry
2007 (8)

Choosing an all-ceramic restorative material: Porcelain-fused-to-metal or zirconia-based?
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2007 138: 662-665

Clinical Comparison of Postoperative Sensitivity for an Adhesive Resin Cement Containing 4-META and a Conventional Glass-Ionomer Cement
Denner, Nana, DDS, Dr Med Dent, et al.
International Journal of Prosthodontics
2007 20 (1): 73-78

Longevity versus esthetics: The great restorative debate
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2007 138: 1013-1015

Surgical lengthening of the clinical crown: a periodontal concept for reconstructive dentistry
Huynh-Ba, Guy, et al.
PERIO—Periodontal Practice Today
2007 4 (3): 193-201

The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: A literature review
Goga, Radu, BDS and Purton, David G., MDS, FRACDS
Quintessence International
2007 38 (2): 106-111

Treatment of localized anterior tooth wear with a glass-fiber-reinforced composite resin: A clinical report
Akar, Gulcan Coskun, DDS, PhD and Dundar, Mine, DDS, PhD
The Journal of Prosthetic Dentistry
2007 97 (3): 133-136

When and how to repair a failing restoration
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2007 138: 1605-1607

When is a full crown restoration indicated?
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2007 138: 101-103

Clinical Evaluation of Posterior Composite Restorations in Endodontically Treated Teeth
Can Say, Esra, DDS, PhD, et al.
The Journal of Contemporary Dental Practice
2006 7 (2)

Influence of remaining coronal tooth structure location on the fracture resistance of restored endodontically treated anterior teeth
Ng, Clarisse C.H., BDSc, et al.
The Journal of Prosthetic Dentistry
2006 95 (4): 290-296

Minimally invasive operative techniques using high tech dentistry (PDF, 148K)
Brostek, Andrew M. Dr., et al.
Dental Practice
2006: 106-106
Editor’s notes: Online publication date September/October 2006.

A review of the management of endodontically treated teeth- Post, core and the final restoration
Cheung, William, DMD
The Journal of the American Dental Association
2005 136 (5): 611-619

Do We Still Need Formocresol in Pediatric Dentistry? (PDF, 593K)
Casas, Michael J., DDS, DPaed, MSc, FRCD(C), et al.
Journal of the Canadian Dental Association
2005 71 (10): 749-751

Fracture resistance of endodontically treated maxillary premolars restored with CAD/CAM ceramic inlays
Hannig, Christian, DMD, et al.
The Journal of Prosthetic Dentistry
2005 94 (4): 342-349

Long-term survival of endodontically treated molars without crown coverage: A retrospective cohort study
Nagasiri, Rapeephan, DDS, MS, and Chitmongkolsuk, Somsak, DDS, Dr Med Dent
The Journal of Prosthetic Dentistry
2005 93 (2): 164-170

Longevity of posterior tooth dental restorations
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2005 136 (2): 201-203

What has happened to conservative tooth restorations?
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2005 136: 1435-1437

Review of Pediatric Sedation
Cravero, Joseph P., MD, and Blike, George T., MD
Anesthesia & Analgesia
2004 99: 1355-1364

Surgical Extrusion Technique for Clinical Crown Lengthening: Report of Three Cases
Kim, Chang-Sung, DDS, PhD, et al.
The International Journal of Periodontics & Restorative Dentistry
2004 24 (5): 412-421

Occlusion-Based Treatment Planning for Complex Dental Restorations: Part 1
Keough, Bernard, DMD, CAGS
The International Journal of Periodontics & Restorative Dentistry
2003 23 (3): 237-247

Occlusion-Based Treatment Planning for Complex Dental Restorations: Part 2
Keough, Bernard, DMD, CAGS
The International Journal of Periodontics & Restorative Dentistry
2003 23 (4): 325-335

The confusing array of tooth-colored crowns
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2003 134 (9): 1253-1255

Avoiding pulpal death during fixed prosthodontic procedures
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
2002 133 (11): 1563-1564

Prosthetic rehabilitation of extremely worn dentitions: Case reports
Cura, Cenk, DDS, PhD, et al.
Quintessence International
2002 33 (3): 225-230

Relationship between crown placement and the survival of endodontically treated teeth
Aquilino, SA, and Caplan, DJ
The Journal of Prosthetic Dentistry
2002 87 (3): 256-263

Short-Term Evaluation of Intentional Replantation of Vertically Fractured Roots Reconstructed with Dentin-Bonded Resin
Hayashi, Mikako, DDS, PhD, et al.
Journal of Endodontics
2002 28 (2): 120-124
Editor’s notes: Over 80% of teeth with vertical fractures in the study were successfully restored by this technique one year after the procedure; Over one-third of them were still successfully restored at two years. Although long-term success may not be achievable with the technique, evidence shows that a significant amount of time may be gained for a patient to plan for a more definitive solution.

Managing incomplete tooth fractures
Ailor, J. Edward Jr., DDS
The Journal of the American Dental Association
2000 131 (8): 1168-1174

Tooth wear treated with direct composite restorations at an increased vertical dimension: Results at 30 months
Hemmings, Kenneth W., BDS, MSc, et al.
The Journal of Prosthetic Dentistry
2000 83 (3): 287-293

Integrated Electromyography of the Masseter on Incremental Opening and Closing with Audio Biofeedback: A Study on Mandibular Posture
Gross, MD, et al.
International Journal of Prosthodontics
1999 12 (5): 419-425

Restoration of the Severely Worn Dentition Using a Systematized Approach for a Predictable Prognosis
Stewart
The International Journal of Periodontics & Restorative Dentistry
1998 18 (1): 47-57

A New Technique for Restoration of Worn Anterior Teeth—1995 (PDF, 565K)
Christensen, Gordon J., DDS, MSD, PhD
The Journal of the American Dental Association
1995 126 (11): 1543-1546

Definitive Restoration of Endodontically Treated Teeth in a German Dental Office: a Retrospective Study
Tekyatan, H., et al.
International Association for Dental Research web site
Last viewed: 9/23/2010
Editor’s notes: From the Proceedings of the 81st General Session of the International Association for Dental Research; June 25–28, 2003.

Endocarditis Prophylaxis Information
American Heart Association web site
Last viewed: 9/23/2010