Specialty & Implant Care
Crowns & Bridges
The most common restorations in dentistry, and the ones most often done without enough attention to how they meet the opposing teeth. That single detail is what separates a crown that lasts twenty years from one that fails in four.
Treated by
Dr. Jonathan Berkowitz, DMD
Residency-trained Prosthodontist
- University of Michigan prosthodontic residency
- Ten years attending prosthodontist, Northport VA
- Implants placed and restored in-house
What a crown does
A crown covers a tooth entirely, restoring its shape and protecting what remains of the natural structure underneath. It is the standard treatment for a tooth that has fractured, has been substantially rebuilt with large fillings, has had a root canal, or has worn down significantly.
A tooth that has had a root canal is particularly vulnerable — it has lost its blood supply and becomes brittle over time. A crown placed after root canal treatment is what keeps that tooth from splitting, and splitting is generally not repairable.
Modern crowns are made from all-ceramic materials such as zirconia and lithium disilicate. They are strong, they do not show the dark line at the gum that older porcelain-fused-to-metal crowns eventually developed, and their translucency can be matched to neighbouring teeth.
What a bridge does
A bridge replaces one or more missing teeth by connecting to the teeth on either side of the gap. The replacement tooth is fixed and does not come out.
The trade-off worth understanding is that a conventional bridge requires the supporting teeth to be reduced in size to accept crowns. If those teeth are already heavily restored, that is no great loss. If they are healthy and untouched, it is a real cost, and an implant may be the better option because it leaves them alone.
We will always explain that comparison rather than defaulting to one or the other. A bridge is faster and often less expensive; an implant is usually the better long-term answer for a single gap between healthy teeth. Which is right depends on your specific situation, and sometimes on your budget, which is a legitimate factor.
Why crowns fail, and how that is avoided
Crowns rarely fail because the porcelain was poor. They fail because of what is happening around them.
The most common cause is a bite that concentrates force in the wrong place. If a crown is fractionally high, or if it takes the brunt of a grinding habit, it will chip, loosen, or fracture the tooth beneath it — and a replacement made the same way will do the same thing.
The second cause is decay at the margin where the crown meets the tooth, which comes down to the accuracy of the fit and the standard of home care.
Assessing and correcting the bite is central to prosthodontic training, and it is why a patient whose crowns keep failing is a case for a specialist rather than for another crown. If you have had the same restoration remade more than twice, the restoration is not the problem.
How a crown is made
- 1
Examination and planning
Assessment of the tooth, the surrounding gum, and the bite. If there is an underlying bite issue, it is identified now rather than after the crown fails.
- 2
Preparation
The tooth is shaped under local anesthetic to make room for the crown, and any decay or failing filling material is removed. A digital scan or impression is taken.
- 3
Temporary crown
A temporary is fitted so the tooth is protected and you can eat and smile normally while the final crown is made.
- 4
Shade selection
The shade, translucency, and surface character are matched to your adjacent teeth — an underrated step that determines whether the crown reads as natural.
- 5
Fitting
The final crown is checked for fit, contact with neighbouring teeth, appearance, and — most carefully — the bite, then cemented. Time spent adjusting the bite here is what determines its lifespan.
Questions
Things people ask
If your question is not here, call the office. Nobody will pressure you into booking.
Call 212-874-1700How long do crowns last?
A well-made crown on a well-managed bite commonly lasts fifteen to twenty years, and often considerably longer.
The factors that shorten that are grinding without a nightguard, decay at the margin, and a bite that was never properly adjusted. All three are largely controllable.
Crown or implant for a missing tooth?
A crown restores an existing tooth; it is not an option when the tooth is gone. For a missing tooth the real comparison is between a bridge and an implant.
An implant leaves the neighbouring teeth untouched and prevents bone loss at the site, which usually makes it the better long-term choice. A bridge is faster and often costs less up front. If the adjacent teeth already need crowns anyway, a bridge becomes considerably more attractive.
Will it match my other teeth?
That is the intention, and it is largely a function of how much care goes into shade selection. Natural teeth are not a single flat colour — they vary from the gum to the edge and have subtle surface texture and translucency.
Front teeth are the difficult case, and for those we take extra time, sometimes with photographs sent to the laboratory or a try-in before final glazing.
Does getting a crown hurt?
The preparation is done under local anesthetic and should not be uncomfortable. Some sensitivity in the days afterward is normal, particularly to cold, and usually settles.
If a tooth remains sensitive or painful for more than a couple of weeks, come back and let us check it — occasionally a tooth that needed a crown turns out to need root canal treatment as well.
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Most people considering implants or major reconstruction have been thinking about it for a long time. A conversation costs nothing and there is never any pressure.
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