A dental crown is a custom-made, tooth-shaped cap used to cover a damaged or decayed natural tooth, restoring its function, strength, and appearance. Crowns are constructed from durable materials like porcelain, ceramic, or metal alloys, but they are not permanent and can fail due to chipping, cracking, or decay underneath. A broken or failing crown can usually be replaced with a new restoration, provided the underlying tooth structure remains healthy enough to support it.
Assessment: Is Replacement Feasible?
The decision to replace a broken crown hinges entirely on the health and stability of the remaining natural tooth structure underneath. A dentist performs a comprehensive evaluation, including a visual inspection and X-rays, to look for hidden issues. The primary concern is often recurrent dental decay that may have developed at the margin where the crown meets the tooth.
If decay is detected, the dentist determines if enough sound tooth material remains after removing the compromised structure to support a new cap. The dentist also checks the integrity of the tooth’s root, looking for vertical root fractures or deep cracks extending below the gum line. A fractured root or insufficient remaining tooth structure (known as ferrule) often makes crown replacement impossible due to the lack of a stable foundation.
The health of the surrounding gum tissue is also a factor, as inflammation or recession can indicate a poor crown fit or underlying periodontal issues. A replacement is deemed feasible only if the remaining tooth can be cleaned, reshaped, and structurally sound enough to ensure the retention and longevity of the new crown. If the tooth is stable, the existing broken crown is carefully removed to prepare for the subsequent steps.
The Step-by-Step Replacement Process
Once the underlying tooth is confirmed healthy and structurally sound, the replacement process begins with the careful removal of the existing crown. The dentist cleans the prepared tooth surface and may perform minor re-shaping to ensure the new crown has an ideal fit and margin seal. Any decay or old filling material must be removed and replaced with a core build-up to provide a strong, clean base.
Next, a precise impression of the prepared tooth and surrounding teeth is taken, using either traditional putty material or modern digital scanning technology. This impression serves as the blueprint for the dental laboratory to custom-fabricate the new crown, matching the shape, size, and color of your other teeth. The final restoration is designed to fit precisely, minimizing the risk of future decay by creating a tight seal.
Because fabrication typically takes one to two weeks in a dental laboratory, a temporary crown is placed over the prepared tooth. This provisional restoration protects the exposed dentin, prevents the tooth from shifting, and maintains the space until the final appointment. During the second visit, the temporary crown is removed, and the new crown is tried in to verify its fit, bite alignment, and aesthetic appearance. After any necessary adjustments, the new crown is permanently bonded to the prepared tooth structure using a strong dental cement.
Options When the Tooth Cannot Support a New Crown
When the damage is too extensive—such as a non-restorable root fracture or structural loss—the tooth must be extracted. In these cases, the goal shifts from restoring the tooth to replacing the missing structure entirely to maintain oral function and prevent bone loss. Several common restorative options are available to fill the gap left by the extraction.
A dental bridge involves placing a prosthetic tooth (pontic) anchored by crowns cemented onto the healthy adjacent teeth. This fixed solution requires that neighboring teeth be strong enough to support the restoration and be prepared for crowns. A popular alternative is a dental implant, which involves surgically placing a titanium post into the jawbone to act as an artificial root. After the implant integrates with the bone, a custom crown is placed on top of the post, providing a stand-alone replacement that does not rely on adjacent teeth for support.
Finally, a partial denture is a removable appliance with artificial teeth attached to a framework that clips into the mouth. While generally the least invasive option, a partial denture is not a fixed solution and must be removed daily for cleaning.