A dental crown is a custom-made cap designed to cover a damaged or weakened tooth, restoring its shape, size, and strength above the gumline. Orthodontic braces are appliances used to gradually shift teeth into proper alignment for improved function and appearance. Since braces require hardware attached directly to the tooth surface, their compatibility with crowns is a common concern. You can absolutely have orthodontic treatment even if you have a crown, but this process requires careful collaboration and planning between your general dentist and orthodontist.
Feasibility and Timing
The timing of crown placement relative to orthodontic treatment determines the complexity of the plan. The most straightforward approach is to complete all tooth movement first, then place the permanent crown after the braces are removed and the bite is stable. Aligning the teeth beforehand ensures the final crown is perfectly sized and shaped for the corrected position, minimizing the risk of needing replacement.
However, a crown may be necessary before braces if a tooth is severely damaged or decayed and requires immediate stabilization. In this scenario, the orthodontist must plan tooth movement around the crown, which is a fixed restoration that cannot be easily resized or reshaped. If the tooth requires extensive movement, the dentist may opt to place a temporary crown before the braces are applied.
If a tooth requires a crown while braces are already in place, the procedure is still possible, though more involved. The orthodontist and general dentist must coordinate the temporary removal of the archwire and any brackets on the affected tooth to allow the crown procedure. In many cases, a temporary crown is placed until orthodontic treatment is complete, after which the final permanent crown is fitted.
Special Bonding Requirements
Attaching an orthodontic bracket to a dental crown presents a significant technical challenge because crown materials, unlike natural tooth enamel, do not readily form a strong bond with standard dental adhesives. Crown surfaces, typically made of porcelain, ceramic, or metal, are much smoother and chemically different from enamel. Therefore, a specialized protocol is required to ensure the bracket remains securely attached throughout treatment.
For porcelain or ceramic crowns, the orthodontist must first modify the surface to create mechanical retention for the adhesive. This often involves micro-roughening the crown surface using a fine diamond bur or sandblasting with aluminum oxide particles. Following this preparation, a chemical coupler like a silane agent is applied to create a durable chemical link between the porcelain and the bonding resin.
When bonding to metal-based crowns, a different surface treatment is used, typically involving sandblasting followed by applying a metal primer to enhance adhesion. Specialized orthodontic adhesives designed for non-enamel surfaces are then used to bond the bracket onto the prepared crown. This multi-step process ensures the bracket has sufficient bond strength to withstand the forces of tooth movement, ideally achieving 6 to 8 megapascals.
Post-Orthodontic Crown Management
Even with successful bonding, a crown placed before or during orthodontic treatment may require replacement once the braces are removed. As the teeth move, the gum line and surrounding bone shift, which can expose the margin where the crown meets the natural tooth structure. This exposed margin can become a site for decay or negatively affect the final aesthetic result.
If a temporary crown was used during treatment, it must be replaced with a permanent restoration to ensure long-term stability and function. Additionally, bonding and removing a bracket from a porcelain crown can occasionally leave a cosmetic imperfection on the surface. This may necessitate a full replacement to restore a pristine appearance, which is why many clinicians prefer to delay the permanent restoration until the tooth is in its final position.
For molars that will experience extensive movement, the orthodontist may choose to use a specialized metal band that wraps completely around the tooth instead of a directly bonded bracket. These bands offer a more secure anchor point and minimize the risk of damaging the crown surface during debonding. Ultimately, coordinating care ensures the final crown fits the newly aligned bite perfectly, providing both a strong restoration and a seamless aesthetic result.