A dental crown is a restoration that covers a damaged or weakened tooth, restoring its shape, size, and strength. Since many people require multiple restorations, the question often arises whether two crowns can be placed directly side-by-side. Having two adjacent teeth crowned is a common and entirely feasible procedure in modern restorative dentistry. However, placing adjacent crowns requires a higher degree of precision and careful planning compared to capping a single tooth.
Specific Considerations for Adjacent Crown Placement
The placement of two adjacent crowns introduces specific biomechanical and technical requirements that dentists must carefully address during the preparation and fitting process. One of the most demanding aspects is achieving the correct interproximal contact point, which is the precise area where the two crowns touch along their side surfaces. This contact must be neither too tight nor too loose; an improper contact can cause patient discomfort or lead to complications like chronic food impaction between the teeth.
If the contact is too weak or missing entirely, food debris can be forced down toward the gum tissue during chewing, causing irritation and inflammation. Conversely, an overly tight contact point makes it nearly impossible for the patient to effectively clean the area with standard dental floss, encouraging plaque buildup. The dental laboratory must manufacture the crowns with precise relational requirements to ensure stability, proper function, and patient comfort.
The fit around the gum line, known as the gingival margin, also becomes notably more complex when dealing with adjacent restorations. Dentists must ensure that both crowns have smooth, sealed margins that integrate seamlessly with the remaining tooth structure and the surrounding gum tissue. Poorly fitted margins create microscopic ledges where bacteria and plaque can easily accumulate, significantly increasing the long-term risk of developing decay and periodontal disease.
The overall contouring of the adjacent crowns must be meticulously coordinated to mimic natural anatomy, specifically concerning the embrasures. Embrasures are the V-shaped spaces that flare out from the contact point, designed to allow for the deflection of food away from the gums. These spaces must be correctly designed in both crowns to allow for effective flossing access and maintain the health of the interdental papilla.
Maintenance and Hygiene Challenges
Once two crowns are placed side-by-side, the patient’s long-term maintenance routine must adapt to address the unique challenges presented by the proximity of the restorations. A common issue is the potential for chronic food trapping, especially if the contact points or contours were not established with precision. Food debris that lodges between the teeth can rapidly lead to gingivitis and may accelerate the breakdown of the underlying tooth structure.
Maintaining hygiene in the crowned area is important because bacteria can still attack the natural tooth structure at the margins of the restoration. This condition, known as secondary decay or recurrent caries, is a primary reason for crown failure, especially if plaque accumulates at the gum line. The margins of adjacent crowns represent two distinct interfaces, effectively doubling the surface area susceptible to bacterial infiltration.
Standard string flossing can be difficult with adjacent crowns because the contact points are often tighter than those between natural teeth. Patients may need to adopt specialized tools to ensure thorough cleaning of the interproximal space and dislodge trapped food particles.
Specialized dental aids are designed to navigate beneath the contact point and clean difficult-to-reach areas near the gingival margin:
- Floss threaders.
- Thick, spongy superfloss.
Dental professionals recommend the use of water flossers, which utilize a pressurized stream of water to dislodge plaque and debris from around the margins and tight contact points. The water jet can thoroughly clean spaces that traditional string floss might struggle to access between two adjacent restorations. Consistent cleaning is the most effective defense against secondary decay and the progression of periodontal disease around dual crowns.
When Alternatives to Dual Crowns Are Recommended
While placing two separate crowns is a common and successful procedure, a dentist may recommend an alternative restorative solution in specific clinical situations. If the adjacent teeth are severely compromised, or if a tooth is missing from the dental arch, a fixed partial denture, known as a dental bridge, might be proposed. A bridge connects the two prepared teeth, using them as anchors to support a replacement tooth or to splint the abutments together for improved stability.
A bridge can sometimes simplify the overall restoration by creating a single, continuous unit that is structurally easier to manage than two independent crowns with separate, complex margins. Another common alternative involves combination treatments, where one tooth receives a full crown while the adjacent tooth is restored with a less invasive procedure. For example, a tooth with less damage might receive an inlay or an onlay restoration instead of a full crown preparation.
This combination approach avoids the technical complexities associated with coordinating two full crown preparations and their precise adjacent fit and contour. The complexity of manufacturing and placing two perfectly aligned crowns can influence the decision, as laboratory requirements may favor a simpler, yet structurally sound, alternative. The final choice depends on the extent of the existing dental damage, the patient’s specific bite forces, and the health of the supporting bone structure.