An Oral and Maxillofacial Surgeon (OMS) generally does not perform the restorative procedure of placing a crown. Their focus is almost exclusively on surgical treatments, while crown placement falls under the specialization of restorative dentistry. The differences in training and scope of practice between surgical and restorative specialists explain why these procedures are handled by different providers.
The Primary Role of an Oral Surgeon
An Oral and Maxillofacial Surgeon is a dental specialist who completes four years of dental school followed by a four- to six-year hospital-based surgical residency. This post-doctoral training focuses on the diagnosis and surgical treatment of conditions affecting the mouth, jaws, face, and neck. Their training includes advanced medical, surgical, and anesthesia components, making them the surgical experts of the dental team.
The scope of an OMS practice centers on complex surgical procedures often referred by general dentists. These include the extraction of impacted teeth, surgical placement of dental implants, management of facial trauma (such as jaw fractures), and corrective jaw surgery (orthognathic surgery). They also diagnose and treat oral pathology, including cysts and tumors.
The Function of Dental Crowns
A dental crown is a custom-made, tooth-shaped cap designed to cover the entire visible portion of a tooth. Its primary purpose is to restore the tooth’s strength, size, shape, and appearance after it has been severely damaged. Teeth weakened by extensive decay, large fillings, or a root canal procedure often require a crown for protection against fracturing.
The crown holds together the remaining tooth structure and distributes the forces of chewing evenly. Crowns are fabricated from various materials, such as porcelain, ceramic, metal alloys, or porcelain fused to metal, depending on the tooth’s location and aesthetic needs. The process involves preparing the natural tooth by filing it down to create space for the prosthetic, which is then permanently cemented into place.
Which Dental Specialists Place Crowns
Crown placement is a restorative dental treatment, not a surgical one. Most dental crowns are placed by a General Dentist, who provides primary care and receives training in restorative procedures like fillings, bridges, and crowns during dental school.
For complex restorations, multiple missing teeth, or advanced cosmetic requirements, a patient may be referred to a Prosthodontist. A prosthodontist is a dental specialist who completes three additional years of post-doctoral training focused on the design and fitting of prosthetic devices, including crowns, bridges, and dentures. Both general dentists and prosthodontists specialize in restoring function and aesthetics, a practice distinct from the oral surgeon’s focus on surgical intervention.
When Oral Surgery Precedes a Crown
Although oral surgeons do not place the final crown, they are often involved in the sequence of treatment that makes crown placement possible.
Implant Placement
The most common collaborative procedure is the placement of a dental implant, which serves as an artificial tooth root. The oral surgeon surgically places the titanium implant post into the jawbone, a process that requires a healing period of four to six months for the bone to fuse with the implant (osseointegration). Once the implant is stable, the restorative dentist attaches an abutment and then places the crown on top of the abutment.
Pre-Prosthetic Surgery
Oral surgeons may also perform pre-prosthetic surgeries. These procedures, such as bone grafting to build up insufficient jawbone or crown lengthening to expose more tooth structure, ensure a stable foundation before the restorative dentist places a crown on a natural tooth.