A dental crown, often described as a cap, is a prosthetic device placed over a damaged or weakened tooth to restore its shape, size, strength, and appearance. Crowns are not permanent and may need removal for reasons such as decay developing underneath the margin or the need for replacement due to wear or fracture. Many people are concerned about pain during the removal process, which is understandable since the crown is cemented firmly onto the prepared tooth structure.
Managing Discomfort During the Procedure
The question of whether crown removal is painful is addressed through the routine use of local anesthesia. The dentist administers an injectable anesthetic, such as lidocaine or articaine, to fully numb the tooth and the surrounding gum tissue before the procedure begins. This application is highly effective at blocking nerve signals, preventing the sensation of sharp pain.
Patients typically report feeling different sensations throughout the process, even though pain is blocked. These sensations are most commonly described as pressure, vibration, or intense noise from the instruments used to break the crown’s seal. Pressure is transmitted through the bone and soft tissue, which the anesthetic does not eliminate, and is often the most noticeable sensation as the crown is loosened. The level of discomfort can be influenced if the underlying tooth has existing issues, such as deep decay, but the anesthesia is intended to manage this sensitivity.
Methods Used to Remove a Dental Crown
Crown removal techniques are dictated by the strength of the cement bond and whether the existing crown needs to be preserved. When the crown is tightly bonded and needs replacement, the dentist often uses a method called sectioning. This involves using a high-speed handpiece with a fine bur to cut a slot entirely through the crown material.
Cutting a slot through the crown, from the chewing surface down to the gum line, allows the dentist to weaken the material and break the cement seal. For metal or gold alloy crowns, a specialized tungsten carbide bur is necessary to penetrate the dense material. Once the crown is sectioned, the dentist gently pries apart the pieces using a specialized instrument to remove the crown from the underlying tooth structure.
If the cement bond is weak or the crown must be removed without destroying it, a non-destructive approach is utilized. This involves specialized mechanical instruments like a crown remover, which applies a brief, controlled force to jar the crown loose. Alternatively, an ultrasonic device may be used to transmit high-frequency vibrations through the crown, which helps weaken the cement interface. The choice depends on the crown’s material, the cement used, and the clinical situation.
Post-Removal Care and Temporary Protection
Once the old crown is removed, the underlying tooth structure, known as the core, is exposed. This prepared tooth is typically smaller and more tapered than a natural tooth. It is highly susceptible to thermal sensitivity from hot or cold stimuli. Furthermore, the exposed dentin tubules, which connect to the tooth’s nerve, can make the tooth sensitive to air pressure and contact.
To protect this vulnerable tooth and prevent adjacent or opposing teeth from shifting into the space, a temporary restoration must be placed immediately. This temporary crown is usually fabricated from acrylic or composite resin material and is secured with a weak, temporary dental cement. The temporary fixture serves as a placeholder, protecting the prepared tooth and maintaining the space until the permanent custom-made crown is ready for final placement.
Caring for the temporary crown requires specific precautions to ensure it remains intact. Patients should avoid chewing hard, sticky, or crunchy foods on the side of the mouth with the temporary restoration, as these can dislodge or fracture the less durable material. It is also advised to floss by sliding the floss out from the side rather than pulling it up, which can unintentionally lift the temporary crown. Mild sensitivity is common post-removal and can often be managed effectively with common over-the-counter anti-inflammatory medications.