The final appointment for a crown or bridge marks the successful culmination of the restorative process. This visit centers entirely on the precise placement of the permanent, custom-made restoration, which was fabricated by a dental laboratory. The goal is to ensure the new crown or bridge restores function and appearance while integrating flawlessly with the surrounding oral structures. This stage transitions the patient from a temporary hold to a long-term solution.
Preparing the Site and Removing the Provisional Restoration
The procedure begins with the removal of the temporary crown or bridge that has protected the prepared tooth surface over the past few weeks. Since this provisional restoration was secured with a deliberately weaker, temporary cement, the dentist can generally remove it with specialized instruments that gently break the seal. The process is typically straightforward and causes minimal discomfort.
Once the temporary covering is off, the prepared tooth structure must be meticulously cleaned. The dentist uses instruments and a polishing paste to scrub away all traces of the temporary cement and accumulated debris. Any remaining residue could interfere with the permanent bonding process or compromise the fit of the final restoration. While many patients do not require anesthesia, it may be administered if the tooth is still sensitive or has a live nerve.
Detailed Assessment: Fit, Color, and Bite Check
Before permanent bonding begins, the dentist thoroughly evaluates the new crown or bridge for three factors: fit, color, and occlusion. The marginal fit is checked first, ensuring the edge of the restoration meets the natural tooth structure snugly and seamlessly at the gum line. This tight seal prevents bacteria and plaque from getting underneath the restoration, which could lead to decay.
The dentist also verifies the restoration’s contact points—where it touches the adjacent teeth—are correct. Dental floss is often used to ensure a slight but definite resistance, or a “pop,” as the floss passes through, which prevents food from becoming trapped. The color match and aesthetic contours are then assessed, often with the patient’s input, to confirm the restoration blends naturally with the smile.
The bite, or occlusion, is a critical check. The dentist uses articulating paper, a thin, colored film, to mark the points where the restoration meets the opposing teeth when the jaw closes. If the restoration is “high” or has uneven pressure, the marks indicate areas for precise, minor chairside adjustments using specialized polishing burs. Achieving a balanced, comfortable bite prevents trauma to the tooth, jaw joint issues, or premature wear on the restoration.
Secure Cementation and Final Polishing
With the fit and aesthetics confirmed, the process moves to permanent cementation, making the restoration an integral part of the mouth. The area is isolated using cotton rolls or other moisture control techniques to ensure the prepared tooth remains completely dry for the chemical bonding process. The dentist selects a strong, specialized dental cement, such as a resin or glass ionomer material, based on the crown material and clinical needs. The cement is carefully applied to the internal surface of the restoration and then seated firmly onto the prepared tooth structure. Pressure is maintained briefly to allow the cement to distribute evenly and begin setting.
Any excess cement that squeezes out around the margins is immediately removed, sometimes using a brief light cure for easier cleanup. Removing all traces of the excess cement is necessary, especially below the gum line, as residual cement can irritate the gum tissue. After the cement has fully set, the margins of the restoration are polished smooth to prevent plaque accumulation. This final polishing ensures a seamless transition between the crown and the natural tooth.
Immediate Aftercare and What to Expect at Home
Following permanent cementation, patients receive specific guidance on immediate aftercare. If a local anesthetic was used, chewing should be avoided until the numbness has completely dissipated to prevent accidentally biting the cheek or tongue. Patients are advised to avoid hard or sticky foods for the first 24 hours to ensure the permanent cement achieves maximum strength.
It is common to experience temporary sensitivity to hot or cold temperatures, particularly if the tooth still has a live nerve. This sensation is often due to residual irritation from the preparation and cementation process and usually lessens significantly over the first few days. Gentle rinsing with warm salt water can help soothe any minor gum irritation caused by the procedure. Patients should contact the dental office if the sensitivity intensifies, if they experience persistent sharp pain, or if the bite feels notably uneven after a day or two.