Crowns, veneers and bridges

Crowns. Teeth become chipped, broken or weakened over time — through trauma, decay, large fillings, cracks, root canal treatment, age-related wear, or simply having been weaker to begin with. An artificial crown is often the best way to keep a tooth for longer, improve how it works and looks, and strengthen one that might otherwise be lost.

Veneers. Porcelain veneers whiten the colour of a tooth, change or fix its shape, fill gaps, and can correct disharmonies in the bite, appearance and position of the teeth.

Bridges. A bridge replaces one or more missing teeth with an artificial tooth anchored to the natural teeth either side. Those neighbouring teeth need to be in good shape to carry it. Where a tooth has been lost to trauma, or is too badly decayed to save with a crown, a bridge can be the right way to fill the gap.

Materials. Crowns and bridges are usually made of ceramic or porcelain for appearance, or metals such as gold. An all-gold crown can be the better choice for a back molar where appearance doesn't matter. We pick the material case by case, on the state of the tooth or the space, and on your own preference where that's feasible and gives a better long-term result.

Appointments. You'll need a minimum of two: one to prepare the tooth, one to fit the finished crown, veneer or bridge. It varies — more appointments if the tooth also needs a root canal or a core build-up, if it forms part of an implant, or if several units are being made. Multiple veneers or crowns take extensive planning and staging, so expect more than two visits.

Your temporary. Between the preparation and the fitting, a temporary crown is cemented on. It isn't as strong as the final one and is more prone to coming off, breaking or fracturing. Take real care with it: avoid hard and sticky foods, and tell us straight away if it loosens or breaks.

Teeth do more than chew and bite, so a weakened or missing tooth is worth restoring:

• To improve appearance and speech.
• To prevent the stresses that damage other teeth.
• To stop the teeth near a gap moving, shifting and tilting.
• To maintain a natural bite and improve how well you can chew.

• This is irreversible. Tooth structure removed to make room cannot be put back, and the tooth will always need to be covered from then on.
• Sensitivity, tenderness and discomfort — in the tooth or the gum — for a few weeks afterwards.
• Infection of the pulp or the gums.
• The nerve may die — during preparation, or months to years later — and the tooth then needs root canal treatment through the new crown, or replacement of it.
• Injury or fracture of the tooth being prepared or restored.
• Jaw joint tenderness or restricted opening for a few days or weeks.
• Allergic reaction to a material or medication used.
• Chipping or fracture of the porcelain, particularly if you grind or clench your teeth.
• Loss of the crown or bridge — the temporary between visits, or the final one later.
• Decay at the margin where the crown meets the tooth, if cleaning between the teeth isn't kept up. This is the most common cause of a crown failing years later.
• Gum recession over time, which can expose a visible margin at the edge of a front crown or veneer.
• Colour matching has limits. A single front tooth is the hardest thing in dentistry to match, and porcelain does not lighten with whitening later — so any whitening you're planning needs to happen first.
• Bite adjustment may be needed after fitting, sometimes at a follow-up visit.
• For bridges: healthy teeth either side are cut down to carry it, cleaning underneath takes more effort, and if one supporting tooth fails, the whole bridge usually has to be replaced.
• Nothing lasts forever. Well-cared-for crowns and bridges commonly last well over a decade, but they are replacements, not permanent fixtures.

• A large filling or an onlay, where enough sound tooth remains.
• Composite bonding for front teeth — less tooth removed, lower cost, but it stains and chips sooner than porcelain.
• An implant instead of a bridge, which leaves the neighbouring teeth untouched.
• A denture to replace the missing tooth or teeth.
• Doing nothing, accepting that a cracked or heavily filled tooth may break further, and that a gap allows the neighbouring teeth to drift.

Attending your follow-up appointments lets us monitor how the tooth and gum settle. After that, this work needs daily care at home and a check-up every 6 months for as long as you have it. Those visits are not included in the cost of the crown, veneer or bridge.

• Follow the instructions you're given about diet and looking after the tooth and gums.
• Clean your teeth, the crown and the gums around them carefully and thoroughly, as instructed.
• Come in for examinations and cleans every 3 to 6 months, as your dentist advises. There's a fee for these visits.
• Don't abuse the work, and tell us straight away if you notice a problem.

If the work isn't maintained and you don't attend your 6-monthly appointments, problems can develop to the point of being difficult, costly, or impossible to treat — and you would be liable for the full cost of correcting them.