Crowns on baby teeth.

I had a patient come in and mention that his little brother had just had 3 crowns done on baby teeth.  His opinion was that this was a total waste of his parents money.  He asked me, “Why would anyone pay that kind of money to  have a crown put on a tooth that is going to be lost in a few years?”.  He was thinking that these were the expensive lab made crowns that cost several hundreds of dollars, but they are actually prefabricated stainless steel crowns that are similar in cost to a filling for a tooth.

The reasons for having a crown doneon a baby tooth are similar to the reasons for having a crown done on a permanent tooth.  When a filling replaces more than 40 % of a baby tooth, a stainless steel crown should be done to strengthen the tooth against breaking apart.  If the baby tooth has had a pulpotomy (removal of the top portion of the pulp tissue, or living tissue inside the tooth), a stainless steel crown should be placed on the tooth to prevent the tooth from breaking apart.

Some individuals are missing a permanent tooth that is supposed to replace a baby tooth.  In these instances, I have done lab made custom crowns to preserve the baby tooth for as long as possible.  I have seen this preserve a baby tooth for years, and even decades.

The main reason for doing any type of crown on a baby tooth is to preserve the necessary space for the permanent tooth to erupt into, or preserve the bab tooth for as long as possible.  It can prevent, or minimize the need for orthodontic treatment when the child finally has all of their permanent teeth in place.  I have had treated children orthodontically only because a dentist had pulled (extracted) baby teeth instead of fixing them.  When a baby tooth is pulled, or lost prematurely, the adjacent teeth tend to move into the space created when the baby tooth is extracted.  This leaves inadequate room for the for the replacement permanent tooth to erupt into the proper alignment with the other teeth and creates a need for orthodontic treatment to resolve the resulting problem.

Whenever possible, baby teeth need to be restored to preserve the space necessary for the permanent tooth to erupt properly.  A crown on a baby tooth may be necessary to accomplish this goal and to strengthen the baby tooth.

The 4 keys to making complete dentures fit properly.

As stated in my previous blog, one of the hardest procedures for my patients to adjust to is going from their own natural dentition (teeth) to an artificial dentition, false teeth or dentures.  The keys to making this transition as successful as possible are the steps taken to make the dentures.  As stated before, the ideal way to do this is to have a 4 to 6 week healing period after the teeth are extracted.  Most people are unwilling to to without any teeth for that long.  Even with immediate dentures, dentures that are placed at the same time the teeth are extracted, the keys for a successful transition are the same.

The first important step is to get a very good initial impression of the upper, or lower arch (teeth, bone structure, and gums).  This should be a very detailed impression that extends as deep as possible into the cheek space and the space between the tongue and teeth.  The dental models that are poured up in dental stone form the foundation upon which the denture is going to be made.  Next, a wax bite rim is made to record the bite relationship between the upper and lower jaws and the facial midline is marked on the wax to make sure the teeth are set properly in relation to the symmetry of the person’s face.

Once this is done, the false teeth are set in wax upon the stone model and are sent back to the dentist to try them in the patient’s mouth to evaluate the overall fit and patient’s bite.  Since the teeth are set in wax, final adjustments can be made to make sure everythings is okay.  It also gives the patient to evaluate the shade (whiteness) of the teeth selected for them and the fit and feel of the future denture.

After the try in appointment, the wax set up is sent back to the lab for processing.  The wax is removed and acrylic is placed around the teeth and cured into the final denture.  The denture is pressure formed onto the model for the best fit possible of the denture to the patient’s mouth.  With immediate dentures, 6 to 9 months after the teeth have been extracted and the dentures placed, a new impression should be taken inside the dentures for a permanent reline to make the dentures fit better.

The keys to complete dentures is to have detailed initial impressions, a good bite registration, a try in appointment of the future denture with the teeth set in wax for evaluation by the dentist and patient , and relines for immediate dentures.

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