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Getting a Dental Crown: What to Expect at Each Appointment

If your dentist has recommended a dental crown, you probably have questions about what the process entails. How many appointments will you need? What happens at each visit? Will it be painful? As a board-certified prosthodontist with extensive training from Tufts University and the University of Freiburg, I've performed thousands of crown procedures at The Face Dental Group in Boston, and I'm here to walk you through exactly what you can expect.

Dental crowns are one of the most common and reliable restorative procedures in dentistry, with success rates exceeding 95% over 10 years when properly maintained. Whether you need a crown to restore a damaged tooth, strengthen a tooth after a root canal, or enhance your smile's appearance, understanding the process will help you feel confident and prepared for your appointments.

Why You Might Need a Dental Crown

Before we dive into the appointment details, it's helpful to understand why crowns are such an important tool in restorative dentistry. A dental crown is essentially a custom-made cap that covers your entire tooth, restoring its shape, size, strength, and appearance.

At our Boston practice, I recommend crowns for several common situations:

• Large fillings: When a tooth has extensive decay or a filling that takes up more than half the tooth, a crown provides the necessary protection and prevents fractures
• Cracked or fractured teeth: Crowns hold together damaged teeth and prevent further splitting
• After root canal therapy: Teeth become more brittle after root canals and need crowns for reinforcement
• Severe wear or erosion: When teeth have worn down significantly, crowns restore proper function and bite alignment
• Cosmetic enhancement: Crowns can dramatically improve the appearance of discolored, misshapen, or poorly positioned teeth as part of a smile makeover
• Dental implant restoration: Crowns attach to implants to replace missing teeth

The Traditional Two-Appointment Crown Process

Most dental crown procedures follow a time-tested two-appointment protocol that typically spans 2-3 weeks. This approach allows for custom laboratory fabrication of your crown, ensuring optimal fit, function, and aesthetics.

First Appointment: Preparation and Temporary Crown (60-90 Minutes)

Your first visit is the longer of the two appointments, but I always ensure my patients are comfortable throughout the entire process. Here's exactly what happens:

Comprehensive Examination and Imaging

We begin with a thorough examination of the affected tooth and surrounding structures. I'll take X-rays to evaluate the tooth roots, supporting bone, and extent of any decay or damage. This diagnostic phase is crucial because it reveals whether additional treatment—such as a root canal—is needed before we proceed with the crown.

At The Face Dental Group, we utilize advanced digital imaging technology that provides detailed 3D views of your tooth structure. This digital approach gives us more information than traditional X-rays while exposing you to less radiation.

Local Anesthesia and Tooth Preparation

Once we've confirmed the treatment plan, I'll administer local anesthesia to completely numb the area. Many patients worry about pain during crown preparation, but modern anesthetic techniques ensure you'll feel pressure but not discomfort.

The preparation phase involves carefully reshaping your tooth to create an ideal foundation for the crown. I remove any decay and then reduce the tooth's enamel by approximately 1-2 millimeters on all sides. This creates space for the crown to fit over the tooth without making it bulky or affecting your bite.

If your tooth has significant damage or a large existing filling, I may need to build up the core structure using a strong composite material. Think of this as creating a solid foundation before building a house—it's essential for long-term success.

Taking Impressions

Once your tooth is properly prepared, we capture its exact dimensions through impressions. At our practice, we primarily use digital 3D scanning technology rather than traditional putty molds. The digital scanner is a small wand that I move around your tooth, capturing thousands of data points in seconds.

Patients consistently tell me they appreciate digital impressions because there's no gagging, no unpleasant taste, and no waiting with uncomfortable material in your mouth. The scan is completed in minutes, and you can even watch the 3D model appear on the screen in real-time.

We also capture impressions of your opposing teeth and your bite relationship. These details ensure your new crown will fit harmoniously with your other teeth and won't cause bite problems.

Temporary Crown Placement

You won't leave the office with a gap in your smile. I'll place a temporary crown to protect your prepared tooth while the permanent crown is being fabricated at the dental laboratory. This temporary restoration is made from tooth-colored resin and is designed to allow you to eat, speak, and smile normally.

The temporary crown is held in place with a special cement that's strong enough to stay in place but easy to remove at your next appointment. I'll provide specific instructions about caring for your temporary crown, but in general, you should avoid sticky foods like caramel and very hard foods like ice or hard candy that could dislodge it.

Laboratory Fabrication Period

After your first appointment, your impressions and specifications are sent to a dental laboratory where skilled technicians will custom-craft your permanent crown. We work with premier dental labs that specialize in high-quality restorations. The fabrication process typically takes 1-2 weeks.

During this time, the lab will create your crown from the material we've selected together—whether that's all-porcelain for optimal aesthetics, porcelain-fused-to-metal for durability, or zirconia for maximum strength. As a prosthodontist specializing in full mouth rehabilitation and cosmetic dentistry, I carefully consider factors like the tooth's location, your bite forces, and aesthetic requirements when recommending crown materials.

Second Appointment: Permanent Crown Placement (30-60 Minutes)

Your second appointment is typically shorter and focused on the precise fitting and bonding of your permanent crown.

Removal of Temporary Crown

We begin by gently removing your temporary crown and cleaning any residual temporary cement from your prepared tooth. I inspect the tooth to ensure there's no sensitivity or issues that developed during the interim period.

Fitting and Adjusting the Permanent Crown

This is where my training in prosthodontics—the specialty of dental restorations—really comes into play. I carefully evaluate multiple aspects of your new crown:

• Fit: The crown should slide onto your tooth with light pressure and fit snugly at the margins with no gaps
• Contact with adjacent teeth: Proper contact points prevent food from getting stuck and maintain spacing
• Bite alignment: Your crown must meet your opposing teeth at the correct angle and pressure
• Aesthetics: The color, shape, and translucency should blend seamlessly with your natural teeth

I use articulating paper to mark your bite contact points and make any necessary adjustments. Even tiny adjustments of fractions of a millimeter can make a significant difference in your comfort. You'll be asked to bite together, move your jaw side to side, and provide feedback on how the crown feels.

This fitting phase may take several minutes as I refine the crown to perfection. My goal is for you to leave the office unable to distinguish the crown from your natural teeth.

Permanent Bonding

Once we've achieved an ideal fit, I'll permanently cement the crown in place. The tooth surface is thoroughly cleaned and may be treated with a special adhesive agent to enhance bonding. The crown's interior is also prepared to maximize the cement's grip.

I apply dental cement inside the crown and carefully seat it on your tooth, ensuring proper positioning. You'll bite down to set the crown while excess cement is removed. For certain crown materials and situations, I use a curing light to harden the cement immediately.

A final polish ensures your crown has a natural luster that matches your surrounding teeth. Before you leave, I'll check your bite one more time and answer any questions about caring for your new crown.

When a Third Appointment Is Needed

In rare cases—less than 5% of the time in my experience—a third appointment may be necessary if the crown doesn't fit properly or if you're experiencing bite discomfort that requires additional adjustment. At The Face Dental Group, our digital impression technology and collaboration with skilled laboratories minimize the likelihood of fitting issues.

Same-Day CEREC Crowns: A Modern Alternative

For patients who prefer to complete the crown process in a single visit, we offer same-day crowns using advanced CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) technology. This option eliminates the need for temporary crowns, multiple appointments, and the waiting period associated with traditional crown procedures.

The Same-Day Crown Appointment (2-3 Hours)

The entire same-day crown process happens during one extended appointment, typically lasting 2-3 hours. Here's how it works:

Preparation and Digital Scanning (10-15 Minutes)

Similar to the traditional approach, I begin by administering local anesthesia and preparing your tooth. However, instead of taking impressions and sending them to a lab, I use our intraoral digital scanner to capture a 3D image of your prepared tooth in minutes.

Digital Design (20-30 Minutes)

Here's where the technology becomes truly impressive. The digital scan is uploaded to specialized software that allows me to design your crown on a computer screen. I can adjust the shape, contours, and contact points with precision, essentially creating a virtual crown before manufacturing begins.

This digital design phase draws on my extensive training in prosthodontics and digital dentistry. I consider your tooth anatomy, bite relationship, and aesthetic goals as I design a restoration that will look natural and function perfectly.

In-Office Milling (20-30 Minutes)

Once the design is finalized, the specifications are sent to our in-office milling unit—essentially a miniature factory that carves your crown from a solid block of dental ceramic. You can relax in our comfortable office, watch TV, or even observe the milling process if you're interested in the technology.

The precision of these milling machines is remarkable, accurate to within 25 microns (about a quarter of the width of a human hair). The result is a crown that fits beautifully and requires minimal adjustment.

Final Placement (10-15 Minutes)

Once your crown is milled, I try it in your mouth, make any minor adjustments needed, and then permanently bond it in place using the same cementation process as traditional crowns. The crown is polished, your bite is verified, and you leave with your permanent restoration complete.

Advantages of Same-Day Crowns

Same-day crowns offer several benefits:

• Complete treatment in one visit, saving you time
• No temporary crown or dietary restrictions during a waiting period
• No need for second injections or additional numbing
• Immediate results—you see your new smile before leaving the office
• Excellent accuracy and fit using digital technology

However, same-day crowns aren't ideal for every situation. For complex cases involving multiple teeth, extensive cosmetic work, or certain crown materials, the traditional laboratory approach may provide superior results. During your consultation, I'll recommend the approach that best serves your specific needs.

What to Expect After Your Crown Is Placed

Whether you chose the traditional or same-day approach, proper care after crown placement ensures long-term success.

Immediately After the Procedure

Your mouth may remain numb for several hours after your appointment. Avoid eating until the anesthesia wears off completely to prevent accidentally biting your cheek or tongue. Start with soft foods and gradually return to your normal diet as you become comfortable with the crown.

Some sensitivity to hot and cold temperatures is normal for the first few days, particularly if you didn't require a root canal. This sensitivity typically resolves within a week or two as your tooth adjusts to the restoration.

Long-Term Care and Maintenance

One of the most common questions I receive is whether crowns require special care. The good news is that crowned teeth should be maintained just like your natural teeth:

• Brush twice daily with fluoride toothpaste, paying particular attention to where the crown meets the gumline
• Floss daily around your crown to prevent gum disease and decay at the margins
• Avoid habits like chewing ice, biting fingernails, or using your teeth as tools that could damage the crown
• Wear a nightguard if you grind your teeth during sleep, as grinding can wear down or crack crowns over time
• Maintain regular dental visits every six months so I can monitor your crown and surrounding tissues

With proper care, dental crowns typically last 10-15 years or longer. At The Face Dental Group, we've seen well-maintained crowns last 20+ years in some patients.

When to Contact Your Dentist

While complications are rare, contact our office if you experience:

• A crown that feels loose or falls off
• Persistent sensitivity that worsens after the first week
• Pain when biting down
• Swelling or signs of infection around the crowned tooth
• An uneven bite that doesn't improve after a day or two

Most post-placement issues can be quickly resolved with minor adjustments or re-cementation.

Choosing the Right Crown Material

The material we select for your crown significantly impacts its appearance, durability, and longevity. As a prosthodontist, I consider multiple factors when recommending crown materials:

All-Ceramic or All-Porcelain Crowns

These crowns provide the best natural color match and are ideal for front teeth or any visible area of your smile. Modern ceramics like lithium disilicate are strong enough even for some back teeth. They're biocompatible and an excellent choice for patients with metal allergies.

Porcelain-Fused-to-Metal (PFM) Crowns

These crowns feature a metal substructure for strength with a porcelain coating for aesthetics. They're durable enough for back teeth where chewing forces are greatest, though they may show a dark line at the gumline if gums recede over time.

Zirconia Crowns

Zirconia combines exceptional strength with good aesthetics. These crowns are virtually indestructible and ideal for back teeth, patients who grind their teeth, or anyone needing maximum durability. Newer translucent zirconia materials can even rival the appearance of all-ceramic crowns.

Gold or