Why do you need to grind your teeth before installing crowns and dentures?

Chief editor of the site:

Snitkovsky Arkady Alexandrovich

Chief physician of the professorial dentistry “22 Century”, dentist, orthopedic dentist

Author of the article:

Scientific team of dentistry “22 Century”

Dentists, candidates and doctors of medical sciences, professors

Turning under the crown has a corresponding medical term - preparation. Since the dentition is in close contact with each other in the bite (occlusion), the installation of any orthopedic structure requires certain preparation. It consists of grinding away hard tissues - enamel and dentin, in order to create space for a future structure, without affecting neighboring teeth. In this way, a stump is formed on which the prosthesis will be installed. This is the essence of preparation.

What is preparation or grinding of enamel: a complete list of indications for this procedure

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1. What is preparation
2. What preparation is needed before turning?
3. Types of turning
4. Peculiarities of turning for different types of prostheses
5. Types of ledges when fixing crowns
6. Features of the procedure in children
7. Will it hurt when turning?
8. What to do if there is pain after turning
9. Is preparation always necessary?
10. How much will the turning cost?

Question to a specialist
To restore “problematic” or missing teeth, we go to an orthopedic dentist who offers various prosthetic options. However, the installation of a veneer, crown, removable dentures or bridge is almost always preceded by dental grinding - and the very mention of it immediately frightens patients. What kind of procedure is this, in what situations is it used, will it hurt, what are the features of the preparation and how the process works in patients of different ages - all this is discussed in today’s material.

Is it painful to install a metal-ceramic crown?

Installing a metal-ceramic crown is a completely painless process.
The only unpleasant moment may be taking impressions with impression material, especially if you have an increased gag reflex. In this case, it is better to resort to 3D prosthetics CEREC.

What is preparation

At its core, the preparation process involves removing part of the hard tissue. This layer, represented by enamel (the outer shell) and dentin (these are the internal tissues), must be equal to the thickness of the prosthesis. Armed with a bur, the doctor cuts off the excess and gives the crown the shape on which the prosthesis will easily and reliably fit. It is important to ensure maximum density and absolute accuracy of its fit. As a rule, the shape of a natural tooth is a cone or cylinder.

Relatively speaking, you will have to “cut off” the amount that is equal to the thickness of the prosthesis. For example, zirconium dioxide will require minimal grinding, but metal-ceramics (after all, there are both ceramics and metal) will require the removal of a thicker layer of living tissue.

Preparation is also carried out during filling, but in this case only inflamed tissues are removed, while healthy ones are preserved. If you need to install a prosthesis, even living tissue will have to be removed.

What kind of crowns are placed on teeth?

The following prostheses are used for dental prosthetics with crowns:

• Metal-ceramic is a budget-friendly, strong and durable crown option. The base of the prosthesis is metal, the top lining is ceramic. This ensures its strength and external aesthetics.
• All-ceramic - crowns for the front teeth are made from ceramic, since the material is not suitable for the significant chewing loads that are inherent in the lateral and chewing teeth.
• Zirconium dioxide is a premium material in modern orthopedics, used to restore both anterior and chewing teeth, as it has unsurpassed strength and naturalistic aesthetics today.

What preparation is needed before turning?

In order to secure the future prosthesis well, the prepared crown must be strong, free of plaque and stone, and free of carious lesions (if any, the doctor will, of course, remove them first). Also, before treating the enamel under any prosthesis, it is important to remove soft and hard plaque.

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Types of turning

The choice of technique depends mainly on the individual clinical picture, as well as on the volume of tissue that needs to be trimmed. There are types that are more extended in time, and there are very fast, safe and pass without the slightest pain. Let's look at all of them that currently exist. But keep in mind that the choice always remains with the attending physician, who will assess the situation and select the most optimal option.

Ultrasonic

This method involves the use of a special apparatus that produces high-frequency vibrations - ultrasonic. And the device itself is called a “scaler” or “scaler”. By the way, it is used to clean enamel from plaque. Also, instead of a scaler, a piezo device can be used - its action is again based on the use of ultrasonic waves, but they are more powerful, which allows it to be used on harder tissues.

During the procedure, the doctor does not touch the enamel with the instrument. Almost no heating occurs. So the risk of damage disappears. As for pain, it may well occur if there is increased sensitivity, so anesthesia will be appropriate. The method makes it possible to dissect only a small volume.

Laser

This is another effective non-contact turning method. The laser acts on the enamel pulsed, but again removing only a very small layer of enamel and inner dentin. By the way, unlike ultrasound, this method is safer, since laser beams have a wound-healing effect. The method is absolutely silent and allows you to quickly achieve the desired result.

Preparation with a drill

This technology involves the use of a good old drill and a diamond (or metal) tip . In fact, this is the most common and optimal turning option. The doctor can choose different speeds of rotation of the bur, but to prevent overheating, water must be supplied. In fact, the process is no different from drilling in the treatment of caries - everything is done in a similar way.

Watch the video at the end of the article - you can get an idea of ​​how the process of preparing a tooth cavity using a drill occurs.

Air abrasive method

This technique is based on the use of a jet of water and a composition with abrasive particles. Using an air-abrasive method, the doctor is able to smoothly grind off the required amount of tissue. The patient does not feel pain. There is almost no heating and vibration. But the technique makes it possible to remove, again, only a minimal amount of tissue.

Chemical turning method

This method involves using exclusively active acids. Penetrating into tissues, special compounds destroy them. The doctor will only have to remove the softened areas and give the crown the necessary shape so that it fits well under the future prosthesis or structure. The procedure is not quick. The method is considered outdated and is not often used.

On a note! Thus, in 99% of cases it is drilling with a drill that is used for prosthetics (and not for the treatment of superficial caries). It is this technology that allows you to remove any amount of tissue in an extremely short time. True, anesthesia will definitely be required (except for those cases when the tooth is already “dead”, that is, without a nerve).

Peculiarities of turning for different types of prostheses

The type of prosthesis that the patient and the doctor chose to install also determines the preparation technology. Let's consider the features of preparation for each type.

For veneers and lumineers

High-quality turning for veneers allows you to achieve good contact with the artificial plate. The patient will not then feel the pad in his mouth as something foreign. But here it is important to understand why exactly this procedure is necessary:

• for a good fit of the veneer (we will explain later how exactly the turning is done),
• so that the linings do not “stand out”, that is, so that the teeth are not excessively thick,
• so that the row can be leveled using veneers. For example, you will have to grind off the front part of the enamel if one of the elements is crooked and stands out in front. Of course, one overlay will be slightly thinner than the others. But it also has a limit on the minimum thickness - often in such situations the tooth is simply given a new shape.

When installing veneers, the enamel is ground down by the dentist in a special way. First, the doctor treats only the outer, “front” part, followed by the side and cutting surfaces. Very often, vertical and horizontal recesses are made in the front, which are filled with dental glue. All this significantly improves the fixation strength of the pads.

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It is interesting that to install, for example, thin veneers made of pressed ceramics or lumineers, such strong grinding is often not necessary (especially if your own teeth are straight). It is enough to simply grind the surface using an air abrasive method or a laser to make it a little rougher. This again will allow the lining to be fixed much better and for a longer period.

Under the tabs

Inlays are prosthetics that replace fillings. They are needed in situations where there are still too few indications for a crown, that is, it is too early to place it. Grinding under an inlay is slightly different from preparing for a filling. In order to install the product well, the doctor will only remove all inflamed (carious) tissue, after which he will carefully process the cavity and take impressions, because the inlay is created in the laboratory.

For crowns

A crown helps restore the integrity and beauty of any tooth, and also protects the fragile pulpless unit from destruction and the risk of caries. When preparing a tooth for a crown, it is important to create a special ledge (their types are listed below) - in fact, the future prosthesis will rest on it. Such ledges are most often located under the gum so that the entire tooth can be completely covered, as well as the transition between the crown and living tissues can be hidden.

Let's consider the features of preparation depending on the material of a single prosthesis:

• for cast metal: grinding starts from the sides, remove up to 0.7 mm,
• like plastic: they are more aesthetically pleasing than metal ones; They can be used to cover both front and side teeth. But here the rules are as follows: a plastic prosthesis is made thicker, especially if a metal base is added. So you will have to grind off quite a lot - more than 1.5 mm,
• for metal ceramics: remove up to 2 mm on each side. Such a prosthesis again consists of a combination of materials, so it turns out to be quite thick,
• under porcelain: the dentist gives the unit being processed a cone-shaped or cylindrical shape. Requirements for the ledge: it is made rounded and goes under the gum by 1 mm. Turning – up to 2 mm on each side. When using pressed ceramics - much less, up to 1 mm,
• for zirconium: it is important to obtain an accurate edge of a rounded or shoulder-shaped ledge. As a rule, it grinds down about 0.5-0.7 mm.

It is important to understand that these indicators are completely average. Everything depends not only on the material as a whole, but also on the specific doctor and laboratory equipment.

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This is interesting! Today, it is very common for metal-ceramic crowns to be created with “shoulder mass.” In terms of thickness, they are no different from ordinary ones, but they have a very big advantage: the outer ceramic coating covers the metal underneath, that is, the metal base does not come into contact with living tissues in any way. This eliminates allergic reactions and does not cause blue gums.

Accordingly, if you plan to install a bridge, then grinding down the supporting teeth will be carried out in the same way as when fixing single crowns. Because the bridge consists of them.

For removable dentures

Often, teeth need to be ground down in order to install removable dentures. But only if a reinforced fixation system is used. For example, clasps that are placed inside the crown part, or telescopic crowns that are fixed on top of living teeth.

When splinting

To prevent the patient's teeth from becoming loose (this also happens with advanced periodontal disease or periodontitis), splinting is used. To secure the splint, the enamel is prepared minimally - for this, a small depression is made on the inside of the entire dentition, inside which a special splinting thread is placed. However, in a number of situations it can be simply secured from above, so turning is not required.

Installation

Before installing a crown, you need to remove tartar and plaque, and treat caries on nearby teeth.
Prepare the tooth itself for installation, treat caries if necessary.

In the absence of the required volume of tissue, the installation of a pin and the installation of a stump pad are required.

This is followed by gentle grinding of the tooth with a drill. The procedure is performed under local anesthesia. Afterwards, an impression is made or a digital copy of the tooth is scanned. This cast/copy is sent to the laboratory, and a specialist creates a prosthesis based on it. If we scan using CEREC technology

, then the doctor begins making the crown literally in 20 minutes, see video:

The finished product is tried on and adjusted if necessary before installation.

If there is a delay in production, then in order to cover the ground tooth, since aesthetics suffer and sensitivity increases, plastic dentures are offered.

Installation steps

So, the crown is made, all that remains is to try it on and install it. The dentist, putting on a crown, asks whether it hurts or not?

If not, then fix the crown with special temporary cement. All that remains is to wait 30 days to make sure that the patient does not have an allergy and that the closure of the teeth in the area where the crown is installed is normal.

After this, at the next appointment at the clinic, the remaining cement is removed, the denture is placed on a stronger composition, permanent cement, and it can only be removed by sawing it in parts.

Types of ledges when fixing crowns

If you look at the photo below, it will immediately be clear what ledges are - they are needed to fix the crowns. Such ledges are located under the gum so that the border between the tooth and the prosthesis is hidden.

Accordingly, they also come in different shapes:

• knife-shaped: in fact, in such a situation there is no ledge - the top of the tooth will simply have the shape of a cone. Solid metal crowns are fixed in this way (but today this method is rarely used),
• rounded: used for attaching metal-ceramic crowns, but also not used often,
• shoulder: this is the most popular option, and it is also universal. Such a ledge, although large in thickness, is considered the most aesthetic. It has an angle of approximately 90 degrees.

Which dentistry in Zvenigorod is best to choose for prosthetic crowns?

There are many dental clinics in Zvenigorod.
One of them is the dental department of the Istok Health Clinic. The dental clinic has been operating in Zvenigorod since 1992. There are 7 dental offices equipped with the most modern equipment, its own dental laboratory, X-ray room, and sterilization department. Here you can receive a full range of dental services, and you can get an appointment at virtually any convenient time. The Clinic's management closely monitors the quality of services provided and materials used.

Will it hurt when turning?

The word “grinding” used to sound scary coming from a dentist. Today, the preparation process does not last long and takes place without any discomfort or pain. Before starting the procedure, the doctor will “freeze” the mucous membrane with a special gel, and the patient will not feel the injection with a good local anesthetic at all. Anesthesia is used both in the case of working with living units (in order to “turn off” for a while the nerve that is sensitive to any manipulation) and with “dead” units in which the nerve is absent. After all, turning involves a very painful retraction of the gums.

Features of the procedure in childhood

When working with baby teeth, dentists try to avoid unnecessary procedures that may pose a certain threat to the condition of the child’s thin enamel. In addition, any additional manipulation using a noisy drill usually results in serious stress for the child.

As a rule, experts offer alternative and more gentle treatment methods that do not require preliminary preparation. In this case, pediatric dentistry is focused on protecting the not yet fully formed enamel from any type of injury. However, there are situations when turning for a crown is indispensable. Most often, preference is given to the chemical method, as it is less painful. Usually it is enough to remove only the tissue affected by caries.

What to do if there is pain after turning

It happens that after the anesthetic wears off, the patient experiences unpleasant sensations. They can be either a type of norm or a pathology. Teeth hurt after grinding for the following reasons:

• overheating occurred: the bur rotates at a very high speed, so if the doctor performed the procedure quickly, without stopping, tissue overheating could occur. In this case, the pain will be monotonous, but will go away on its own after a few days or weeks, less often - after a couple of months,
• During preparation, too much was removed: the dentin layer has become thin, the nerve is close, so it is completely normal that the tooth will react with pain. But this is no longer the norm - to prevent such situations from occurring, most doctors still suggest depulping before installing a prosthesis,
• the gums are injured: quite often doctors use special threads and metal plates to push back the mucous membrane. Therefore, slight inflammation and swelling of the gums after the procedure is normal, which disappears on its own within a few days.
• errors when grinding: what to do after the procedure for processing units if the painful symptoms do not disappear even after several days? This is a reason to visit the dentist. It is possible that the nerve was injured or the root split, which led to the development of an inflammatory process. In such a situation, the pain will be acute, tissue swelling is possible (and not only the gums, but even the face). This situation requires a prompt solution.

On a note! The important point is that after turning, a temporary prosthesis is almost always installed - be it a veneer or a plastic crown. After all, after preparing the support, impressions are taken, based on which the dental technician in the laboratory will work on the design of the prosthesis. To save the tooth and restore its aesthetics, the doctor will suggest a temporary replacement.

Does it hurt to insert teeth?

Typically, patients are interested not only in how a crown is placed on a tooth, but also how painful it is. The most unpleasant stages here, of course, are preparing teeth for prosthetics (i.e., treating them, filling root canals), and sometimes also the process of taking impressions. If already dead teeth are used for crowns, then turning them is completely painless and does not even require anesthesia. If living teeth are ground down, a local anesthetic is first injected.

The only painful moment that I myself (being a dentist) have personally experienced is when, when taking an impression, the doctor performs gum retraction. Retraction refers to the widening and deepening of the gingival sulcus, which is accompanied by a small degree of separation of the soft gum tissue from the tooth. This is done in order to make a more accurate impression of the neck of the tooth, and it is better to do this immediately under anesthesia.

Is preparation always necessary?

The good news is that no, not always. If a minor correction of the defect is expected - for example, with the help of artistic restoration, then the dentist will simply limit himself to grinding. This will enhance the adhesion of the glue and material.

Dentists do not always treat enamel before fixing veneers[ii] - this has already been discussed earlier. No preparation is required when installing classic removable dentures, which are fixed to the supporting teeth using plastic or metal hooks. Teeth are also not injured when defects are replaced with implants - these are artificial analogues of roots, the installation of which in no way affects the position and condition of neighboring teeth. Even when you subsequently need to place a crown on top of the implant.

Important! It is necessary to understand that preparation will be required only if there is “something left” of the tooth. That is, if the top is destroyed at the root, there will be nothing to grind. In such situations, you need to build up the root - for example, using a pin or stump tab. And then fix the single prosthesis from above.

However, you still cannot do without the turning stage when installing a classic crown. Science has not yet come up with other ways to reliably fix such prostheses.

Classification of dental crowns

Modern medicine does not stand still, and today a very wide variety of crowns of various types and materials has appeared.

According to their purpose, crowns can be of two types: restorative (a complete, functional and aesthetic product) and supporting (used to secure a “bridge”).

The crown can be made from the following materials:

• metal;
• metal composite;
• metal ceramics;
• ceramics;
• porcelain;
• zirconium.

Also, each crown is graded according to design:

• full crowns. Used to completely restore a lost tooth;
• equatorial crowns. A metal plate that covers the tooth to preserve its tissues and shape (partial damage to the tooth);
• stump crowns. A crown built onto the gum;
• half-crowns They completely replace the tooth on all sides and can also serve as a support for a “bridge”;
• telescopic crowns. They differ in that their height after installation can be adjusted (relative to the gum);
• pin, jacket, etc.

How much will the turning cost?

The cost of dental preparation differs depending on the economic policy of the clinic.
But in most situations, no one highlights it as a separate service - it is simply included in the overall price of prosthetics. That is, for example, if installing a ceramic crown costs 20 thousand rubles, this implies that the price also includes preparation. But sometimes you will have to pay an additional 500 to 2000 rubles for a temporary crown, which is placed on a ground tooth to protect it. Not all clinics operate on an all-inclusive basis, so you definitely need to clarify what exactly is included in the price of prosthetics. Belenchikov A. A., Biragova A. K., Epkhiev A. A. Assessment of changes in the microstructure of hard dental tissues after preparation with various types of burs. Journal of health and education in the 21st century, 2021. [ii] Vedernikova L. V., Zholudev S. E. Planning the aesthetics of ceramic veneers without preliminary tooth preparation, 2013.

Without turning - alternative methods of prosthetics

• removable prosthetics: the most cost-effective and fastest option for restoring the integrity of the dentition. In this case, the structure can be fixed using a special fastening system on the supporting teeth or even in the absence of all of them in the oral cavity. In this case, no turning of supporting elements is required,
• conditionally removable prosthetics: in this case, tooth roots are used to fix the system, which must be in excellent condition. During the installation of the prosthesis, they are strengthened using special pins with a small lock. When installing the prosthesis, the lock automatically snaps into place and the system is securely held in the mouth,

  
  Clasp dentures with locks

• adhesive bridge: to fix such a structure, the presence of two supporting elements is necessary, but they are not subject to preparation. Along the edges of one or more artificial crowns there are special plates that allow you to fix the system by attaching it from the inside using dental glue,
• implantation: this treatment method involves replacing not only the crown, but also the root, which allows you to restore the anatomy and return the full functionality of the entire dental system. In this case, the implant, which acts as a root, is installed inside the bone tissue, and then a crown or any other orthopedic structure is put on it.

How much does the procedure cost? It is impossible to give an exact answer to this question, because everything depends on the scale of the planned manipulations, the choice of a specific preparation method, and the pricing policy of the dental center. As a rule, this procedure is included in the full cost of a particular treatment method. For example, using a drill will not cost anything (included in the price), but you will have to pay extra for using advanced technologies, such as a laser.

Video review from a patient about prosthetics for all teeth using the all-on-6 technology. New smile in 3 days!

1. Rogozhnikov G.I., Loginov V.A. Restoration of hard dental tissues with inlays, 2002.
2. Abakarov S.I. Protection of prepared teeth with vital pulp, 2005.