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A crown covers the whole tooth rather than filling part of it. This page explains what a crown is, when one is used instead of a filling, the kinds that exist for back teeth and for front teeth, and how long they last. It does not describe what happens at the appointment, and it cannot tell you whether your child needs one.
Where a filling rebuilds the part of a tooth that was lost, a crown fits over the tooth and covers it completely. The AAPD describes preformed crowns as prefabricated crown forms adapted to the individual tooth and cemented in place with a biocompatible luting agent — in other words, they arrive ready-made in a range of sizes rather than being built up on the tooth.
Covering the whole tooth is the point. The AAPD notes that full coverage combats recurrent caries and provides strength and long-term durability with minimal maintenance, which it describes as desirable outcomes for children at high risk of decay.
A crown is like a little hat for a tooth. Instead of patching one part, it covers the whole tooth and keeps it safe. Some hats are silver and shiny, and some are white so they look like the tooth did before.
A crown is not a bigger filling, it is a different approach. A filling relies on bonding to the tooth structure that is left, so when there is not much left, or when the damage runs across several surfaces, there may not be enough to bond to. Covering the tooth sidesteps that problem — which is why crowns come up most often for the teeth that are most damaged.
The AAPD lists the situations in which preformed metal crowns have been indicated. This is the guidance, not a diagnosis — whether any of it applies to a particular tooth is a question for the dentist who has looked at it.
For front teeth the AAPD sets out a separate list: full coronal restoration of a decayed primary incisor may be indicated when decay is present on multiple surfaces, when the biting edge is involved, when cervical decalcification is extensive, when pulp therapy is needed, when decay is minor but oral hygiene is very poor, or when a child’s behaviour makes keeping the tooth dry very difficult.
Back teeth and front teeth tend to be crowned differently. Back teeth do the chewing and are barely visible, so durability usually leads. Front teeth are seen every time a child smiles, so appearance carries more weight — and, as the next section explains, they are harder to restore.
These are the types you may hear named. Each entry says what the thing is and the trade-off the AAPD records for it. None of this is a recommendation.
The silver-coloured metal crown, used mostly on back teeth. The AAPD describes it as the most durable option, with retrospective studies reporting greater longevity than amalgam or resin-based restorations in primary teeth. The trade-off is that it looks like metal.
A white ceramic crown, used front or back. The AAPD describes them as strong, esthetic and biocompatible, with higher parental satisfaction than the alternatives and relatively better gum health than stainless steel. The trade-offs are that more of the tooth must be reduced to fit one, and they cannot be adjusted once made.
A tooth-coloured crown for front teeth, bonded to the tooth rather than cemented over it. The AAPD reports two retrospective studies finding 80 per cent still in place after three years, and that parental satisfaction is high. It needs enough tooth left to bond to.
A stainless steel crown with a window cut in the front and filled with tooth-coloured material, so the metal does not show from the front. The AAPD notes that published studies on the effectiveness of open-faced crowns are sparse, given that easier and more esthetic alternatives now exist.
A stainless steel crown that arrives with a tooth-coloured facing already bonded to the front. The AAPD reports excellent retention of the crowns themselves but a high incidence of partial or complete loss of the resin facing, and says long-term studies are still needed.
The AAPD is unusually candid about this: it calls the treatment of decay in primary anterior teeth “one of the biggest challenges in pediatric dentistry”, and lists the reasons. They are worth knowing, because they explain why a dentist may be more cautious about a front tooth than a parent expects.
Crowns are the durable end of the range, but the AAPD’s point that restorations have finite lifespans applies here too. The figures it reports differ by type: for stainless steel crowns, five studies comparing them with amalgam found an average five-year failure rate of 7 per cent against 26 per cent. For zirconia crowns placed in a university clinic, survival was 93 per cent at twelve months, 85 per cent at twenty-four and 76 per cent at thirty-six. For resin strip crowns, 80 per cent were still in place at three years.
The AAPD reports that the main reasons stainless steel crowns fail are the crown coming loose and perforation — wearing through. On facings, it reports excellent retention of preveneered crowns themselves alongside frequent loss of the resin front. A crown that comes off is not necessarily a failure of the tooth underneath, and is a reason to ring the dentist rather than to worry.
A crown has been suggested and I want to understand why. Ask which type, why a crown rather than a filling for that particular tooth, and what the alternatives are. If appearance matters to you or to your child, say so — there is more than one tooth-coloured option and they differ. There is a list of questions to ask a dentist in the For Parents section. Nothing here is a second opinion, and none of it is based on your child’s teeth.
Ask your dentist, because the answer is specific to that tooth. In general terms the AAPD lists crowns as indicated where decay is extensive or across multiple surfaces, where another material would be likely to fail, after pulp therapy, and for children at high risk of decay. It also notes that full coverage combats recurrent decay in a way a filling does not, because it seals the whole tooth.
No. The AAPD states that where a stainless steel crown would otherwise be indicated, zirconia crowns may be considered instead for esthetic reasons, while noting that evidence on zirconia for back teeth is limited. For front teeth there are several tooth-coloured routes. They differ in durability, in how much of the tooth has to be reduced, and in cost, so it is worth asking what is being proposed and why.
It can. The AAPD reports that the main reasons preformed metal crowns fail are crown loss and perforation. With preveneered crowns it separately reports frequent partial or complete loss of the tooth-coloured facing, while the crown itself stays put. If a crown comes off or a facing chips, contact your dentist — it is a common enough occurrence to have been studied, not an emergency in itself.
That is a decision for your dentist, and it turns partly on how long the tooth still has to do its job. The AAPD’s restorative guidance treats primary teeth throughout rather than as a lesser case, and it lists crowns among the options for them specifically. There is more on why decay in baby teeth is taken seriously on What is a cavity?
Because the studies have not been done. The AAPD states that most evidence for the clinical techniques used to restore primary anterior teeth is regarded as expert opinion, and that while this does not preclude their use, it points to a strong need for well-designed prospective studies. That is a fair thing to know: it does not mean the treatments do not work, it means the comparisons between them rest on less evidence than you might assume.
Every clinical statement on this page comes from the American Academy of Pediatric Dentistry document below, including the figures on how long each type of crown lasts.
This website is for education only and does not replace care from your dentist, physician, or emergency services.