Crown Coverage
Ceramic Crowns
Ceramic restorations have become increasingly popular in recent decades due to several advantages. These include their high biocompatibility with the human body, as well as the absence of allergic reactions thanks to their metal-free construction. Additionally, ceramic restorations offer higher comfort compared to metal crowns and provide a more natural appearance. Zirconium and lithium disilicate are two of the most often used ceramic materials in dentistry. Zirconium dioxide quickly gained popularity in dentistry for dental restorations due to its affordability, compatibility with natural teeth, and strength. Due to its exceptional optical characteristics, lithium disilicate is often regarded as the optimal material for dental restorations. Due to high demand, both zirconium-based and lithium disilicate materials are frequently processed using CAD/CAM systems. These systems allow for the rapid production of all-ceramic dental restorations, which exhibit excellent mechanical properties and an exceptionally realistic appearance.1
Delta Dental of Kansas (DDKS) provides coverage for ceramic and metal crowns for members ages 12 and up. A covered DDKS member is benefitted one crown per tooth every 5 years. When treatment planning full coverage restorations, there are certain national processing policies and guidelines we want to outline again.
As a reminder, our processing policies are set at the national level by a committee composed of 70% dentists and chaired by a dentist.
Delta Dental National Policies
- Crowns and indirectly fabricated restorations are an optional benefit unless the tooth is damaged by decay or fracture to the point that it cannot be restored with amalgam or resin.
- If the deciduous tooth is an “extra tooth” in addition to the normal complement of teeth, a crown is not a benefit.
- If a crown is being proposed or has been done where periodontal bone support appears to be inadequate, benefits are not available due to the unfavorable prognosis for the tooth.
- Restorations for altering occlusion, involving vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion (wear), abfraction or for periodontal, orthodontic or TMD therapy, or other splinting are not a benefit.
Treatment Planning Guidelines to Consider
Anterior Teeth
- The replacement of any existing restoration must be necessary due to caries, fractures, or missing tooth structure.
- At least 50 percent of the incisal angle must require replacement due to decay or fracture.
- A least 50 percent of remaining tooth structure requires replacement due to a large existing restoration involving both mesial and distal surfaces, or due to decay or fracture
Posterior Teeth
- A least 50 percent of remaining tooth structure requires replacement due to a large existing restoration involving multiple surfaces, or due to decay or fracture
- Extensive recurrent decay
- Prior endodontic treatment
- Evidence of cuspal fracture