Stop Crowning Around?
Choosing Your Dental Crown
Late one evening my attention abruptly turned from the classical music playing over head to an impatient knock outside my operatory wall. A patient had come seeking advice. The question wasn't if she needed a crown, but what kind of crown to get. She needed an answer and she needed it now, for time was of the essence. For those of you that don't know, a crown or cap fits over the tooth to hold it together after being treated for decay, breaks or fractures. Her concern like many others was getting one that was not only long lasting and functional but good looking as well.
I told her, this wasn't going to be an open and shut case. The dentist really has to use their best judgment when evaluating which type of crown to use. Now-a-days, there are many different types, and the success rate of the crown depends on many factors. The key is knowing that your dentist wants you to be happy with your crown because if you're not happy then they are not happy.
Since time was of the essence, and I didn't want to be late to dinner, I offered her some general information to help her understand more about the three types of crowns. Although the dentist will ultimately decide the fate of that tooth in the best interest of the patient, there are some choices that can be made together.
PFM
Currently the porcelain fused to metal or PFM crown is the most prescribed lab manufactured restoration. A metal liner fits snuggly over the tooth and then a porcelain layer is fused over the metal for aesthetics. This makes for an attractive yet durable restoration. A high noble metal mostly of gold is preferably used due to its biocompatibility and flexibility. There is also less chance of an adverse or allergic reaction. These crowns are strong and can withstand a lot of occlusal or biting force; great for people who clinch and grind. Although, some people do get bummed out when metal can be seen at the edge of the crown near the gums and the porcelain chips. Not that this happens all the time, but it can.
All Ceramic
These crowns are the most natural looking available. Two common types of all ceramic crowns are the Lava crown and the Cerac crown. The Lava crown is milled at the lab and has a wonderful translucent appearance making the restoration look real. They are a good choice for front teeth but the dentist will have to use their judgment when it comes to back teeth. They are more fragile. The Cerac crown uses a harder more durable ceramic and has similar aesthetic qualities. It's not as strong as a PFM, but works great in a broader spectrum of situations. Since it is milled at the dental office, the details of anatomy depend upon your dentist's artistic ability. One very big benefit of the Cerac is having the crown made in one appointment and no temporary crown.
All Metal
Metal crowns have been around forever and for a good reason. They are made of gold or mostly gold due to the metal's unique properties. Gold is extremely durable, fits with precision, doesn't chip or break, withstands strenuous chewing conditions, and has a slower rate of wear. Metal crowns are probably the most reliable and long lasting of all the crowns today, but aren't the most popular. Less and less are being fabricated because they are unnatural looking, silver and gold don't scream subtle. If they are used, it's usually for teeth not visibly involved in the smile.
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