What type of Dental Crown ("tooth cap") should you have made?

If you want a healthy and beautiful smile, you may need a crown (or more) to cover teeth and restore them to normal shape and size. A crown can make your tooth stronger and improve your appearance.  Crowns are generally used to protect weak teeth from breaking and restoring ones that are already broken. Crowns are a good way to cover teeth that are discolored or badly shaped. They are also used to cover dental implants.

Dental Crowns (also known as caps) can be made from metal (gold or other metal alloys), ceramic materials (such as porcelain) or a combination of both.

Comparing the different Types of Crowns
CROWN FACTORS	ALL-PORCELAIN (ceramic)	PORCELAIN Fused to metal	GOLD ALLOYS (high noble)	BASE METAL ALLOYS (non-noble
General Description	Porcelain, ceramic or glass-like fillings and crowns, including Cerec 1-hour crowns.	Porcelain is fused to an underlying metal structure.	Alloy of gold, copper and other metals resulting in a strong, effective filling, crown or bridge. This group of dental alloys has a composition that must be over 60% noble metal (gold, palladium and/or platinum), of which more than 40% must be gold. These metals are the "gold standard" of dental alloys to which all others are compared.	Alloys of non-noble metals with silver appearance resulting in high strength crowns and bridges. The alloys are also know as base metals. Their noble metal content is less than 25%. They often contain large percentages of nickel, chromium or beryllium.
Principal Uses	Inlays, onlays, crowns and veneers.	Crowns and fixed bridges.	Inlays, onlays, crowns and fixed bridges.	Crowns, fixed bridges and partial dentures.
Durability	Brittle material, may fracture under heavy biting loads. Strength depends greatly on quality of bond to underlying tooth structure and the clinical capability of the dentist.  Our new Cerec Emax crowns show strength and durability capabilities similar to metal crowns!	Very strong and durable, however the porcelain is still prone to fracture, especially in tight biting areas and people who grind their teeth.	High corrosion resistance prevents tarnishing; high strength and toughness resist fracture and wear.
Resistance to Wear	Highly resistant to wear, but some porcelain systems can rapidly wear opposing teeth if its surface becomes rough.	Highly resistant to wear, but porcelain can rapidly wear opposing teeth if its surface becomes rough.	Resistant to wear and gentle to opposing teeth.
Crown Appearance	Color and translucency mimic natural tooth appearance.  Lab technician capabilities are very important.	Porcelain can mimic natural tooth appearance, but metal limits translucency.	Metal colors do not mimic natural teeth.
Average Number of Dental Visits to Complete	Minimum of two, except for Cerec crowns (including Exam) which normally are done in one visit.	Minimum of two; matching esthetics of teeth may require more visits.	Minimum of two dental visits.

Metal Crowns are made of a mixture of gold, copper, titanium, and other metals that provide strength and resistance to corrosion. The classic metal dental crown is one made of gold, or more precisely a gold alloy. Over the decades a variety of different metal alloys have been used in making dental crowns. Some of these metals can be silvery in color and can contain a various mixture of different metals, such as titanium, vitallium, silver, etc.

Metal Crowns that Provide Strength:
Having a gold dental crown made can be an excellent choice and we always recommend these type of crowns for back teeth. Gold is a very workable metal and this helps us to be able to achieve a very precise fit with the crown.  Gold crowns withstand biting and chewing forces well and it would be unusual for a gold crown to break. Of all of the types of dental crowns, gold crowns probably have the greatest potential for lasting the longest.  Also, the wear rate of a gold crown is about the same as tooth enamel. This means that a gold dental crown won't create excessive wear on the teeth it opposes (the teeth it bites against).

Metal Crowns can be white or yellow:
In those cases where an all-metal dental crown is being placed, you might have a preference as to whether it should have a yellow (like gold) or silver ("white") coloration. An alloy's composition determines its color. The noble dental metals are gold, platinum and palladium. In most applications the overall cost between using a high noble or base metal alloy might be small, however if you have a large crown it might be a consideration. If dental insurance is paying a part of your bill, you might check to see if there are any limitations as to the type of metal that can be used. The policy might state that they do not cover the cost of high noble alloys.

You may also want to consider that some people have metal allergies.  Studies have reported that about 10% of the female population and 5% of the male have an allergic response to nickel, chrome and/or beryllium alloys (metals often found in nonprecious dental alloys).

At our office we only use precious metals, unless patient requests a lower priced crown such as a nonprecious metal.

Finding the Root Cause - Case #27
Yellow Front Teeth due to Trauma
Yellow Front Teeth Before	After with new Veneers

Patient was told nothing could be done!
Due to previous trauma, our young business executive had “put up” with yellow front teeth for many years.  His old dentist told him that nothing was possible for his teeth besides bleaching.  After careful x-ray examination we found that his front teeth were severely damaged and showed infections in the roots. 

Many teeth that suffer blows or even minor trauma can undergo slow degeneration and chronic low-grade infections that are hard to
detect.  It is important that proper x-rays are developed to ascertain the status of the health of these teeth.  Often, normal examinations
can miss such problems.

Root canal therapy was performed to stop the progress of the root breakdown and the teeth were reinforced with titanium posts. 
BriteSmile teeth whitening procedure was also completed in order to provide a more radiant smile.

Soon after, 8 Lumineers were fabricated and cemented on his front teeth.  The patient stated:  “All of these years went by and nobody
told me that this could be done for my teeth.  I am amazed to look at myself in the mirror now!  I can’t stop smilling!”

			As you can see, esthetically the outside of PFM Crowns are made to look like natural tooth structure, while reinforced with metal on the inside for optimal strength.
PFM Outside	PFM Inside

Porcelain-fused-to-metal dental crowns are somewhat of a hybrid between metal crowns and porcelain crowns. First, the dental technician makes a shell of metal that fits over the tooth. Second, porcelain is fused over this metal at high temperatures.  The porcelain hides the metal substructure, giving the crown a white tooth-like appearance. These crowns can have porcelain placed on the entire surface or selectively used only on the outside visible area, thereby leaving metal to withstand heavy biting forces on back teeth.

Porcelain-fused-to-metal (PFM) dental crowns can be a good choice for either front or back teeth. These crowns are strong enough to withstand heavy biting pressures and can have an excellent cosmetic appearance. Many patients may complain of an older PFM crown that can show the metal that lies underneath a crown's porcelain layer, years after it is placed.  This can be visualized as a dark line found right at the crown's edge.  This mainly happens after a few years if the gums recede.  Our highly trained technician specializes in hiding these metal collars during fabrication by blending porcelain over these margins.  This helps to decrease any chances of metal exposure in the future. 

Getting the Ultimate Care at Comfort Dental
Implant Reconstruction and Empress Crowns
Before	After Implants and Crowns

The Comfort Dental Difference

Tom came to our office for a weekend emergency visit regarding bleeding gums and pain.  To make a long story short, soon after relieving his pain and infection we diagnosed many dental problems in his mouth.  Most of these problems were simply a result of the poor dental care that he had received from his dentist, who was also his friend.  He had learned to accept less than the standard of dental care for many years.

Tom decided that it was in his best interest to seek continued care at our office and receive the best that modern technology has to offer.

Implant Reconstruction and Empress Crowns

We started his dental care with a comprehensive gum treatment program. We were able to save as many teeth as possible.  Unfortunately, his lower front teeth had suffered extensive bone damage due to the gum infection and he required placement of 2 mini-implants manufactured by 3i Corporation.  These implants helped to stabilize his jaw bone and allowed us to fabricate all-porcelain crowns in order to restore his dental health and give him the smile that he always wanted.    His dental interest peaked to the point that he also wanted 4 Empress veneers placed on his upper 4 front teeth to give him the new smile he always dreamed about. 

Tom had a hard time going through his security gate at work as the guard did not recognize him on Monday morning.  He actually had to show his i.d. badge!