6 factors to consider when picking out the best kind of crown for your tooth. -

A checklist of FYI facts about dental crowns to use when determining which kind makes the right choice for your situation.

What's the best kind of crown for your tooth?

This page contains a couple of different resources for figuring out what type of crown most likely makes the optimal choice for your tooth.

  • Our "6 Factors to Consider" section is a quick run-through of the information found elsewhere on our pages (we provide links) detailing the comparative pros and cons of each type of dental crown, and with what applications these factors are likely to play an important role.
  • We also offer our "Crown Selection Drill Down" that guides you through the process of picking out the best type of crown by answering just a few questions.
  • Our last section provides an example of what dental clinicians tend to feel makes the "best practice" choice for different types of teeth and applications.

 


A) Checklist: Factors to consider when choosing a type of crown for your tooth.

#1 - There is no single "best" type of crown.

No one type of dental crown offers the best solution for all applications. So before you make a final decision, quiz your dentist about all of the different types of crowns. Especially if up to this point they've only mentioned placing one kind.

Hopefully, they'll outline the same general issues our page does. If not, quiz them some more. Because if you're after superior aesthetics, or great strength, or the right combination of the two, it really does matter which is placed.

#2 - At least consider a gold crown. They make an excellent choice for back teeth.

If cosmetic appearance is not a factor, nothing can beat a gold crown, period.

  • They provide excellent service. - All-metal crowns are the strongest, most durable type of dental cap. Because they are solid metal, there is nothing to chip off. Likewise, they don't crack or break.
  • They're very biocompatible. - While exceptionally durable, gold crowns won't wear down opposing teeth (like porcelain-surfaced crowns can).

A gold dental crown.

Picture of a gold dental crown.

No type of crown gives longer, more predictable service than a gold crown.

The only disadvantage of a gold cap is its color. But if it won't show (like when placed on teeth way in the back) this isn't a drawback.
Need more details? Visit our Gold Crowns page.

#3 - The great advantage of all-porcelain crowns is their beauty.

The big advantage of having porcelain (all-ceramic) dental crowns placed is that they create an exceedingly life-like end result. So, in those situations where cosmetic considerations are of great concern, all-porcelain crowns make an excellent choice.

a) The trade-off of all-ceramics is one of strength and cost.

An all-ceramic dental crown.

Picture of an all-ceramic dental crown for a front tooth.

Ceramic dental crowns can excel in their lifelike appearance.

Even though modern ceramics have been developed that are much stronger than dental porcelains of the past, no type of all-ceramic can boast of having a service track record that comes close to matching that of all-metal or porcelain-fused-to-metal crowns. And they usually cost around 10 to 20% more.

b) All-porcelain dental crowns can make an excellent choice, but only in selected situations.

Ceramic crowns can make a great choice for upper front teeth, where cosmetic appearance is a major concern. However, when considered for molars, bicuspids, or lower front teeth, their risk of fracture and higher cost may make other types of crowns a better choice.

Need more details? Visit our Porcelain Crowns page.

#4 - Porcelain-fused-to-metal crowns are a middle ground between all-metal and all-ceramic caps.

The construction of porcelain-fused-to-metal crowns (PFM's) is one where an overlying surface of porcelain is fused onto an underlying thimble of metal.

A porcelain-fused-to-metal dental crown.

Picture of a porcelain-fused-to-metal dental crown.

PFM crowns offer good strength characteristics and a natural appearance.

This makeup allows PFM's to offer many of the benefits of both all-metal and all-ceramic crowns.
  • Porcelain-fused-to-metal crowns are very strong. - While not as strong as all-metal crowns, dentists routinely place PFM caps on back teeth.
  • Porcelain-fused-to-metal crowns can produce pleasing aesthetics. - While not as translucent, the cosmetic appearance of PFM's can often approach, and possibly equal, those of all-porcelain caps.
PFM's do have some disadvantages.

Porcelain-fused-to-metal crowns do have some shortcomings that may come into play in some situations:

  • If the tooth's gum line recedes, the crown's underlying metal edge may show and spoil the tooth's appearance. (An important concern with front teeth.)
  • Unless proper protocol is followed when the bite of a PFM crown is adjusted, its porcelain surface may wear opposing teeth.
  • It's possible for portions of the crown's porcelain covering to fracture off.

The new type of porcelain-metal crown.

In recent years a new type of porcelain covered restoration has been developed. It's called the pressed-to-metal (PTM) or pressed-over-metal (POM) crown.

To look at one of these restorations, you'd think it was a PFM. But what's different about it is its method of fabrication and that a stronger, possibly more esthetic, type of ceramic is used.

  • On the upside, PTM/POMs address all of the limitations of PFM's stated above.
  • Their biggest downside is that they don't yet have a time-tested track record of use.

Need more details about PFM and PTM/POM's? Visit our Porcelain-fused-to-metal Crowns page.

References for the technical details of the factors discussed above - Rosenstiel, Shillingburg

#5 - Make sure to compare costs.

You can expect a PFM or all-metal crown to cost around 10 to 20% less than an all-ceramic. (Cost estimates for different types of dental caps.)

a) If dental insurance is involved ...

It's common for a dental plan to cover 50% of the cost of a crown, minus the plan's deductible.

As an example, for a crown that costs $1000, and a plan that has a $100 deductible, insurance would pay $400.

[If you're concerned about costs, have your dentist file a "predetermination of benefits." In response, the insurance company will report the amount of benefits they will provide for your planned work.]

Common dental plan exclusions:
  • No benefits for replacing crowns (that the plan previously paid toward) that are less than 5 years old.
  • No coverage for crowns that are placed for purely cosmetic purposes. However, ask your dentist about this point. The crown you think is strictly cosmetic in nature may serve other (covered) purposes as well.
b) If you're paying for your crown out-of-pocket and its cost is a bit of an expense ...

Ask if you can arrange to pay half of your crown's cost now and half later, possibly even stretching the second half over a couple of payments. This arrangement can provide a way where your dentist can cover their immediate costs, yet help to accommodate your financial needs too.

Need more details? Visit our Dental Crown Costs page.

#6 - Make sure you understand why your dentist has recommended a crown.

Dental crowns serve many important functions. But if your tooth does not require one then other types of dental restorations make a better choice.

 

b) There are other ways to improve the cosmetic appearance of teeth.

If it's just a change in appearance that's needed, porcelain veneers may provide a less invasive way to accomplish the same cosmetic end result. In some situations, just placing tooth bonding may suffice.

c) In some situations, a second opinion can be a good idea.

If your new dentist suggests several crowns (while your previous dentist never did), or if your current dentist seems to solve every problem by placing one, a second opinion may be in order.

It's expected that dentists' opinions will vary. However, over-diagnosing the need for crowns can be hard on your pocketbook and bad for your teeth. When in doubt, consider seeking a second opinion.


B) Which type of dental crown makes the best choice for you? - Our drill-down selector.

By answering the questions below we can help you to drill down to the kind of crown whose characteristics best match up with your needs. And each answer box that opens also provides a link to information on our pages that discusses the special issues that should be considered with that type of crown.

How to use our drill-down selector: When you click an answer link, its answer box will expand.

▶  First question - Will your crown be placed on a front tooth or back one? -
  • Front teeth = Incisors, Canines (cuspids, eyeteeth).
  • Back teeth = Molars, Premolars (bicuspids).

 

C) What type of crown do dental clinicians think makes the best choice?

The following information comes from an article written by Dr. Gordon Christensen and published in the trade magazine Dental Economics. Dr. Christensen is a well respected dental researcher and clinician (we use several of his articles as reference sources for our pages).

In this article, he delineated the kinds of crowns that he felt typically made the best choice for each type of tooth or application. In our outline of that information below, we've listed his preferred material (crown type) first, and then the others in decreasing order of his preference.

We've added notes to this list so to help you understand what we expect was the rationale associated with these choices.

Section references - Christensen

  • Application: Upper or lower second molars -

    Preferred crown types: all-metal (gold alloy) > PFM (porcelain-fused-to-metal) > full zirconia > lithium disilicate

    Notes: This order of crown types suggests that for back teeth where heavy chewing forces are involved, the strongest type of restoration makes the best choice. Gold is listed as the preferred construction material because most people's second molars don't show prominently and therefore its metallic look is not typically an issue.

    Links to further information on our pages about the types of crowns discussed in the article:
    all-metal (gold alloy)
    PFM (porcelain-fused-to-metal)
    all-ceramic (layered construction)
    full zirconia (monolithic construction)
    lithium disilicate (monolithic construction)

  • Application: Lower first molars -

    Preferred crown types: all-metal (gold alloy) > PFM > full zirconia > lithium disilicate

    Notes: Once again, for teeth that don't show prominently when the person smiles, choosing the type of restoration that has the greatest strength makes the best choice.

 

  • Application: Upper first molars -

    Preferred crown types: PFM > lithium disilicate > full zirconia

    Notes: Upper first molars typically are visible to others, so for that reason, only porcelain crowns are included in this list. PFM is shown as the first choice, no doubt due to the great strength and longevity this type of construction usually provides.

    Since lithium disilicate doesn't create as strong a restoration, we were surprised to see it listed ahead of full zirconia. The text of the article stated that the preference for it was based on it's more favorable aesthetic characteristics.

  • Application: Upper or lower premolars (bicuspids) -

    Preferred crown types: lithium disilicate > PFM > full zirconia

    Notes: For premolars, lithium disilicate is listed ahead of PFM. This would imply that for these teeth the superior strength of a porcelain-fused-to-metal crown is not necessarily needed. It also suggests that the aesthetic disadvantages of PFM's (primarily the "dark line," see above) make the all-ceramic construction of lithium disilicate crowns the better choice.

 

  • Application: An individual upper or lower front tooth -

    Preferred crown types: all-ceramic > lithium disilicate

    Notes: Here the first recommendation is for some type of all-ceramic crown but not one made using a high-strength synthetic porcelain.

    That's because creating an individual crown that precisely matches the color and translucency of neighboring teeth is very challenging. And using a high-strength porcelain would only make this task even more difficult (see above).

  • Application: All 6 upper or lower anterior (front) teeth -

    Preferred crown type: lithium disilicate

    Notes: When placing an entire set of crowns, the issue of color matching is much less of an issue. As long as all of the crowns match each other, the case will usually look acceptable (and hopefully much better than just that).

    That means choosing lithium disilicate makes the better choice. It has reasonably good aesthetic characteristics and also has greater strength than the typical dental ceramic.

 
 
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Comments

Which dental crown material is best?

Your pages talk about the different kinds of crowns but with my tooth my dentist only talks about putting a ceramic one on it. From reading this page, I'm not entire sure that makes the best choice. It's a back tooth that broke from chewing. I'm afraid the ceramic will be fragile. Any insight you have would be appreciated.

BC

We'd like to think that all dentists take the time to explain the pros and cons of the various options that a patient has. (In most cases there would always be at least two options that might make a reasonable choice.)

However, possibly it was so very clear to them which made the better choice that they just offered the one kind. Although with a back tooth, that wouldn't seem so likely to us.

In all cases, choosing the right material depends entirely on your specific situation and what issues exist. As a formal answer to your question but in a nutshell (as opposed to the drawn out version above), here are some general rules ...

Which dental crown material is best?
  • Metal - All-metal crown construction, especially when a gold alloy is used, makes a preferred choice in terms of fit, strength, durability and longevity. It makes an excellent choice for back teeth that don't show very much.
  • Ceramic - All-ceramic crowns generally make the preferred choice when the appearance of the tooth is of utmost concern. Obviously that would include front ones, but possibly also those to the side or back.

    Choosing the best kind of ceramic (and associated construction type) involves weighing esthetic vs. strength characteristics. Usually some kind of compromise must be accepted.

  • Porcelain-fused-to-metal - These crowns offer advantages of both all-ceramic and all-metal construction, and therefore may make a good choice for any tooth.

    In cases where just strength or appearance is the primary concern, the other types may make a better choice. But often this kind of crown provides the best balance between the two.

You specifically mention a "ceramic" crown for your back tooth. We don't know if that means a porcelain-fused-to-metal one (a good choice) or an all-ceramic (possibly not a good choice for teeth that revceive a lot of chewing pressure).

An all-ceramic can make a good choice for a back tooth but typically only a "best choice" if a suitable type of ceramic and method of construction is used. Your dentist should explain what they have planned so you can feel more comfortable with the (their) decision.

Our types of dental crowns page explains much of what we've mentioned here in greater detail.

zirconia vs. metal

Are zirconia crowns better than metal?

anonymous

At face value your question seems to ask if a zirconia crown is better than an all-metal (gold) one. But we can also see how you might be asking if a zirconia crown is better than a porcelain-fused-to-metal one.

(It also needs to be mentioned that you don't state what type of zirconia crown construction is involved, which would be a factor too.)

In general terms:

Are zirconia crowns better than all-metal (gold) ones?
No, not better. Possibly a zirconia crown is a near equal.

Gold crowns have an over 100 year track record proving they are lasting and reliable restorations. Gold crowns probably cause less wear of opposing teeth (the teeth that bite against it). Having an all-metal construction, restoration fracture is not an issue.

In comparison, zirconia crowns have only been around since the 2000's. And they likely cause more opposing tooth wear than gold. While some forms of zirconia crown construction are very strong (monolithic), as compared to metal, the potential for fracture exists. Although with proper crown design [read thickness on the chewing surface] and using an appropriate type of zirconia, this risk should be minimal.

Are zirconia crowns better than porcelain-fused-to-metal (PFM) ones?
Possibly. As an advantage, PFM's have a track record dating back to the 1960's and are a tried and proven type of restoration.

However, considering a zirconia crown (especially monolithic construction) as an alternative is a strong trend that is growing among dentists. As an advantage, well polished zirconia crowns tend to wear opposing teeth less than the type of porcelain used with traditional PFM crowns (feldspathic porcelain).

With either case, a properly constructed and well polished zirconia crown can make a good choice. But they still don't have the proven track records of the other two types of crowns, hence the term "better" isn't so appropriate.

Repair of front lower teeth

I am 70. I have only one lower back molar. I have my 6 front lower anterior and all my upper jaw teeth. Four of the front uppers have crowns. I have a strong scissor bite that is now causing abrasion wear to three of my lower anterior teeth. I have tried lower partial dentures and found very painful with no resolution. I do not want implants(apparently, my cheeks have grown onto gums making dentures and implants an issue)
My plan is to crown the three lower anterior teeth and the two upper front teeth without crowns. I need teeth that will be hard wearing. What would be your recommendation?

ghbryce

Without commenting on the treatment plan itself, it's easy enough to state that for front teeth (teeth that need to be white in color), the strongest/most durable types of crowns would generally be:

1) Porcelain fused to metal (PFM).

2) All-ceramic crown, monolithic construction, high-strength ceramic (like zirconia).

PFM crowns offer the longest track record in documenting their being able to provide good service. But lower front teeth are typically tiny in size, which poses challenges for the dentist when attempting to create the most lifelike appearance (due to their multi-material, multi-layered construction).

Monolithic zirconia crowns are touted as being very strong, but don't have the long track history like PFM crowns do to prove it. Their all-ceramic construction offers some advantages in achieving a good aesthetic result, although the monolithic construction method offers some disadvantages.

The links above discuss the associated issues for each of these respective types of crowns. Upon asking, your dentist should be able to explain how they will apply in your case.

* Comments marked with an asterisk, along with their associated replies, have either been edited for brevity/clarity, or have been moved to a page that's better aligned with their subject matter, or both. If relocated, the comment and its replies retain their original datestamps, which may affect the chronology of the page's comments section.


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