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.

Crown selection checklist:

#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.

(This page gives a basic run down of what types of crowns are generally preferred for different kinds of teeth.)

#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, dentist's 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/POM's 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.

#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 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 just for purely cosmetic purposes. However, ask your dentist on 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.

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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.


Would you like to avoid the hassle of getting crowns on other teeth?

Anyone can have a tooth that needs to be capped as a result of an accident. But beyond that, there are some basic steps you can take that may help you to avoid being placed in a position where you ever need to have a tooth crowned again. Use this link to read our page that explains what to do.

 

Written by: Animated-Teeth Dental Staff

Content reference sources.


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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.

crowns

I had a crown placed on my left first upper incisor when I was a kid and chipped a tooth. It's a stainless steel shell that was placed on the tooth after ( I suppose ) it was shaved down, but I don't remember the precise procedure.

I'm 64. I had this done when I was in grammar school.

It's still there still doing fine. I don't give a crap how it looks it bites and it's been durable.

My former ( retired ) dentist didn't seem to think this type of prosthesis was still avaiable or that it would be desirable if it were. Personally I think it's the best thing anyone ever did for one of my teeth. I don't know if they're still availble or not but I intend to see and the piece-of-crap composite restorations which have been put on the other upper first incisor have been damaged from normal/natural chewing accidents ( one tooth overlapping the other improperly while biting or chewing and a piece being split off ) and more recently I ate some tough meat for the first time in the year since the most recent composite restoration was placed and ever since the incising surface has been crumbling away.

I want another of those can-caps put on that one to match the other one. I don't want a $1,500 crown. I don' t want a $2,000 implant. I want what I know works good, requires only one visit and is cheap. I've been "bent over" enough in my life now and, frankly, I'm sick and tired of it. Do procedures that are affordable and work well. I've had two expensive crowns fail and the last one didn't even have a pulpectomy have to be done on it. But it failed. Or something kept giving me pain and yanking it did solve the problem... I know I saw some guy who lost a finger to a snow-blower on a TV news magazine show whose brother was working in some research facility and gave him some powder made of pig-bladder collagen to put on the wound and he grew a perfectly good finger back and it wasn't smaller, he wasn't a little kid and he said the only problem with it was that he had to cut the nail more often than the ones on the other fingers. So what? This pig-bladder collagen crap won't work on blown-off limbs of veterans or to grow a new tooth after one's extracted? What's the hold-up? That was a decade or more ago and it wasn't only on the CBS news-magazine show Sunday Morning either. I also saw an article in Discover magazine about a year later. It wasn't the April edition either.

Meanwhile can't we stick with crude-but-effective? I've had that can-cap on my tooth for like 55 years now. I've had people try to knock my teeth down my throat with their knuckles. I've had motorcycle and bicycle accidents that would probably have made most people soil their tidy-whities. It's still there biting apples and yes, somewhat overcooked piece of perch.

Diogenes

With several issues in dentistry, we totally agree with you. We're so disheartened to see more serviceable solutions cast to the wayside simply because they're not tooth-colored, or what's currently being pushed by dental manufacturers and their marketing budgets.

In the case of stainless steel crowns, we're more in line with your retired dentist's opinion (that this type of crown might not ... "be desirable if it were").

There are a number of issues associated with the placement of preformed crowns on permanent teeth of adults. (That link explains.)

Generally those reasons make that choice less than ideal. Possibly your case is the exception. Hopefully you and your current dentist can work an acceptable solution out.

As far as availability ... We Googled around and saw where finding them for back teeth is still possible. We weren't entirely sure we did notice anyone still manufacturing them for adult/permanent front teeth.

Buildup on inside of bridge

I have a bridge #6 through #12 on 3 implants, it's porcelain on metal. The problem is the metal picks up a thin film that drives me absolutely crazy. Is there a solution (mouthwash or toothpaste) or a material that could be applied (similar to applying fluoride to children's molars that would deter any biological from adhering to them? As a result, I grind constantly. They were done at a dental school, I insisted on all porcelain (pmf 360 degrees over metal) but was told it would not hold. I am literally going out of my mind on this.

Leon53

Plaque accumulation in this are can lead to the failure of implant cases (Google peri-implantitis), so this should be a concern to your dentist.

We will say that biofilms tend to recolonize tooth surfaces more quickly if the removal of their colony has been incomplete. So possibly more effective cleaning (flossing, electric toothbrush) might benefit the situation.

In theory, any metal surfaces that exist should be highly polished (smooth). However, it's conceivable (theoretically) that some degree of corrosion has occurred (due to an uncommon effect of your saliva on it) and that aids in the retention you notice.

Historically chlorhexidine mouthrinse (a prescription item) has been used to help reduce biofilm formation. Although it's use is associated with some nuisance side effects (Google it).

Also, the use of fluoride products in general (toothpaste, rinses) tends to inhibit dental plaque formation. In theory, the placement of fluoride varnish might too, although that is a film itself (which tends to wear off over time).

Beyond that, evidently there is a developing field in dentistry related to the use of coatings to inhibit biofilm accumulation on teeth and restorations.

We spent quite a bit of time Googling and reading and didn't necessarily come up with any concrete answers or products. But looking around on your own may come up with some articles that you could pass on to your dentist.

Some of the keywords that seem applicable to this subject are: biofilm, anti-biofilm, antifouling coating, dental implant, crown. Best of luck in your search.

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.

Continued Tingling Discomfort in Root Canalled Molar

I developed painful sensitivity in my upper left back molar. The tooth had a large silver filling that had been present for at least 40 years. Negative xrays during a couple of visits to my general dentist. Referred to an endodontist and had positive longitudinal tap sign and positive cold testing. He did a root canal that was painless and I assume did a temporary filling. It felt painless for two weeks until I saw my general dentist again. His plan was CAD/CAM in the office. He shaped my tooth, did the scans and impressions, but the milling machine software crashed. He sent me out without a temporary, I avoided chewing on that side, came back 4 days later and he made the CAD crown and cemented it. It was hitting really high as soon as I started eating and it sadly took about 5 visits before he got the bite right. I have have tinging discomfort in it to both longitudinal and lateral pressure (tongue and finger) and with chewing. Endodontist took another full mouth X-ray scan (kind off like a CT). He says the root canal work looks fine and can not justify retreating. No obvious cracks are seen. He ground the crown a bit more. My bite feels fine but the tingly pain persists. HOWEVER, I took the Medrol dose pack that he prescribed and the tooth started to feel completely normal. But the discomfort returned a day or two after I completed the dose pack. Endodontist has pretty much relegated my tooth as one of the “few” that don’t behave and he assumes I’ll elect to have it extracted. I’m just about ready to do this but feel like there has to be a solution. Plus, I’ve “invested” quite a bit. Any analysis would be appreciated.

sgmorr

We're not going to have much to offer. While Googling around, we kept bumping into a statistic that suggests that roughly 5% of treated cases are still mired with some level of persistent pain that's not possible to resolve.

It sounds like your endodontist has checked your tooth out as well as can be. In regard to what you mention about taking Medrol (the only item that seems to create an improvement) ...

The use of the Medrol (a steroid) has the effect of limiting inflammation. With your case, the question would be is the persistent inflammation (that the steriod when taken helps to minimize) associated with some type of treatment failure/inadequacy (missed canal, undetected additional canals, cracked root, etc...), all of which have been searched for but can't be identified by your endodontist and therefore they can't treat.

Or is the inflammation still due some type of occlusal traumatism (as in the shape of the crown still isn't right).

In the sense of grasping at straws, in theory even though your bite feels right, during left and right excursions there could be some prominence that gets hit and therefore still traumatizes your tooth. A scenario could be that this occurs as you grind your teeth at night.

If the only alternative is extraction, there seems little harm in trimming the crown down just out of occlusion as a try. Possibly it already is.


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