What could be the possible reasons for having a dentin-bonded all-porcelain crown on a central incisor and a porcelain fused to metal crown on the first molar? Also what would be the differences between the two different kinds of materials?
Thank you and much appreciated.
– Ranje from Alabama
There are two reasons for using the all-porcelain crown on an incisor and porcelain fused to metal on a molar:
1. Porcelain fused to metal crowns are stronger than pure porcelain. Pure porcelain is plenty strong enough to serve on an incisor. They are usually strong enough to serve on a first molar, but there could be a risk of cracking of the crown on a first molar, and that’s why even some true cosmetic dentists will use porcelain fused to metal on molars.
2. And back on a first molar, it is very difficult for others to tell the difference between a porcelain fused to metal crown and an all-porcelain crown. All-porcelain has a lifelike translucency, where porcelain fused to metal is opaque and develops a dark line at the gumline. Unless you have a really wide smile, people simply aren’t going to see that on your first molar. In my practice, I never used porcelain fused to metal crowns on front teeth–they’re just ugly, especially after you’re used to the beauty of all porcelain crowns. Patients, after being told the difference, were always willing to pay a premium, beyond their insurance coverage, for the lifelike all-porcelain crown on a front tooth.
But we need a warning here. Do not ask your dentist to do an all-porcelain crown for you on a front tooth if he or she hasn’t brought it up. These crowns require special expertise. If your dentist knew how to do them well, he or she would not want to do any other type of crown for you. Take their failure to mention this option as evidence that they’re uncomfortable with the clinical requirements of the more beautiful crown, and if it’s important enough to you that this is what you want, find a true cosmetic dentist to do this right. The all-porcelain crown will break if it’s not bonded on properly. And your dentist is very unlikely to confess, when pressed, that he or she isn’t familiar with the bonding techniques–they simply won’t let on that this is an issue.
– Dr. Hall
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