Hi Dr. Hall,
My dentist had recommended porcelain fused to metal crowns for my front top anterior teeth to fix wear and a gap. After reading all the different kinds of crowns available I asked if he could do an all ceramic set maybe Zirconia. His reply and his partner’s reply is that they will only do porcelain fused to metal crowns. Their credentials (at least the partner who overlooked my case) are quite impressive as are their prices, and they say that since I tend to grind my teeth and I do not want to wear a night guard that if I get Zirconia they feel that they won’t hold up. Is it true that occasional grinding without a night guard eliminates Zirconia or an all ceramic crown. I have been waiting for years to have this fixed and they are ready to start the process. They also charge more for anterior crowns vs posterior, not sure if that is the norm. I need to get my smile back. Thank you for any response you could provide!
– Bob in Los Angeles
I recommend a second opinion. Yes, Zirconia crowns are very strong and will work on the front, even under great stress. And something great about them is that they can be made thinner than porcelain fused to metal, meaning that less of the tooth is ground away, which will leave your front teeth stronger. I used all-ceramic crowns on front teeth with people with severe grinding problems, and they didn’t break. And zirconia is much stronger than the materials I used then.
Not knowing your mouth, I can’t prescribe with certainty, and the issue may be more that they feel they need metal as an opposing chewing surface for your lower teeth, which doesn’t wear down the lower natural teeth as much. Although there are soft porcelains that can be used on the surface of zirconia, too.
I suspect that, in spite of your dentist’s credentials, he may not have that passion for appearance-related dentistry. His passion may be for things that work well – it’s kind of an engineering approach. Many dentists that have a great deal of education are very academic types and consider it beneath them to worry too much about appearance issues.
And don’t ever try to push a dentist outside his or her comfort zone. For others that may read this post, if your dentist recommends porcelain fused to metal crowns for front teeth, don’t try to get them to do all porcelain. If they really care about the artistic quality of their work, they will have a strong aversion toward placing porcelain fused to metal single crowns on front teeth. If you don’t like the preferences of your dentist, then find a dentist who is more in harmony with those preferences rather than push your dentist outside their comfort zone and risk disaster. You’re fortunate that your dentist had the integrity to resist your request. Some will say, “fine, we can do that,” and they really aren’t good at the technique that you want, at all.
But I would strongly encourage you to give in on the night guard issue. There is a risk beyond just wearing your teeth down. As you get older, you can break off your teeth at the gumline from the grinding. That can happen whether you have crowns or not, and may even happen more readily if you have crowns.
Yes, some dentists charge more for anterior crowns.
You’re in the Los Angeles area. We recommend a number of excellent Los Angeles cosmetic dentists there. Go to one of them for a second opinion. See what an expert cosmetic dentist says before you go ahead with this.
– Dr. Hall
Click here to read more about porcelain crowns on front teeth.