Hi Dr. Hall,
I am about to go through a procedure that will hopefully change my smile. I currently have a metal crown in the front right tooth and it looks TERRIBLE. In addition to that the left front tooth has a very bad discoloring but also has deep fillings, and next to it, the tooth also has major fillings. My dentist initially recommended that I restore my smile with Lava Crowns, and then decided that he would use e-max crowns.

Is there a difference between these two products? I keep on searching the web to see which is better but I usually find sources that support both products. In addition to this I want the product to look as natural as possible. Is one better than the other? My dentist told me that the e-max crowns usually cost more, but that he would leave it as the same price as the Lava Crowns (which – according to him – cost less). Is this also true? And my last questions would be, what is the durability of each of these? Please help.
– Angie from California

Angie,
The key questions in how these crowns are going to make your front teeth look are not going to be anything about which brand of ceramic crown your dentist uses. The key questions are going to be, “How artistic is your dentist?” And, “How artistic is the dental lab that your dentist has chosen?” Both questions center around your dentist, because an artistic dentist will make sure that the dental lab he or she uses produces highly esthetic work.

The Lava Crown and the e.max Crown are both fairly similar. Both have a high-strength core that is milled rather than cast. Lava crowns have a zirconia core and then have a layer of feldspathic porcelain baked over them. The e.max crowns come in two types. One has a lithium disilicate core and the other has a zirconia core. The e.max crown comes from Ivoclar, and it can be covered with either a baked feldspathic porcelain or a pressed ceramic. The consensus is that both of these are highly esthetic, but I don’t think either of them is the very most esthetic crown. On pure esthetics, I would lean toward a pure feldspathic porcelain that is bonded directly to the tooth without an inner milled core. Both e.max and Lava are high strength, and I couldn’t tell you which is stronger. Pure feldspathic porcelain isn’t as strong, but it will last as long in the mouths of most people as long as you don’t have an abusive bite. Some esthetic dentists think the pressed ceramic is the most beautiful, but more lean toward the feldspathic porcelains. Some esthetic dentists will choose one or the other depending on the demands of a particular case.

But again, the key ingredient is the dentist. Let me ask you this. If you were asked by your community to commission an oil painting for the foyer of a local concert hall, would you research the brand of paint, or would you focus on the selection of the artist and let the artist pick the paint he or she felt most comfortable using? I think you would pick the artist. But you’re approaching the creation of a life-like reproduction of your two front teeth as if it is some commodity to be purchased at a discount store, and all you have to worry about is the brand. Dentists vary greatly in their artistic abilities. 98% of dentists have very little artistic inclination – they chose a career in dentistry because they like to fix things. Some dentists rise to the top in artistic abilities, and they become renowned among celebrities who will fly across the country to see a particularly artistic dentist. On the mynewsmile website, I cater more to the general public and I search out from among the top 1% of artistic dentists and list them here for the benefit of my visitors. I have a lot of e-mails from disappointed patients who make the same mistake of thinking that the dentist on the corner, by virtue of having a dental license, is an artist. It doesn’t work that way.

As far as a choice between e.max and Lava, I think probably more cosmetic dentists use e.max. I have an e.max crown on one of my premolars. Done well, in the right hands, it can produce a nice result for front teeth. Depending on the amount of discoloration in your one front tooth, Lava or e.max can help block out some of the unwanted color. But I would still prefer straight feldspathic porcelain in that situation with a great lab technician who knows how to use opaquing porcelains. I think e.max may tend to cost a little more, but that’s going to depend mostly on the laboratory that’s doing it. Costs for both will vary greatly depending on the laboratory technician that is using it.

It does bother me some that your dentist switched recommendations. My guess is that he spoke with his laboratory technician about your case, and the technician recommended e.max, so the dentist is going along. An excellent cosmetic dentist would have a firm idea from the very beginning of how to best treat your case and wouldn’t be wavering about this.

Dr. Hall