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Which is the best kind of veneer?

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Hi Dr. Hall!

I’m looking to have my veneers replaced with some that are more aesthetically pleasing and natural looking .

I’ve been to several dentists for consults. One recommends e.max or zirconia. The other recommends feldspathic for a more natural look. Which do you recommend for veneers and crowns? I’m wanting them to look natural and last several decades if well cared for. What’s your advice and what material do you typically use for cases like this?

Thank you!
Kristi from Missouri

(See Dr. Hall’s answer below.)


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Kristi,
A couple of things concern me about your question.

First of all, it’s the wrong question. You’re talking about porcelain veneers as if it were something like a filling—a straightforward repair of your tooth. It’s not. It’s art, and the material chosen for the veneer pales in comparison to the question, “Who is the artist?” Your question is like asking, “Which is the best art? Water color, acrylic, or oil?” without giving consideration to who the artist is. Instead of being concerned about the medium for the smile makeover, look at photos of the dentist’s work, check his or her credentials and reputation. If the dentist is accredited by the American Academy of Cosmetic Dentistry, that makes them a pretty safe bet as someone who can do a beautiful smile makeover, but there are some excellent cosmetic dentists who aren’t accredited.

But there are a couple of other little things in your question that concern me. First, you asked about which material is best for veneers or crowns. I hope that one of your dentists isn’t trying to get you to replace your veneers with crowns. If so, that is a red flag. It’s an indication that the dentist isn’t comfortable doing porcelain veneers, so I would cross them off. Veneers require little to no removal of healthy tooth structure. Crowns on front teeth require grinding the teeth down to stubs. I wouldn’t trust a dentist who wanted to do that when veneers are an acceptable alternative.

And then one of the materials suggested was zirconia. I will qualify the answer in my first paragraph by saying that I don’t believe zirconia would be the material of choice for an artistic cosmetic dentist. Zirconia has to be ground out of blocks of material and it isn’t possible to introduce subtle color variations that would be needed for a truly natural result. Zirconia can be stained on the surface, but that is tricky to get right and isn’t the same as baking the color variations into the porcelain. About the other choices, feldspathic porcelain or e.max, I know of excellent cosmetic dentists who can get beautiful results with either material.

I hope this is helpful.
– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

What type of crowns should I get for my two front teeth?

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Dr. Hall,
I’m looking to replace my two porcelain-fused-to-metal front teeth crowns for aesthetic reasons. I have a root canal done on one of them and would like to know what would be the most aesthetic-looking restoration that might have to cover up a dark tooth? I’ve been told that the feldspathic layered porcelain could achieve that, but I’m concerned about strength of this type of crown. Any light you can shed on this for me would be greatly appreciated.
– Kathy J. from Arizona
(See Dr. Hall’s answer below.)


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Kathy,
I appreciate your concerns, but you’re asking the wrong question. Far more important in getting beautiful crowns is who is making it, not what it is made out of. Yes, it is true that it is impossible to get a completely natural look out of porcelain-fused-to-metal crowns. But there are a number of choices of all-ceramic crowns that can look so beautifully natural that even a trained professional wouldn’t be able to tell, even on close inspection, that they aren’t your own natural teeth. As far as strength, any of the all-ceramic options would be strong enough for your front two teeth. You need to find a dentist with strong artistic ability and then let him or her use a material that they are comfortable with. They will have a master ceramist who is also intimately familiar with the material and knows how to work with it to produce beautiful results.

The underlying dark tooth needs to be masked out with some type of opaquer. There are various ways to do that. Myself, I preferred blocking out the dark color with composite buildup material and doing the crown over that. But some colleagues would rather have their technician accomplish that with an opaque layer in the crown. Any of the popular crown materials—feldspathic porcelain, lithium disilicate, or zirconia, can be made opaque and can accomplish that quite nicely. With zirconia and lithium disilicate, the ceramist will then layer that over with feldspathic porcelain to produce a beautifully natural result.

Many expert cosmetic dentists have great success with e.max crowns, which consist of a strong core of lithium disilicate layered over with feldspathic porcelain.

The most challenging aspect of your case will be to get a dentist/ceramist team that can block out the dark color of your one front tooth and get it to match perfectly the other front tooth. So you’ll need to go to an expert cosmetic dentist.

The worst thing you could do would be to pick the material you want and then ask your dentist to use that type of crown on you. Doing that puts pressure on the dentist to go outside their comfort zone, asking the dentist and ceramist to work with a material with which they may not have much experience. That’s a recipe for an unattractive result. Plus, if the dentist doesn’t have enough artistic ability, they’re not going to produce a beautiful result, no matter what material they use.

I hope this is helpful.
– Dr. Hall

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Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Is zirconia radioactive?

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Dr. Hall, you have kindly answered a dental question for me before. Currently, I am wrestling with what would be the healthiest option for a crown for me to have placed on a lower molar (next to last) which has a 30-plus-year-old crown on it and which required dental surgery to remove severe infection so the tooth could be saved. It seems my dentist saved the tooth but he wants me to return in five weeks to remove the old crown and place a new one. He mentioned zirconia but I understand this material is extremely difficult to remove should I have further problems plus I have read there is radioactivity in this material. I considered e.max and then Encore PFM which has 4o% palladium. I am confused over what would be most healthy in the long run and my dental appointment is looming. Dental issues are definitely life changing. Any clarity you can provide me would be so appreciated. Thank you.

– Sandra from Mississippi


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Sandra,
So which is the safest crown? It probably has less to do with the three materials you mentioned and more to do with the expertise with which the crown is crafted. Your greatest danger with a crown, among those three excellent materials, will be with recurrent decay, which will be minimized by having a precisely fitting crown. And if your dentist was able to save this tooth from a severe infection, that’s a good sign that he may have the skills to make an excellent, well-fitting crown.

Yes, there are trace amounts of radioactivity in zirconia. Some zirconia materials used in dentistry are refined to minimize that radioactivity. But even without that, the amount is extremely small. There is also radioactivity of a similar amount in brick, stone, and concrete. Actually, there is even some radioactivity in water.

Some people also question whether or not there is an allergic sensitivity of some people to zirconia. We had one report of that and then it turned out to be a case of burning mouth syndrome. And yes, zirconia is very difficult to remove, but that is the dentist’s problem, not yours. He or she may wear out a diamond bur or two trying to get it off if that ever becomes necessary, but that won’t hurt your tooth any. The e.max crowns are also difficult to remove, porcelain fused to metal not so much.

If you are allergic to a lot of things, an all-ceramic crown would seem to be a good choice. The two popular, strong ceramic materials are zirconia and lithium disilicate. The CEREC crown-in-a-day is made out of lithium disilicate. The e.max crown is made of a lithium disilicate core veneered with feldspathic porcelain. It can be made highly aesthetic and has become very popular with dentists because of its strength, aesthetics, and the ease of working with it. I have one of those on a first premolar. But if you want the safest, longest-lasting crown on a lower first molar, cast gold would be the material of choice. Whether or not that would show would depend on how wide your smile is. I have crowns on three of my second molars, and they are all cast gold. Gold can be cast to a very fine margin, won’t ever break under the most severe oral stresses, and is extremely biocompatible. After gold, the strongest material for a crown for a molar would be zirconia.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Is palladium a toxic metal? My crown has palladium in it.

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Dr. Hall,
Recently from my periodontist who also does cosmetic dentistry I was fitted with 6 high noble porcelain-fused-to-metal crowns. I knew they were PFM crowns but later I discovered they are Encore crowns and contain 40% palladium. I have read of the toxicity of this metal and am concerned that there is such a high percentage of it in my crowns. I am now considering having them removed and considering e.max or even zirconia, whichever is the most inert. I hope you will advise me on what steps I should take.
Thank you for your time.
– Sandra from Delaware


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Sandra,
I was struck by your question because I had never heard of palladium toxicity, and I try to keep myself informed of these things. Many dentists, I feel, are much too casual about metal toxicity issues. You can check other posts in this blog where I list various metals used by some dentists that cause sensitivity reactions. But palladium? I decided to do some research to see where this idea comes from.

In the movie Iron Man 2, Tony Stark has an arc reactor that keeps him alive and powers his armor, and this arc reactor has a palladium core. In the movie, the palladium is poisoning his blood. In the real world, however, palladium is a noble metal and a member of the platinum group, and is fairly biocompatible. Yes, there are compounds such as palladium chloride that are toxic, but that is very different from the pure metal. And remember, that we are not talking about putting this metal into the tissue but only putting it into a situation where you are in superficial contact with it.

Also, in doing an online search, I discovered a natural health website that alleged that palladium is a heavy metal that is highly toxic. (not true—palladium is a precious metal that is actually fairly light.) To put their claims in context, near the bottom of the page is a link for visitors to get themselves tested to see if they have palladium toxicity. The link takes us to a page that urges visitors to send in $325 for a hair mineral analysis. So if we follow the money it seems that we are discovering the motivation for their mis-information.

Almost every dental alloy that is used in making crowns and bridges has palladium in it. Like platinum and gold, palladium doesn’t corrode. Its presence in a dental alloy lends a certain amount of stiffness to the alloy, so it is pretty much required in stress-bearing dental bridges. Alloys without palladium tend to be very soft.

Here is a chart of dental alloys manufactured by Aurident for use with porcelain-fused-to-metal crowns. Aurident is one of the leading manufacturers of dental alloys.
a chart of dental alloys used with porcelain fused to metal crowns, showing the percentage of palladium in the alloy
You can see the percentage composition of the various alloys. Au is gold, Pt is platinum, Pd is palladium, and Ag is silver. Notice that palladium, while it isn’t in every alloy, it is a component of more alloys than any other metal. When it isn’t present, the metal will be softer and will be more yellow in color. Soft is good in some situations. It makes the metal easy to burnish so that it fits tightly to the tooth. But a soft metal without palladium can also make the restoration susceptible to bending or breaking. The second column, labeled “class,” shows how the alloy is categorized. The square icon with the HN means high noble. These are alloys that have at least 40% gold and a total of at least 60% noble (precious) metals, of which palladium is one. Sometimes these alloys are simply called “gold,” and the term “porcelain fused to gold” is used. The triangles with the N are noble alloys that have at least 25% precious metals.

Even with gold alloys used in gold crowns, almost all of them have palladium in the alloy.

In my mouth, four of my crowns have metal in them—three gold and one porcelain-fused-to-metal—and I am pretty confident that each of them has some palladium content.

My opinion, Sandra—you don’t have anything to worry about, and as long as you are happy with how they look and aren’t having an allergic reaction, I would leave well enough alone. There are some instances reported of palladium allergy. If that is your situation, you will have symptoms such as redness in the gums around the crowns and/or an itching or burning sensation there.

Switching to zirconia? While rare, there are also some instances that have been reported of zirconia allergy. I had one woman write to me who, after going the rounds with several dentists, finally decided that she was allergic to the zirconia in her crowns. I have decided never to tell someone that it’s impossible for them to be allergic to some dental material. Sometimes it seems that putting anything artificial in your mouth carries at least a tiny amount of risk. Wouldn’t that be ironic if you are having no reaction to the palladium and switch to something else only to find out that you are actually allergic to the new material!

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Ugly e.max crowns are too thick

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Good morning, Dr. Hall.
My question: Can adhesive-bonded e.max crowns be safely removed without breaking the natural tooth which is already fragile?
History: I recently had the front six teeth re-crowned with e.max. The four front teeth have now been crowned for the 5th time (all by different dentists). I was happy with the first crowns I had, but after 15 years they needed to be replaced. I have yet to find a dentist who can replicate the smile I had before. I’m now stuck with e.max crowns that are thick and bulky with dark showing around the gum over my central incisor. My dentist said he would replace them but I know with each manipulation, I am risking the possibility of losing a tooth (or teeth).
My dentist said he made the e.max crowns thicker because my gums were thick (the gums have buttressed from years of clenching). He has now asked I have crown-lengthening and have some if the bone removed before replacing crowns.
I am so afraid of losing my teeth and having to have dental implants but I so want my old smile back.
Any advice would be greatly appreciated.
– Carol from Alabama


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Carol,
If I’m getting this straight, your dentist gave you thick crowns because your gums are thick. If that is his true reasoning, I wouldn’t let him re-do your case. There is a gross misunderstanding of esthetic and functional principles here. Thick crowns will cause the gums to become inflamed and puffy, so this has the potential to be a functional disaster. Plus there is no aesthetic reason for your crowns to be made thick in this situation. The dentist should make sure there are natural contours to the teeth as they come out of the gum.

Let me explain.

I found this photograph showing thick crowns with puffy gums what happens when crowns are too thick. It creates a protected space where the crown meets the tooth and in that protected space, gum-disease-causing bacteria multiply freely. Microscopic food particles will get trapped there, it is impossible to clean effectively, with resulting gum disease and puffy gums.

After almost 40 years of experience in dentistry, I must say I have never heard this aesthetic principle taught or even mentioned, that thick gums mean you need to do thick crowns. Rather, what I have heard is that you always need to have a natural emergence angle where the crown meets the tooth. You should not be able to feel any bulges as you run an explorer up from the root of the tooth onto the crown – the contour should be straight and smooth.

Now, as to your actual question about removing e.max crowns. These crowns are made of a very tough material – lithium disilicate – which makes them difficult to remove. And you say they were bonded on. The only way to get these off is to grind them off. Your dentist will need a supply of diamond burs to methodically grind these off your teeth. If the dentist is good and knows what he or she is doing, there should be no damage to your existing teeth. That isn’t a problem.

But I wouldn’t trust your current dentist to do that very carefully. His idea about thick crowns doesn’t show much care for precision in knowledge, which would make me worry about his being clinically careful. I would go to one of the dentists on our recommended list–I’m confident any one of them would do a great job for you here in carefully removing the existing crowns and replacing them with a beautiful smile.

Besides the functional mistake in your new smile, there was a serious aesthetic mistake, and I want to say something about that, too. No good cosmetic dentist would have ever bonded these crowns onto your teeth without a test-drive first, either duplicating the new smile in plastic so you could wear that as a temporary smile makeover, or temporarily cementing the new crowns, so he and you could make sure that you love this new smile before it was bonded permanently.

I hope this is helpful.

Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Metal present in dental ceramics

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Hi Dr. Hall,
I like your website–it is informative.
I am a naturopath and need a crown. I’m concerned over some of the materials used. After my research, so I far like the look of the ceramic crowns (is this glass?) and wondering what Vita ceramic is made out of. I’m finding it hard to get an answer. I basically don’t want any with metals or lithium as I have thyroid issues.
Thank you,
Vanessa from New Zealand

Vanessa,
Any crown that is all ceramic is not going to have any metal in it. But I’m reading between the lines of your question, and I think you are asking about avoiding any metal ions in the crown. I don’t believe this is going to be possible to do, as there are metal ions in every dental ceramic I am aware of.

Let’s get into a little chemistry. Iron is a metal. Rust is iron combined with oxygen–iron oxide. While rust isn’t a metal, it has metal ions in it. And while you wouldn’t want to eat metallic iron, of course, iron ions are essential to life. They’re an important ingredient of our diet, since the hemoglobin in our blood has iron ions in it. The iron in our blood is what gives blood its red color.

Similarly, sodium is a metal. As a pure metal, it is toxic, but combined as a metal ion with chlorine it is sodium chloride, or common table salt, and is also essential to life.

Other metal ions that are important ingredients in our diet include calcium, potassium, magnesium, zinc, copper, manganese, molybdenum, and cobalt.

Lithium is a metal that is in the same family as sodium. It is so reactive that it doesn’t occur freely in nature, so it is found naturally in its ionic form combined with other elements. Lithium disilicate is a ceramic that is very strong and has been developed in the past few years to be used in dental crowns. I have in my mouth an e.max crown, which is made of lithium disilicate.

Zirconium is another metal. Combined in its ionic form with oxygen, it is known as zirconia, and is a ceramic that is even stronger than lithium disilicate and has also been developed recently to be used in dental crowns. It is so strong that it can be used in bridges without requiring a metal framework, something that is very risky with other ceramics.

You mention Vita. Vita is a brand of porcelain. Porcelain is a conventional ceramic that has been used for many years for dental crowns. It isn’t very strong by itself, but when it is bonded to tooth structure, it is strong enough for crowns on front teeth and premolars. Dental porcelains are made with kaolin as a key ingredient. Kaolin is a clay that has silica and aluminum oxide. Aluminum again is a metal, but it isn’t aluminum metal that is in these crowns but aluminum ions.

Glass is pure silica (silicon dioxide). Silicon is not a metal, but glass isn’t strong enough to be used as a crown, though there are some crowns that use a layer of glass on the outside (Empress crowns). However, the glass they use in Empress crowns is a leucite glass that has aluminum tectosilicate in it.

So you can take all of this information and figure out what you want to do. I am not aware of any biocompatibility issues with any of these ceramics. However, if you were to ask me my opinion about which one would be least likely to provoke any biological reaction, I would say the zirconia.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Response from Aaron from Indiana – polishing veneers and Supersmile toothpaste

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This is a final follow-up to a correspondence with Aaron from Indiana.
See his original question about a smile makeover that had lost its shine and the follow-up: “Do porcelain veneers lose their shine that quickly?”

Greetings Dr. Hall,

I went to my cosmetic dentist and had another e.max crown placed and was prepped for another one on my right lower side. The crown looks great and I am highly satisfied with my lower left molar restoration. I also had a polish and the luster on my cosmetics has been restored. I have been using Supersmile for 4 days. My teeth look so amazing and I love the Supersmile product. After using the toothpaste, I went ahead and ordered a tube of the accelerator. In conjunction with the at home Zoom treatments, I think the Supersmile products will get the shade on my lower teeth where I want it to be and with less sensitivity. The low abrasion factor and the calprox are big selling factors for me maintaining my new super smile.

– Aaron from Indiana

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

What treatment is needed for a calcified root canal?

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Hi Dr Hall,
First of all I appreciate the good work that you are doing.
Regarding my question: my daughter had yellow staining on her right front tooth. The doc did an x-ray and said the root canal is getting calcified and suggested a root canal. After the root canal we suggested to leave it as such but he said the tooth would fracture and a crown is a must. The crown he suggested was LAVA. We were not happy with the finish so we are trying an e.max or perhaps a metal-free ceramic. To push us to decide fast he frightened us that the gums are falling down. But I am happy I did not go with a badly made crown. I would like to know whether I have been taken for a ride and two which is the best crown to use? My gratitude for your enlightening blog I shall recommend to all my colleagues. My prayers and God Bless
– Bransdon from India

Bransdon,
I’m glad to be able to help.

First of all, I’m not sure why your daughter needs a root canal on this tooth. Just because the canal is getting calcified? As long as it’s not infected, she doesn’t need a root canal treatment. Calcification of a root canal is just the depositing of extra dentin inside the tooth. It  can happen after a traumatic injury – it’s the tooth’s attempt to protect itself against infection of the canal. Also, all teeth tend to have their canals get a little calcified as we get older.

Second, even if she has a root canal treatment, she doesn’t necessarily need a crown on this front tooth. While a back tooth that has had a root canal treatment will be prone to fracture if it doesn’t have a crown, a crown on a front tooth with a root canal treatment will weaken the neck of the tooth. A back tooth has a chewing surface. Chewing pressure on this surface will tend to push apart the cusps of the tooth, possibly causing it to split. But if a front tooth breaks, it tends to break around the neck of the tooth, and it just breaks off entirely at that point rather than splitting as back teeth do.

The Lava crown and the e.max crown are very similar to each other. They both have a very strong lithium disilicate base overlaid with a feldspathic porcelain, but they are made by different companies. They are a good crown for dentists who aren’t very good at cosmetic dentistry procedures, but they require aggressive tooth reduction, which will further weaken this tooth.

In India, you have to be very careful with getting crowns or any type of complicated dental care. I’m not all that familiar with their standards there, but I know they aren’t as high as they are here in the United States. But the best thing to do for a front tooth that does not have a large filling, which sounds like it is your daughter’s situation, is, after the root canal treatment (if it needs that), to then have a translucent fiberglass post placed to strengthen the tooth. Before placing the post, all of the root canal cement and root canal filling materials should be cleaned out from the inside of the visible part of the tooth – this will help insure against discoloration. If the color is off, I would have that fixed with a thin porcelain veneer. That will help the tooth retain its maximum strength. And I would try to seek out a dentist who is somewhat familiar with cosmetic dentistry procedures. There are dentists in India who are members of the American Academy of Cosmetic Dentistry, and I would seek out one of those. (You can go to the AACD website and pull up a membership list.)

I do not recommend, in the United States, relying on membership in the AACD for any type of assurance that a dentist will do good cosmetic dental work. But in India, it does show a strong level of commitment to cosmetic dentistry to be willing to fly to the United States to learn these procedures.

– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Which looks better and is more durable, e-Max or Lava crowns?

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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

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

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