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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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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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.