Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 7, 2019

All ceramic vs porcelain-fused-to-gold crowns


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Dr. Hall
I am having crowns replaced over tooth number 4 & 5. There is, as I believe, no cosmetic value of using pure porcelain versus Crown Porcelain fused to High Noble. There is a significant extra cost of $200.00 per each pure porcelain. In general, would a pure porcelain fused to a High Noble versus pure porcelain be just as effective over the long term?
– Garry from California

Garry,
First, I like to talk about terminology so we know exactly what we are talking about. We should be saying all-ceramic crowns, not all-porcelain. Porcelain is only one of various ceramics that have been used for crowns and even some dentists gloss over this terminology. Few dentists are placing all-porcelain crowns on back teeth these days because they are very technique sensitive and are much weaker than the newer high-strength ceramics, lithium disilicate and zirconia. The eMax crown, which I believe is the most popular crown being used by dentists today, features a lithium disilicate core with porcelain baked over it. Lithium disilicate has reasonable aesthetics—it is white and somewhat translucent—but it comes in blocks and is shaped by milling, so the technician doesn’t have the ability to manipulate the color the way porcelain color is manipulated. Porcelain comes in a paste and it is placed, shaped, and then baked. So the ceramist can apply various colors and translucencies of the paste in different layers over the lithium disilicate core with a great deal of control over the aesthetics.

My guess would be that your dentist is talking about putting all-ceramic crowns on your teeth numbers 4 and 5, which are the first and second premolars on your upper right. So your question is, should you get porcelain fused to high noble (otherwise called porcelain fused to gold) instead.

Cosmetic dentists consider upper first premolars to be in the smile zone on almost all patients. Practically everyone will show that first premolar prominently when they smile. It may not be prominent when you look at yourself straight on in the mirror, but it is very noticeable from the side. For me, I would not want a crown made of porcelain fused to gold or any other metal here because there will be a significant risk of a dark line showing at the gumline. The dark line comes from the metal foundation showing through right at the margin of the crown.

Behind that first premolar, in my smile, the teeth are all in the shadows, so the aesthetics is much less critical there. In my mouth, I do have a porcelain fused to gold crown on one of those teeth. I also have a crown on my upper left first premolar, and that crown is an eMax.

So my answer is that I disagree that there is no cosmetic value here. Having said that, if you were my patient and wanted the porcelain fused to gold crown on your first premolar, I wouldn’t fight you on that. But then I probably wouldn’t have the issue come up because I would charge the same fee for either crown. A porcelain fused to high noble crown is a premium crown, and I charged more for that than for a porcelain fused to noble (semi-precious metal) crown. But I don’t understand why the all-ceramic crown needs to be more than the porcelain fused to high noble.

– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

April 21, 2007

Porcelain crowns on lower front teeth.

Filed under: Crowns for front teeth — Tags: , — mesasmiles @ 2:42 pm

Dear Dr. Hall,
I recently had root canal treatment performed on my bottom two front teeth. My dentist indicated that I will need to have crowns put in. But the two bottom front teeth have very short roots, and there may be issues of strengh and stability of these teeth. It order to address these two issues it was suggested by my dentist that I have four porcelain fused to gold crowns put in. Two crowns would be for the two bottom front teeth with short roots , and crowns for each tooth beside these teeth. The stability would come from metal the lab would use to connect all four crowns together. I was also told that you would not see the metal, and that the crowns would appear like four individual teeth.

I asked my dentist if the procedure can be done using all procelain crowns instead of porcelain fused to gold since all procelain crowns have a more natural appearance and there was my concern about the black line appearing on the gumline if the gums recede? She insisted that porcelain fused to gold crowns was the best method for this situation.

My question is: Is it possible to have this procedure done with all procelain crowns? Do I have any other options?

Awaiting your response. Thank you,
– Nancy from Quebec

Dear Nancy,
As we say on our web site, all porcelain crowns look much more natural than porcelain fused to metal crowns. With the metal in them, they tend to get a black line at the gumline.

But you need to be very careful about pushing your dentist to use a material or procedure he or she may not be comfortable with or disagrees with. It’s much better to find a dentist whose philosophy you’re comfortable with and then trust their judgment.

In the case of lower front teeth, where she wants to splint the teeth together, there are several factors that weigh against using all porcelain crowns:
1. The black line at the gumline rarely shows with lower front teeth, on most people.
2. With gold metal on the back of the crown, the dentist will have to grind away less tooth structure on the tongue side of these lower front teeth. Since these lower front teeth are so small, that’s a significant factor.
3. She can join the metal in each crown into a strong metal framework.

So I would tend to agree with your dentist in this situation, just based on what you’re telling me, without doing an exam myself, which admittedly limits me here. If you aren’t happy with that, though, I wouldn’t push your dentist, as I said, but would get a second opinion from our Montreal cosmetic dentist, and see if there is a more esthetic way to do it.
– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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