My dentist is recommending ceramic crown for my molar because she says that ceramic is better on the gum than metal crown. She is recommending a Lava crown. But the Lava crown is very expensive ($1200). My insurance doesn’t pay for Lava crown but pays for all porcelain/ceramic substrate.
What is your recommendation?
– James in California
There is some confusion here. A Lava crown is a “porcelain / ceramic substrate” crown. It is a very strong ceramic, with porcelain baked over the ceramic core. And as far as being kind to the gum tissue, I think gold is the best in that property. Of the ceramic crowns, Empress is noted for being very compatible with the gum tissue.
As far as what I would recommend, that would be hard to say without knowing more about your situation, what your bite is like, and exactly which tooth we are talking about.
And I also want to clarify this for others, because I am often getting e-mails where people want to know what is the best crown? They read that Empress is the best, or Lava crowns are the best, and so forth. And it really depends on the situation. Plus, the quality of the crown depends mostly on the skill of the dentist who is placing it. This is what is going to determine the preciseness of the fit, more than any other factor.
I have crowns on all my molars. On my second molars, I have gold crowns. That’s because they have the most stress on them, and gold will not break. Also, you can’t see them at all, so the function and longevity is more important there.
On my first molars, which are the ones closer to the front, I have a mixture of all-porcelain and porcelain-fused to metal crowns. Porcelain fused to metal doesn’t look as nice, but for a tooth that is in the shadows, as all of my first molars are, you can’t really tell the difference between the all-porcelain and porcelain fused to metal.
I have one crown on a premolar and I wouldn’t have anything other than a bonded all-porcelain crown there. It shows prominently in my smile, and the all-porcelain looks exactly like a natural tooth.
Where the gum has receded and a tooth shows prominently, it would be important to me to have a bonded all-porcelain crown. When you bond porcelain, you can feather out the edge so that the transition where the crown ends and the tooth begins is undetectable.
If you have gum disease and want to avoid any inflammation of the gums, the best way to do that is to keep the margin of the crown high and away from the gums, so that what touches the gums is natural tooth structure. But then you may have to balance that with esthetic considerations.
I hope this is helpful.
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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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