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
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.
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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.
I have a Lava crown that has a bluish line at the gumline, and my dentist wants to replace it with a porcelain fused to metal crown. Why would I do that?
I don’t think you should go to a porcelain fused to metal crown. That’s the wrong direction. That will look worse.
That’s one problem that can happen with either of these crowns – the Lava or the e.max crowns. They are strong enough to be cemented conventionally rather than being bonded on. And when that is done, they can get that line at the gumline. It’s a subtle line, not as dramatic as the black line you can get with porcelain fused to metal. You say your line is bluish. That should be able to be minimized with a new e.max or feldspathic porcelain crown, bonded on.
The fact that your dentist is recommending a porcelain fused to metal crown is a big red flag. I wouldn’t let this dentist do a crown on my front tooth, if you want it looking natural.
– Dr. Hall
Thank you. That is what I thought!
You have clearly explained about the situation in a very excellent manner. It’s nice to hear your comparison between the latest technologies and existing ones.
Joanne Joseph says
I’ve been to two dentists to get my front right tooth looked at. I have a horrible looking cheap crown there and I’m ready to change it. I’ve been told by one LAVA crown and the other Emax and I’m not sure which one is better for my front tooth.
I don’t know much about the laboratory they’re using as it’s my first time using both dentists. I just want the crown to look good and as natural as it can look. I don’t want it looking bulky either.
There’s a metal placed in my tooth already I guess to hold the crown. I actually have requested they remove that because it has been there a long time.
Response by Dr. Hall,
Both the Lava and the e.max crown, in the right hands, will look great and perfectly natural.
About the metal in the tooth–it sounds like that might be the metal post going down into the root. Removing that could cause irreversible damage to the root and result in losing the tooth. I’d be really careful there.
What do you advise please?
Hi Dr. Hall,
Thanks for the great answer.
I was a little worried when my dentist says she will be using feldspathic veneers for me. Your answer has made me feel a little better. However, it seems like all the research I’m seeing online is stating that Pressed/emax veneers are stronger, fit better, and are less abrasive to your enamel. See here: https://www.dentistryiq.com/articles/dem/print/volume-10/issue-4/materials/all-veneers-are-not-created-equal.html
Do you agree with the analysis in the site above?
I would really like emax veneers, as they sound like they are 2-3 times stronger than feldspathic, however, if feldspathic veneers are as strong as normal teeth and can last 15-20 years, I would be happy.
Would appreciate your feedback. Thanks!
Response by Dr. Hall
You’re right about the advantages of pressed ceramic veneers in that the material is stronger and the material is less abrasive to the opposing tooth. And in most cases they may fit better, though that would be more a factor with crowns than with veneers. Here’s the other side of the story, though.
The dentists online who are touting the pressed ceramic veneers are not, in most cases, your most artistic cosmetic dentists. The reason highly artistic cosmetic dentists tend to prefer the feldspathic veneers is that the esthetics are superior. In the article you quote, Dr. Pescatore (who is an excellent cosmetic dentist but is not an accredited cosmetic dentist) kind of admits that but says he can work within the esthetic constraints and get a result that is just as good. That kind of sounds like car ads that tell you that this cheaper car is “just as good as” a Lexus or a Cadillac.
As far as strength, the veneer by itself is, even in the case of pressed ceramic, no where strong enough to survive in the oral environment. It gets its strength from the bond to the tooth. Veneers, when they are properly bonded, don’t break, so to me, that is a non-issue.
As far as wear against the opposing teeth, if we are talking about veneers on the fronts of the upper teeth, they don’t occlude against any other teeth, and so again, that isn’t an issue if we are talking about your basic smile makeover. That would be a factor with veneers on the lower teeth or with crowns.
And then, the preparation for pressed ceramic is more aggressive. The dentist has to remove twice as much tooth structure, because the material is thicker.
Having said that, there are some dentists who can create gorgeous smile makeovers with pressed ceramic. The big issue is the artistic ability of your dentist. Don’t rely on her claims. Can you independently verify that this dentist is one of the maybe 1-2% of dentists who can create a beautiful smile makeover? That’s where you need to be careful.