Dental Crowns: What Do I Need to Know

Dental Crowns: What Do I Need to Know

by Kristina Mackie, DDS
Loretto Family Dentistry, PLLC

Respect The House Rules, Even The Unspoken Ones.
Ask. Most people will not volunteer, but will be relieved when you ask, which includes “rules” like locking the doors, leaving the dog out, or bedtimes. And do as the homeowners do. Follow their lead. If they remove their shoes inside, you remove your shoes.

There are a plethora of options when a dentist considers the right solution for you. Generally speaking, there are 3 types of crowns with different subsets. They include all metal, porcelain fused to metal (PFM), and all-white or ceramic.

All metal crowns may have a mixture of different metals including but not limited to gold, platinum, palladium, silver, cobalt, nickel, and even tin. These crowns do not contain mercury as is seen in amalgam (metal) fillings. Regardless of the metal mixture, metal crowns have the benefit of resiliency when it comes to patients who have a very aggressive, hard bite or where there is limited space. They can be thin and strong and wear-resistant. The downside of all metal crowns is they are obviously not the most aesthetic option. Secondarily, patients with metal allergies may want to opt for high noble metal crowns as they are the most inert when compared with non precious alloys. I rarely place all metal crowns in my practice due to patient acceptance and other comparable alternatives however, there are definite indications for them, and at times, there is no better option.

Porcelain fused to metal crowns have been around for decades and are still a viable option today. I utilize porcelain fused to metal crowns on occasion. I will place them when metal is required on the chewing surface for wear-resistance with porcelain on the part of the crown that is more visible or in the smile line. PFM crowns can be made with porcelain wrapping all around the metal substructure as well. I see this quite often in patients’ mouths and they can last decades. However, their weakness lies at the junction where the metal meets the porcelain which can make them fracture-prone. Patients with metal sensitivities should also discuss this concern with their dentist prior to material selection. They are more aesthetic than all metal crowns but less than all ceramic options.

All white crowns, commonly referred to as all ceramic crowns, can be made of a multitude of materials. Lithium disilicate crowns are the workhorse in my practice. I love these crowns for several reasons. They are both strong and natural-looking. They have an element of translucency to them as is seen in tooth enamel which lends to their life-like appearance. Patients are also unlikely to have an allergy to this material. Lithium disilicate crowns still require adequate clearance or “space” as they need to be thicker than metal crowns to ensure resiliency to bite force. They are not without fault. They can fracture unlike all metal crowns however, lithium disilicate has surpassed traditional porcelain materials used in the past in terms of strength and longevity.

A well-made crown which is also well-cared for by the patient can last decades. Any man-made material can breakdown over time so crowns are not expected to last a lifetime (although some do). I liken crowns to tires; they will wear and last according to the miles put on them and the care and maintenance they receive.

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