6 factors to consider when picking out the best kind of crown for your tooth.

What’s the best kind of crown for your tooth?

This page contains a couple of different resources for figuring out what type of crown most likely makes the optimal choice for your tooth.

• Our “6 Factors to Consider” section is a quick run-through of the information found elsewhere on our pages (we provide links) detailing the comparative pros and cons of each type of dental crown, and with what applications these factors are likely to play an important role.

• We also offer our “Crown Selection Drill Down” that guides you through the process of picking out the best type of crown by answering just a few questions.
• Our last section provides an example of what dental clinicians tend to feel makes the “best practice” choice for different types of teeth and applications.

A) Checklist: Factors to consider when choosing a type of crown for your tooth.

#1 – There is no single “best” type of crown.

No one type of dental crown offers the best solution for all applications. So before you make a final decision, quiz your dentist about all of the different types of crowns Pros, cons, etc…. Especially if up to this point they’ve only mentioned placing one kind.

Hopefully, they’ll outline the same general issues our page does. If not, quiz them some more. Because if you’re after superior aesthetics, or great strength, or the right combination of the two, it really does matter which is placed.

#2 – At least consider a gold crown. They make an excellent choice for back teeth.

If cosmetic appearance is not a factor, nothing can beat a gold crown, period.

• They provide excellent service. – All-metal crowns are the strongest, most durable type of dental cap. Because they are solid metal, there is nothing to chip off. Likewise, they don’t crack or break.
• They’re very biocompatible. – While exceptionally durable, gold crowns won’t wear down opposing teeth (like porcelain-surfaced crowns can).

A gold dental crown.

No type of crown gives longer, more predictable service than a gold crown.

#3 – The great advantage of all-porcelain crowns is their beauty.

The big advantage of having porcelain (all-ceramic) dental crowns placed is that they create an exceedingly life-like end result. So, in those situations where cosmetic considerations are of great concern, all-porcelain crowns make an excellent choice.

a) The trade-off of all-ceramics is one of strength and cost.

An all-ceramic dental crown.

Ceramic dental crowns can excel in their lifelike appearance.

Even though modern ceramics have been developed that are much stronger than dental porcelains of the past, no type of all-ceramic can boast of having a service track record that comes close to matching that of all-metal or porcelain-fused-to-metal crowns. And they usually cost around 10 to 20% more Fees for crowns..

b) All-porcelain dental crowns can make an excellent choice, but only in selected situations.

Ceramic crowns can make a great choice for upper front teeth, where cosmetic appearance is a major concern. However, when considered for molars, bicuspids, or lower front teeth, their risk of fracture and higher cost may make other types of crowns a better choice.

Need more details? Visit our Porcelain Crowns page.

#4 – Porcelain-fused-to-metal crowns are a middle ground between all-metal and all-ceramic caps.

The construction of porcelain-fused-to-metal crowns (PFM’s) is one where an overlying surface of porcelain is fused onto an underlying thimble of metal.

A porcelain-fused-to-metal dental crown.

PFM crowns offer good strength characteristics and a natural appearance.

• Porcelain-fused-to-metal crowns are very strong. – While not as strong as all-metal crowns, dentists routinely place PFM caps on back teeth.
• Porcelain-fused-to-metal crowns can produce pleasing aesthetics. – While not as translucent, the cosmetic appearance of PFM’s can often approach, and possibly equal, those of all-porcelain caps.

PFM’s do have some disadvantages.

Porcelain-fused-to-metal crowns do have some shortcomings that may come into play in some situations:

• If the tooth’s gum line recedes, the crown’s underlying metal edge may show and spoil the tooth’s appearance. (An important concern with front teeth.)
• Unless proper protocol is followed when the bite of a PFM crown is adjusted, its porcelain surface may wear opposing teeth.
• It’s possible for portions of the crown’s porcelain covering to fracture off.

The new type of porcelain-metal crown.

In recent years a new type of porcelain covered restoration has been developed. It’s called the pressed-to-metal (PTM) or pressed-over-metal (POM) crown.

To look at one of these restorations, you’d think it was a PFM. But what’s different about it is its method of fabrication and that a stronger, possibly more esthetic, type of ceramic is used.

• On the upside, PTM/POMs address all of the limitations of PFM’s stated above.
• Their biggest downside is that they don’t yet have a time-tested track record of use.

▲ References for the technical details of the factors discussed above – Rosenstiel, Shillingburg

#5 – Make sure to compare costs.

You can expect a PFM or all-metal crown to cost around 10 to 20% less than an all-ceramic. Crown fee estimates.

a) If dental insurance is involved …

It’s common for a dental plan to cover 50% of the cost of a crown, minus the plan’s deductible.

As an example, for a crown that costs $1000, and a plan that has a $100 deductible, insurance would pay $400.

[If you’re concerned about costs, have your dentist file a “predetermination of benefits.” In response, the insurance company will report the amount of benefits they will provide for your planned work.]

Common dental plan exclusions:

• No benefits for replacing crowns (that the plan previously paid toward) that are less than 5 years old.
• No coverage for crowns that are placed for purely cosmetic purposes. However, ask your dentist about this point. The crown you think is strictly cosmetic in nature may serve other (covered) purposes as well.

b) If you’re paying for your crown out-of-pocket and its cost is a bit of an expense …

Ask if you can arrange to pay half of your crown’s cost now and half later, possibly even stretching the second half over a couple of payments. This arrangement can provide a way where your dentist can cover their immediate costs, yet help to accommodate your financial needs too.

Need more details? Visit our Dental Crown Costs page.

#6 – Make sure you understand why your dentist has recommended a crown.

Dental crowns serve many important functions. But if your tooth does not require one then other types of dental restorations make a better choice.

b) There are other ways to improve the cosmetic appearance of teeth.

If it’s just a change in appearance that’s needed, porcelain veneers Applications, pros, cons. may provide a less invasive way to accomplish the same cosmetic end result. In some situations, just placing tooth bonding Applications, pros, cons. may suffice.

c) In some situations, a second opinion can be a good idea.

If your new dentist suggests several crowns (while your previous dentist never did), or if your current dentist seems to solve every problem by placing one, a second opinion may be in order.

It’s expected that dentists’ opinions will vary. However, over-diagnosing the need for crowns can be hard on your pocketbook and bad for your teeth. When in doubt, consider seeking a second opinion.

B) Which type of dental crown makes the best choice for you? – Our drill-down selector.

By answering the questions below we can help you to drill down to the kind of crown whose characteristics best match up with your needs. And each answer box that opens also provides a link to information on our pages that discusses the special issues that should be considered with that type of crown.

►  First question – Will your crown be placed on a front tooth or back one? –

• Front teeth = Incisors, Canines (cuspids, eyeteeth).
• Back teeth = Molars, Premolars (bicuspids).

a) For front teeth –

Which is the bigger concern?

1) Exceptional appearance. – All-ceramic crowns are renown for their ability to create a lustrous, life-like result. But make sure you read through our discussion, not all types of all-ceramics can make this claim. Why not?

2) Strength & durability. – Porcelain-fused-to-metal restorations are a type of hybrid crown. They have a metal under structure that creates great strength, yet their porcelain surface gives a natural look.

But as we outline in our discussion about them, PFM’s have some inherent characteristics that can present difficulties View the list.. But in the hands of a talented dentist, they can usually be managed.

b) For back teeth –

Which is the bigger concern?

1) Strength & durability.

Would an all-metal crown be acceptable? – If YES … There is absolutely no type of crown that has better characteristics than a gold one (strength, longevity, durability). So it the look of one isn’t a problem, then having one placed typically makes a great choice.

(Note: The appearance of an all-metal crown can be toned down by adding a “porcelain window.” Example.)

If NO … In applications where both a natural-looking tooth and great strength are required, porcelain-fused-to-metal crowns have a long history of providing reliable, lasting service.

As a newer alternative, high-strength compounds Engineered ceramics. have been developed for some types of all-ceramic crowns (zirconia seems to be the strongest). But ask your dentist a lot of questions about why an all-ceramic is their recommendation because they don’t have a long established track record like PFM crowns do.

2) A natural appearance.

In applications where a “white” crown is needed for a back tooth, porcelain-fused-to-metal crowns have the longest history of providing reliable, lasting service.

As a newer alternative, high-strength compounds Engineered ceramics. have been developed for some types of all-ceramic crowns (zirconia seems to be the strongest). But ask your dentist a lot of questions about why an all-ceramic is their recommendation because they don’t have a long established track record like PFM crowns do.

C) What type of crown do dental clinicians think makes the best choice?

The following information comes from an article written by Dr. Gordon Christensen and published in the trade magazine Dental Economics. Dr. Christensen is a well respected dental researcher and clinician (we use several of his articles as reference sources for our pages).

In this article, he delineated the kinds of crowns that he felt typically made the best choice for each type of tooth or application. In our outline of that information below, we’ve listed his preferred material (crown type) first, and then the others in decreasing order of his preference.

▲ Section references – Christensen

• Application: Upper or lower second molars –

  Preferred crown types: all-metal (gold alloy) > PFM (porcelain-fused-to-metal) > full zirconia > lithium disilicate

  Notes: This order of crown types suggests that for back teeth where heavy chewing forces are involved, the strongest type of restoration makes the best choice. Gold is listed as the preferred construction material because most people’s second molars don’t show prominently and therefore its metallic look is not typically an issue.

  Links to further information on our pages about the types of crowns discussed in the article:
  all-metal (gold alloy)
  PFM (porcelain-fused-to-metal)
  all-ceramic (layered construction)
  full zirconia (monolithic construction)
  lithium disilicate (monolithic construction)

• Application: Lower first molars –

  Preferred crown types: all-metal (gold alloy) > PFM > full zirconia > lithium disilicate

  Notes: Once again, for teeth that don’t show prominently when the person smiles, choosing the type of restoration that has the greatest strength makes the best choice.

• Application: Upper first molars –

  Preferred crown types: PFM > lithium disilicate > full zirconia

  Notes: Upper first molars typically are visible to others, so for that reason, only porcelain crowns are included in this list. PFM is shown as the first choice, no doubt due to the great strength and longevity this type of construction usually provides.

  Since lithium disilicate doesn’t create as strong a restoration, we were surprised to see it listed ahead of full zirconia. The text of the article stated that the preference for it was based on it’s more favorable aesthetic characteristics.

• Application: Upper or lower premolars (bicuspids) –

  Preferred crown types: lithium disilicate > PFM > full zirconia

  Notes: For premolars, lithium disilicate is listed ahead of PFM. This would imply that for these teeth the superior strength of a porcelain-fused-to-metal crown is not necessarily needed. It also suggests that the aesthetic disadvantages of PFM’s (primarily the “dark line,” see above) make the all-ceramic construction of lithium disilicate crowns the better choice.

• Application: An individual upper or lower front tooth –

  Preferred crown types: all-ceramic > lithium disilicate

  Notes: Here the first recommendation is for some type of all-ceramic crown but not one made using a high-strength synthetic porcelain.

  That’s because creating an individual crown that precisely matches the color and translucency of neighboring teeth is very challenging. And using a high-strength porcelain would only make this task even more difficult (see above).

• Application: All 6 upper or lower anterior (front) teeth –

  Preferred crown type: lithium disilicate

  Notes: When placing an entire set of crowns, the issue of color matching is much less of an issue. As long as all of the crowns match each other, the case will usually look acceptable (and hopefully much better than just that).

  That means choosing lithium disilicate makes the better choice. It has reasonably good aesthetic characteristics and also has greater strength than the typical dental ceramic.

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.