Compared with Gold and Metal Crowns

With old technology, dental crowns always needed to be made with a metal foundation.

Today, we can make them out of pure porcelain, ceramic or aesthetic reinforced resins. There are still occasions on the back teeth when the durability of a metal crown makes it the restoration of choice. But for crowns that show, wouldn’t you rather have one that looks as natural as possible?

Dental Crown Choices

A dental crown is needed when a tooth is badly broken down – either a cusp has broken off, or there are large old fillings or a large portion of tooth decay. A filling is used to fill a small portion of the tooth – a crown when the tooth has extensive damage. And when you have one made, there are three basic categories: metal (usually gold); all porcelain crown ; or porcelain fused to metal. This is some information to help you decide which type of these three basic choices you want.

This is the newest type of dental crown. Since dentists are not generally trained in dental schools in the bonding techniques required to place these crowns, you should be careful to only have them done by trained cosmetic dentists. All porcelain or all ceramic has the most beautiful appearance. It mimics the appearance of nature to the point where it is difficult to tell that it is not a natural tooth. It takes advantage of the new bonding technology, which allows a cosmetic dentist to bond it to your tooth so that it acts like it is one piece with your tooth – it’s like an enamel replacement. An all porcelain crown costs more than gold or a porcelain fused to metal. It is metal-free, and thus satisfies the needs of patients with metal.

On back teeth, when we use bonding technology, many cosmetic dentists do what are called porcelain onlays. These are very similar to all porcelain crowns, and sometimes the terms are used interchangeably. Using the term onlay, however, means that we are grinding away less of the tooth – we leave the healthy tooth structure alone as much as possible. With an onlay, since we can keep the margins away from the gum, we greatly reduce the tendency to gum inflammation that can occur with dental crowns. It also is metal-free.

Where appearance is not a concern to you, gold could be the best choice. Since the gold metal is very workable, gold crowns are able to have a more precise fit than any other type. Gold also eliminates the slight possibility of chipping that exists with anything that contains porcelain. For simple longevity, nothing beats gold.
Porcelain fused to metal crowns have a nearly natural appearance, subject to two limitations: Because they have a metal substructure, they require the use of an opaquer under the porcelain, which makes it impossible to re-create the translucency of natural teeth.

General Recommendations

In situations where there is a high amount of concern about appearance, a bonded all porcelain crown (metal-free) is the nicest restoration. For the front teeth, the advantage is its natural, lifelike translucency and not having to deal with the possibility of the potentially unsightly dark line at the gum line of the tooth. For back teeth, the advantage of a porcelain onlay is the conservation of healthy tooth structure and kindness to the gums.

Where appearance is no concern to you, gold is a logical choice, because it has the best fit and the best chance of lasting the longest. It will never crack or chip.

For teeth that are toward the back but that still show when you smile, a porcelain fused to metal crown is a good choice. Because it isn’t in such a prominent position, it usually looks very natural, and although it’s not indestructible, it’s strong enough to resist the heaviest biting stresses.

Craig W. Conrow DDS MS FACP is dedicated to the area of Cosmetic and Implants Dentistry, providing preventative maintenance and restorative dental health care for our patients. Take advantage of our modern dental facility and excellent dental care.