What Should A Good Porcelain Crown Look Like?
Dentistry is a unique profession. We don’t just deliver a service, but we also deliver a product. Porcelain crowns, or caps, among many other type of restorations are delivered on a daily basis in a dental practice. So, what makes one dentist different from another? Why does one dentist charge more? What could the big difference be?
Here is a quick example of the difference between a good crown and a bad crown.
The sole purpose of a porcelain crown is to repair and preserve the tooth, mimicking its original shape and function. The color should match the existing teeth, so it blends in.
This is what we expect from a GOOD crown:
- Perfect Fit
- Matching contour to the neighboring teeth
- Straight emergence profile from the gum tissue
- Good contact between the teeth and the opposing biting surface
- Good color and stain match to neighboring teeth
Common errors seen in a BAD crown:
- Poor fit of crown – Results in recurrent decay, sensitivity, quick failure of crown.
- Over contoured crown – Results in inflammation around tooth, gum disease, recurrent decay and quick failure of crown.
- Crown fits on tooth like hat on a hat rack – Result is same as #2
- Crown is either too tight between teeth, too light or no contact at all – Results in food impaction, and consequent recurrent decay.
- Crown looks like a marshmallow or corn kernal rather than a tooth.
So now you know what a good crown should look and fit like. Now why are not all crowns made like this? Simply put, making a good crown is an art and requires a high level of skill. It takes time, and time is money.
The dentist needs to deliver a perfectly prepared tooth, a perfect mold of that tooth, and a perfect prescription to what he/she wants from the technician.
The technician needs to perfectly trim the model, perfectly build the crown on the model, and perfectly adjust that crown on the model. Then the dentist needs to try this crown on the tooth first, make any necessary adjustments, and then cement the crown perfectly. There is no room for error!
Preparing the tooth takes time and skill. Taking a perfect mold takes time and skill. The less a dentist gets paid for a procedure the less time he/she can spend on it. It is a simple matter of economics. It is a business. Running a dental practice is very expensive and there is significant cost involved.
Now, once a perfect mold exists the crown needs to be made by a highly skilled technician. The more skill the technician has the higher the cost. It is a very simple formula. You get what you pay for!
All these steps and requirements put together are what it takes to make a good crown. A bad crown is not much better, and sometimes worse, than no crown at all.
Look at the photos and see if you can identify the differences between the good and bad crowns. Then, decide which type of crown you want in your mouth.
I could literally post thousands of photos of bad dentistry.
The difference between a good and a bad crown is immense – the aesthetics are better, the fit is better, the longevity is better. Would you expect to pay the same for a good and a bad crown? Of course not. A crown should last a very long time – decades. So, if the cost difference is less than a few pennies per day over the lifespan of the crown, why not get the good crown?
At Ideal Dentistry we only place good crowns because that is the right thing to do.
Keep smiling,
Dr. Chris
posted in Blog, Cosmetic Dentistry
Adrienne
Thank you so much for taking the time to respond and Happy New Year!
I have a couple of follow up questions (hope you don’t mind…I feel guilty for monopolizing your time).
First, I guess that I neglected to point out that this tooth (#30) was formerly crowned, it had an older crown that was cracked so this dentist took it off, used the existing post and put on the new crown (the BruxZir) so I can’t figure out why this crown is so “malformed” for my mouth . Might it have something to do with the lab (?) or the partial impressions (?)
As you know, the crown was seated temporarily since it was immediately obvious (at least to me and my husband) that it would have to be redone because of color and size issues. I am so dissatisfied with this BruxZir (it feels like a malformed foreign object in my mouth!), I would like to have the dentist replace it with an Emax rather than with another BruxZir (Emax is the other type of crown that he offers) May I ask you :
1. If you had to choose between an Emax and a BruxZir which would you choose and why?
2. I would like to request that this dentist do full mouth impressions for the lab (rather than the quadrant impression that he made for the BruxZir). My Dentists (before this one) have always done full mouth impressions stating said that full mouth impressions are better. Instinctively, I know this just makes sense but can you please tell me exactly why?
3. Should this dentist do full mouth impressions and get me an Emax crown made for me if I request it?
4. Do you feel like it will be an uphill battle? And lastly.
5. Do you have any suggestions on how best to go about making these requests?
Your advice is VERY VERY much appreciated! This has been an awful experience for me.
Adrienne
January 1, 2013 at 1:32 pm
hahndds
Wow, that is not a cheap crown. I really hope you find the right dentist! Kentucky is a great place to visit
Dr. Chris
January 8, 2013 at 5:06 pm
hahndds
Good Morning Adrienne,
Don’t ever worry about using my time up, this is what I like to do!
1. Emax vs BruxZir: A BruxZir crown crown is made out of zirconium and is very strong. Most labs make this out af of a solid block of Zirconium giving it a monochromatic, saturated look. They sometimes then are “painted” with color to make them look better. I am not a fan of what is called the “staining” technique of crowns. A Emax crown is made out od lithium disilicate and is a newer type of crown. It “can” be cemented according to the manufacturer, but I prefer to bond them on. They can be stained or “layered”, giving a more esthetic result. They also are pretty darn strong, but, not the most esthetic crowns either. I don’t use “BruxZir” crowns but rather crowns that have a zirconium core with porcelain baked over the core for esthetics. I use Emax in patients who have very strong bites (bruxism as well) but don’t really like to. So, here is the bottom line: A GOOD lab technician can make ANY crown look nice and work well! So, it is not the crown that is the issue, it is the lab. In general, I prefer cemented restorations over bonded restorations for many reasons.
(this is an insurance issue)
2. Full mouth impressions capture the entire functional mechanism. The “other” side of the mouth has a “canine” as well that is responsible for anterior function, which is critical for design of the “angles” of the crown. Plus, the other side most likely has the “natural” tooth left that now is getting a crown, so, a beginner lab tech can simply copy the shape and size of the tooth. Every “quality” dentist will take a full mouth impression and bite registration.
3. I would do a full mouth impression and get either an Emax of a Zirconium core crown, not a pure zirconium crown. Say you want the “layered” technique, not the stained technique. Make sure the crown matches the shape and size of the opposing tooth in the same arch.
4. It most often is an uphill battle to get dentistry redone as dentists cut cost not because they don;t care but because the get paid too little to make any money
5. Well, I would put your feelings in a nice letter, that takes the emotion and confrontation out of it. I also would consider a new dentist, out-of-network, who focuses on you, not the insurance company. You may end up paying to redo the crown with that type of dentist.
Keep smiling,
Dr. Chris
January 9, 2013 at 6:38 am
Adrienne
Thanks Dr. Chris,
your information is invaluable. All dentists should be as great you! All I can say about my dentist (soon to be “not” my dentist) is that he has become a very wealthy man in his given profession – even though he accepts insurance. How he has managed to accumulate such wealth is not a hard equation. He gives everyone as little time as possible and works on volume. In his case – very HIGH volume. I believe that everyone deserves to make a good living at what they do and I understand the insurance “problem” however, even those dentists who do accept insurance need to do right by their patients. After all, this is a helping profession…a healthcare profession. It’s unethical to see your patients as simply a means to an end…or a way to buy another sports car. Insurance should not be putting dentists in the poor house but at the same time insurance-accepting dentists should not rely on cheating their patients to become wealthy. I believe that there can be a better balance. This has been an education for me. Maybe, if your insurance-accepting dentist drives a Bentley, walk away (ha ha)
!!!!!!
It’s incredibly kind of you to go out of your way to give me, and all the others that seek your advice, so much of your time and consideration. Thank you so much
I will follow all of the advice you gave me and will give you an update. Thanks again
January 13, 2013 at 1:44 am
Adrienne
Quick question: in your response to my inquiry on Jan 9th you said that an Emax can be bonded or cemented but that you prefer to bond it. Why?
Also later you said that you, I assume – generally speaking, that you prefer cemented restorations over bonded ones. Is that correct or a typo?
If you can clear that up for me, I’d be grateful. Just want to make sure that I completely understand. Thank you!
January 15, 2013 at 5:54 pm
hahndds
Well said Adrienne
All the best to you.
Dr. Chris
January 22, 2013 at 8:55 pm
Kate
Dr. Chris,
Your comments/reply to Adrienne were actually quite helpful to me as well. If i may ask for some more detail, I would be forever in your debt!
I am actually in the process of having six anterior restorations completely redone by whom I’m confident is the best qualified in my area, after a horrible experience with my general dentist. I had three crowns placed on my 7, 8, and 9 as the result of fractures on the 7 and 8, and my previous dentist recommened I restore all six front teeth for the best result including veneers on my 6, 10, and 11 – HUGE mistake as I had nothing but problems with my canines veneers, and simply surprised of the outcome and wish I’d researched much more sooner.
I’m now in a better place after better temporaries have been put on, however, i’m now ofcourse concerned about the end result. My previous dentist’s lab tech used Empress, and they were bulky and grey. My new dentist’s lab tech may likely use EMax – if so, i prefer for a gradual transition of color toward the back….would that help these not look so obvious? Are Emax veneers less bulky than Empress? Thanks so much for your advice and feedback….very much appreciated. Kate
January 24, 2013 at 10:29 pm
hahndds
Dear Kate,
So, I am probably going to complicate things a bit more for you, sorry…
First, the material of the veneers is not nearly as important as the skill of the technician (singular, not technicians!). The better the dentist the closer the relationship between the dentist and the lab technician. Big labs have many technicians that vary greatly in skill level. To achieve consistent quality you need to know who will be making your restorations. I, for instance, use 4 different technicians to satisfy all my patients. One technician makes beautiful Hollywood white smiles (I call these my Knockout Veneers), another one makes beautiful restorations that challenge nature (these are what we call Natural Veneers), another technician works with matching shades on single teeth, and yet another “lab” makes restorations for those patients that want to save money (or have to), etc.
So, in your case, ask your dentist who will make the veneers. Go to their website, see if you like the work (yes, most good labs have good websites).
Now to the more detailed answer. I personally am not a fan of emax. I have done my fair share and tried to like the material because of its strength, but, I am just not a fan. It just does not have the translucency and realism I like. Empress on the other hand can look really beautiful, but, the most beautiful veneers are felspathic veneers (hand stacked porcelain). Why does everyone now recommend emax? Well, simple, it is easy for the lab to make!
Now, if a good technician works with emax then you will probably get a pretty good result, just make sure they “layer” the porcelain, not just make one big blob and stain the outside (this is how the vast majority is made).
Some of my preferred porcelains: Noritake, Creation, Authentic, Empress Esthetic. Empress is second, and emax is last. There are more, but I am used to the above.
So, to address the “six-pack”. Most good cosmetic dentists will avoid doing 6 teeth for many reasons, one being the fact that most mouths will have a back corridor down the side of the back teeth afterwards. There are some blog posts I wrote on this, so search for black corridor or six pack. I recommend 4, 8 or 10 usually. You can simply put composite facings on the back premolars (4,5,12,13) to help avoid the six-pack look.
I hope this helps! Make sure you love the temporaries and tell the dentist to match them in shape and form closely! That way there is no surprises.
Keep smiling,
Dr. Chris
January 27, 2013 at 8:41 am
Robert Kelly
What can I do if a dentist damages a tooth intentionally but for unknown reasons, then lie/deny when she was confronted about it? I want the behavior corrected but the office manager has been inaffective in handling the matter.
March 20, 2013 at 6:28 pm
hahndds
Dear Robert,
Sounds like there is an ethics issue in your office. Generally speaking I surround myself with people that I respect and enjoy working with. If I encountered what you have described I would remove myself from the situation (find another job) and possibly report the doctor to the dental ethics board. Tough road…sorry
Keep smiling,
Dr. Chris
March 26, 2013 at 6:41 am
Kathleen Shaw
Hi, I recently went to the dentist to have a filling replaced from old metal to composite. I have a crown (molar) #31 behind that tooth that when tapped by my dentist that day showed a sign of sensitivity in one spot. It doesn’t hurt now, it isn’t sensitive since he tapped it, but when I rub all around the tooth it feels like “its there”. Never noticed this before because nobody ever tapped it. He was going to replace it “now” anyway because it has a small pie shaped wedge that chipped out right after I got it in 2006 or 07. Now my dentist wants me to go to a (can’t remember name) DR that deals in root canals to check it out first before he does the crown replacement. I just want to get a new cap. BTW, it looks like a marshmallow not a tooth, and the color is horrible, bright white. I have to be diligent and floss all the time so it stays nice and clean. I’d do this anyway, but more with this capped tooth. Do I really need to go to the other DR? By your description, I’ve got a lousy cap! Thank you, Kathleen
April 2, 2013 at 3:58 pm
Kathleen Shaw
And one more thing, the cap feels like it could move if someone really tried to push it.
April 2, 2013 at 4:17 pm
hahndds
Dear Kathleen,
Let me try to answer your question with the information I have
First, your dentist should have an “x-ray” of the tooth and be able to determine the need of an root canal treatment most of the time through several tests.
Second, it sounds like the crown is not “ideal” and that a “wedge” shaped part at the gumline is missing in the tooth. This is called an abfraction, if I am understanding you correctly. These lesions are due to a bad “bite” which means the crown is hitting the opposing teeth incorrectly. So, first I would have a simple bite adjustment done!!! Then, re-eval the tooth in a few days and again in 3 weeks. I bet it would feel better.
Let me know!
Keep smiling,
Dr. Chris
April 6, 2013 at 8:57 pm
Ella McVey
Dr Chris,
I would be so grateful if you could answer my question.
20 years ago (aged 11), I fell off my bike and broke my front right tooth in half..my dentist placed a temporary crown and for the last 13 years I have had a porcelain fused to metal crown. My teeth are very nice (if I do say so myself), they are straight and white, but recently I have become very self conscious of how my crown spoils my smile.
I have become very aware that the crown sits much lower down on the gum line than the front left tooth, and has a bluish appearance around the gum. It also looks a different round shape at the gumline whereas the natural tooth is more pointed.
Is it ever possible for a crown to sit as high up on the gumline as the natural tooth? So that they look the exact same length?
April 18, 2013 at 3:48 pm
hahndds
Dear Ella,
This question is very personal to me as I had the exact same experience myself at age 12. This accident is part of the reason why I now am a dentist!
So yes, you can absolutely have matching front teeth, and you should!
The most challenging thing in dentistry is a single front tooth restoration so I strongly urge you to see a AACD Accredited Cosmetic Dentist to help you with this challenge. You can find them through the aacd website.
The two front teeth must be as identical as possible.
Keep smiling,
Dr. Chris
April 20, 2013 at 7:14 am
Anton
Dear Dr. Chris,
I recently had the replacement crown however there is big silver stain in shape of a circle in middle of the crown. I saw it right after I got home. There is no way the doctor didn’t notice it. I wonder what that is and why the doctor didn’t do anything about it at the time. I’d like to know if it is normal before I call the office and question them. Thanks much for your advice again.
Anton
April 20, 2013 at 2:18 pm
Kevin
Hello,
I have had a crown placed on one of my upper molars 8 months ago, but I see that there is a gap between the edge of the crown and my gumline on one side of the tooth. The gap is very easily noticeable. Does the crown need to be replaced due to high risk of getting cavities?
Thanks,
April 22, 2013 at 5:45 pm
hahndds
Dear Kevin,
Generally speaking, if a crown does not fit perfectly on the tooth (meaning there is a gap between the crown and the tooth) then it will decay. So yes, if you have a gap, see your dentist and have it replaced!
Hope this helps.
Keep smiling,
Dr. Chris
April 23, 2013 at 5:36 am
Will
Dr. Chris,
I have a concern with my new crown. It is on my very front tooth and the Dentist shaved a huge angle on the tooth, because of the way I move my jaw back and forth.. Asthetically, it doesn’t look uniform, and he wants to shave the ajoining front tooth similarily to make them match.. I feel this is really going to affect my esteem. SO, my question is, why didn’t he just leave the tooth straight (uniform with the adjoining tooth), and is the crown that fragile that it needed to be done?
April 24, 2013 at 2:18 pm
hahndds
Dear Will,
A single front tooth restoration is the pinnacle of cosmetic dentistry! Meaning, there really are not many things in dentistry that are more difficult. That being said, there are too many variables for me to give you an accurate response. Here are some guidelines:
First, all treatment options should be discussed prior to treatment. This would include the possible need to work on adjacent teeth.
Second, the shape and design of the new front tooth should have been determined in the prototype phase (the temporary). Once the temporary looks good and functions well you move on to the final restoration, never before.
It looks like there might have been some skipped steps in your case and that means an unpredictable result is likely. Being that a single front tooth truly requires an expert cosmetic dentist I would recommend you seek out a AACD ACCREDITED COSMETIC DENTIST to give you the best possible result.
You are right, it will affect hour confidence among many other things. This needs to be done right and I hope you seek a dental expert before proceeding with any other treatment.
Keep smiling,
Dr. Chris
April 27, 2013 at 7:17 am
charlise
I just got a crown on in it hurt bad. Plus it got a white ring around it. what does that mean?
May 11, 2013 at 11:31 pm
hahndds
Dear Charlise,
I am sorry for your poor dental experience. Dentistry these days should not be that uncomfortable.
It is difficult to diagnose a white ring around a crown without actually seeing it…my best guess would be the tissue is blanching for some reason – this usually is the case with tight fitting implants or bridges, but not so much with crowns. Can you give me some more information?
Thanks,
Dr. Chris
May 13, 2013 at 8:54 pm