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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:

  1. Perfect Fit
  2. Matching contour to the neighboring teeth
  3. Straight emergence profile from the gum tissue
  4. Good contact between the teeth and the opposing biting surface
  5. Good color and stain match to neighboring teeth

 

Common errors seen in a BAD crown:

  1. Poor fit of crown – Results in recurrent decay, sensitivity, quick failure of crown.
  2. Over contoured crown – Results in inflammation around tooth, gum disease, recurrent decay and quick failure of crown.
  3. Crown fits on tooth like hat on a hat rack – Result is same as #2
  4. Crown is either too tight between teeth, too light or no contact at all – Results in food impaction, and consequent recurrent decay.
  5. 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.

Good Crown
Good Crown
Good Crown
Good Crown
Bad crown
Bad Crowns
Bad Crown
Bad Crowns
Bad Crown

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

241 thoughts on “What Should A Good Porcelain Crown Look Like?

  1. Dr. Chris

    Dear R Nash,

    It was a good thing that your dentist redid the crowns. Now, getting the bite correct is not “optional”, but required. Take all the time you need to get this done right, regardless of how “annoyed” the dentist may get.
    Maybe you should have him put in writing that he/she would be paying for any problems arising from having a bad bite that was not there before the 2 crowns were placed. For some reason I don’t think he/she would sign that paper and go ahead and adjust your bite :) Sorry, a bit passive aggressive but this type of problem should never happen…

    Keep smiling,

    Dr. Chris

  2. Kim

    Hi Is it normal for my crown to have a silver ring all around the bottom? I don’t have it on the bottom of my upper crowns (all molars) . Also one of my crowns has silver (looks like a filling in it) do you know why they would have made it that way?

  3. Dr. Chris

    Dear Kim,

    Sounds like it is a porcelain fused to metal crown. The dentists opted for this crown for their reasons and should have probably discussed with you the options first. I would ask your dentist why he/she used this type of crown as it is becoming less and less prevalent.

    Cheers,
    Dr. Chris

  4. Kim

    Hi Dr. Chris,

    Thank you for getting back to me. I just had another crown put in and this one has it too. Is it cheaper for the dentist? Is it stronger? He only showed me the outside and he held it so I didn’t really see it inside. He did not show it to me in my mouth before he cemented it in, but the other ones he has done look good, except for that ring around the bottom of them which I really don’t like. I just want to make sure there is no amalgam in them as that is what I wanted to cover up. Such a shame I have been leaking mercury into my system for years, as that is really what is in amalgam fillings. I think it is very interesting that almost no one gets amalgam fillings anymore, yet no one ever really talked about the change. Makes me wonder why??

  5. Kerri

    Hi Dr Chris
    I had a root canal done over a year ago and from day one have had a problem with it.. The best way to describe it is that it feels like the post and crown are way to tight. After reading this it confirms what I already knew and that is that I also have a bad crown. It looks like a blob of porcelain was just laid over my tooth. The tooth is really bothering me lately. When I went back right after I was told there was nothing wrong with the root canal.. I have two others that I don’t even think about. The only difference between this one and the others is the post. Is it possible a post could have been put in wrong and can this be fixed?

  6. Patricia

    I’ve been a patient of my dentist for 15 years and had extensive dental work. One of my more recent crowns has been cold sensitive ever since it was placed several years ago. It wasn’t cold sensitive before the crown. There is a very noticeable gap on the inside between the crown and my gums. Could that be the reason? I could tell he was not happy with it when he was placing it. When I complained about the sensitivity I was told it was temporary. When it didn’t subside he adjusted my bite and said if that didn’t help he would have to do a root canal.

  7. Katie

    Hello,

    I have just had 3 crowns fitted over very discoloured teeth, due to very old fillings from when I was a teenager (now 26), whilst they do look quite d=good, I can just see the black of my real tooth around the top of the crown where it meets the gum and also if i look inside my mouth the white crown doesnt go all the way up to the gum on the inside and therefore is showing black from my actual tooth. I am very self conscious with black teeth and I had these crowns hoping they would cover all the black. Question being, should I be able to see any black of my real tooth?

    Many thanks,

  8. cara

    How long should a dentist replace a bad crown for free? Tooth # 15 was chipped so my dentist put a porcelain fused to metal crown on, problem was it didn’t fit so he sanded off the porcelain on the back side of the tooth, exposing the metal underneath. since this is a back molar you can’t see the exposed metal unless my mouth is wide open and you are really looking. I asked him to replace it a few months after it was placed, but he said the crown was fine and didn’t recommend replacing it. I have since changed dentists and my new dentist wants to replace the crown. The crown is only 2 years old, is my old dentist required to replace it for free? My insurance won’t cover it because it is less than 5 years old.

    Thanks

  9. eric weaver

    what about trimming good teeth to fit the crown/ I figured the crown was too big and they would trim the crown instead of my other teeth

  10. Dr. Chris

    Dear Eric,

    Sometimes the bite is adjusted on the opposing tooth for various reasons. Regardless, the dentist should explain to you “why”. If the tooth that is receiving the new crown is already cut down to it’s minimum size and there is still not enough room for porcelain or gold then the opposing tooth will need to be adjusted.

    If the new crown is just too big then you are right, the crown itself must be adjusted and not the opposing tooth.

    Cheers,

    Dr. Chris

  11. Dr. Chris

    Dear Cara,

    If the crown was adjusted to the point were it was worn down to the metal it should have been replaced before it was cemented. Crowns should be adjust prior to being cemented of course for these reasons. The metal usually is super thin!
    Now, 2 years later you will have a tough time proving that this was the case as the chart notes most likely will not reflect your story.
    On a good note, as long as the metal is not worn away the crown is sealed and should be fine, meaning that it does not need to be replaced for that reason. Why does your new dentist want to replace it? The metal showing is not reason enough for a replacement unless you wear through the metal……
    Insurance, which is not concerned about you one bit fyi, won’t pay for a replacement because the just picked the 5 year number out of a hat. I do not let insurance dictate treatment and would look at your health first – sometimes crowns placed a month ago by dentists should be replaced!

    I hope this helps,

    Dr. Chris

  12. Dr. Chris

    Dear Katie,

    The black from your underlying tooth is visible due to many reasons…if the dentist wanted to hide it completely he/she would need to put the edge/margin of the crown deep below the tissue. That being said, if this was one of your chief complaints then you need to discuss this with your dentist as the crown may be a functional success but esthetic failure. Most dentists will want you to be happy and possibly redo them with a margin that goes deeper below the tissue.
    Now, margins that are above the tissue are actually healthier for you! Getting the tissue exactly right is the pinnacle of Cosmetic Dentistry and not easy for most to get perfect.

    I hope this helps,

    Dr. Chris

  13. Dr. Chris

    Dear Patricia,

    If there is a gap where the crown touches the tooth then it needs to be redone asap! If your dentist is not communicating with you on this then go get a second opinion on that tooth before you do need to kill the tooth with a root canal. Most dentists will work with you on getting it right :)

    Cheers,

    Dr. Chris

  14. Dr. Chris

    Dear Kerri,

    There are so many variables here….I would need to see a picture of the root canal and post to give you an honest opinion. One thing I can say though, your feelings usually are right and you may need a second opinion to look at this situation.
    You should not be able to feel the post or root canal for that matter. The crown may be too tight and have poor contours which would result in the situation you described.

    Cheers,

    Dr. Chris

  15. Jenny

    Hi,
    I recently had two front teeth crowns placed due to my natural teeth worn down. The first crowns that came in were wrong color and the second set seemed better, but I only really got to see them for a short time in the bathroom before they were cemented in. Now it’s been 2 months since I got them done and I’ve realized that they are so much more yellow than the surrounding teeth. I used to love my smile but now hate it due to the color of my crowns. They look really nice otherwise, but I just can’t get over the color difference. Is it too late for me to get them replaced without having to pay the full price for new ones since I did already approve them? I’m scared to ask my dentist about it.

  16. Jody Really just a nobody housewife

    I had a bad feeling about one of the five crowns my dentist pressured me into getting..I had to have a better dentist remake it because it was so poorly fit. I just had another one put on by the first dentist (he is the only one who participates with my dental plan) and it is totally flat, while the surrounding teeth are of normal contour for teeth. I am just now starting to think that he, not only was just doing crown to line his pockets, but is not doing a satisfactory job and on all of them, I eventually needed a root canal done. With this last one, I could feel that he was grinding the tooth really low down, and I think he even realized that it was too ground down and now the tooth is very sensitive to cold, hurts with pressure…so guess what, I am probably going to need endodontic work on this one too. I guess learning now is better than never. I think he has been unethical pushing these crowns on me, then they all eventually needed root canals. Btw, each crown costs me (out of pocket) $1,000. And each root canal costs me $800.

  17. Dr. Chris

    Sorry about your experience Jody but it has been my experience that most dentists try to do their best. The cost of dentistry is high not because us dentists want to line our pockets but because we had to spend at least 8 years of post High School education learning about Dentistry. Most dentists graduate today with $250,000.00 to $500,000.00 in loans and zero income. Then we have to build a business, pay staff, pay labs, and make a living :) Yes, it is a business but why would anyone smart enough to become a Dentist or Doctor spend 8 years of their life during which they certainly could earn a great living doing many other things become a Dentist or Doctor only to continue to struggle?
    Sorry for the rant, but I still am paying my student loans :) I chose to put my patients first and do not subscribe to any dental insurance plans. This is for the patients benefit as I am here to serve my patients. $1000.00 for a crown is about half my fee so I do not know how a dentist can use a premium lab and deliver premium care and make a living at that cost, sorry. I also understand that not everyone can afford that cost so I do spend a lot of time helping my younger patients understand how to avoid crowns and root canals in the future – this is the key. There needs to be a dentist for everyone – some dentists are forced to charge $600 for a crown due to the insurance company owning them – I would rather do just about anything than work in that type of environment.
    So, I hope you are able to prevent future problems with proper diet, function control (proper nightguard), proper oral hygiene and good dentistry.

    Cheers,
    Dr. chris

  18. Dr. Chris

    Dear Jenny,

    Never be afraid to speak to your dentist. He/she may charge you a bit for redoing them since you approved them but you need to be happy with your smile.

    I hope you get the smile you desire,

    Dr. Chris

  19. Francine

    Hi,
    I recently had a crown/cap placed on an implant for tooth #31. Since day one there has been a gap between the bottom of crown and top of my gum; extending about 5-7mm from back of tooth #30 to implant post. I continuously have food getting trapped in this area. I thought I could live with this, but I can’t. I went back to dentist and he told me this happens and it’s normal. There’s really nothing he can do and if he attempted to do something it could cause other problems. He did suggest making gap larger to allow better cleaning.

    I believe this answer to be unacceptable. Am I correct?

    I’m concerned to have him do any more work regarding crown/cap because if something goes wrong I think he’ll say he warned me of that.

    I’ve only had crown since Jan 2016 is this something I can get my money back.. so I can get a new crown elsewhere?

    I’d appreciate your opinion.

    Thank you,
    Francine

  20. Dr. Chris

    Dear Francine,
    While I am not able to actually see the implant it is usually best to not have this gap. If the implant in the bone is not placed correctly then sometimes it is impossible to get a proper emergence profile (tooth contour). I would suggest you get a second opinion with someone that can actually see the implant and x-ray so that you can make an educated decision. I would not make the gap bigger!

    Cheers,

    Dr. Chris

  21. Vince

    Hello Dr. Chris,

    What is your thoughts of a Composite Resin Crown over a Porcelain Crown on a Molar.

    Thank-you,

    Vince

  22. Dr. Chris

    Dear Vince,

    What a great question! I am not sure what the circumstances are so it is hard to answer if this is the right course of action but you certainly can bond composite resin (like indirect Componeers) to porcelain if done correctly. This would prevent the need for more tooth removal and could be a great option to open the bite or change occlusal anatomy (as well as improve esthetics).

    Cheers,
    Dr. Chris

  23. Michael Solomon

    Hi there.

    I recently had a crown put on a front tooth that I broke when I was a kid. I am getting a weird sensation from the tooth whenever it makes contact with my bottom teeth. I can only describe it as a pressure or pushing sensation. It is not pain at all. The temporary did not have this problem, only the permanent crown is doing it.

    Any idea what this is? I am not sure how else to describe it and I am afraid my dentist will not know what I am talking about.

  24. Dr. Chris

    Hello Michael,

    It sounds like you just need a simple bite adjustment. This is quick and easy so go ahead and talk to your dentist before it causes a problem :)

    Keep smiling,

    Dr. Chris

  25. Mona

    Hello,
    I had a crown done on tooth #3, I cannot see but feels ok, my issue is when I floss it feels like floss gets under the crown and shreds the floss and if I pull it harder it breaks the floss. I talked to my dentist and he says that is good to floss around and get underneath…he said he could perhaps “buff it up” a little. This makes me doubt that the crown is done correctly, I thought everything has to be sealed so well. I do not feel there should be an edge where floss gets under. What should I request from the dentist?
    Thank you,
    Mona

  26. Dr. Chris

    Hello Mona,

    Shredding floss is a bad sign…an x-ray (bitewing) might be able to show the actual fit of the crown but “buffing” it would not solve this issue as it is between the teeth and you cannot correct that location unless the tooth next to it is gone.

    I hope this helps.

    Cheers,

    Dr. Chris

  27. Mona

    Dr. Chris, Thank you for your response. What would you suggest I do??? Can I require the dentist to re-do the crown??? Please advice how to act on this.Thank you again, Mona

  28. Shirley

    Chris,

    Have you ever educated your patients on the burden that insurance places on them? For some of us providers, we have no other choice than to offer 600 dollar crowns BECAUSE of insurance negotiations. And it’s sad, because there’s a FINE difference between the work I used to do as a fee for service practice associate vs. an office with over 20 PPOs associate. I hope the people who ask you for an opinion understand the limitations of what their insurance gets them. You don’t really get to be picky on the small things (shade matching, translucency of anterior restorations), Just the things in which would cause HARM to the patient, but minor issues are rarely ever addressed being reimbursed by insurance.

    Shirley

  29. Rob

    Dr. Chris,

    I had a crown done in 2009 & it has never bothered me, i recently went for a cleaning & my dentist informed me that the gums around the crown were inflamed & irritated. He used a explorer today & told me that the gums began bleeding when he used his explorer & that this was not normal, i asked what the option to correct this issue was & he explained that either replacing the crown or seeing a endourologist to get minor surgery & move the gum line up or down (cant remember) would fix my problem.

    I have no pain or sensitivity in the tooth @ all.

    The same dental office i went to today are the ones that did the crown initially, the dentist that seen me today did not do the crown, a doctor that is no longer there did. The Dentist from today informed me that it looked like the crown was not the best fit from the get go.

    He also explained that I could try using a stimulator & water pick & try healing the gum around the tooth, before trying minor surgery or replacing the crown.

    Here is a x-ray of the crowned tooth: http://imgur.com/P6eqIAv

    Picture of tooth 1: http://imgur.com/wcghpG8
    Picture of tooth 2: http://imgur.com/dGjajqR

    What is your opinion on this, please let me know what you would recommend for one of your patients? Thanks!

  30. Dr. Chris

    Dear Rob,

    The images were EXTREMELY helpful! Here is my adjusted image showing you what the problem is:
    Poor Fitting Crown
    The crown fits terribly bad and you need a “good” new crown. If this was produced by the current office and they watched this on x-rays for years then you NEED to find a new dentist. This is one of the worst fitting crowns I have seen.
    So, do not get any “surgery” as the problem is entirely the bad crown – the fact that the dentist mentioned surgery as an option makes me shudder.

    Keep smiling,

    Dr. Chris

  31. Dr. Chris

    Dr. Shirley,

    You are completely correct, insurance places a tremendous burden on dentists! Patients cannot expect a Ferrari for the cost of a used Yugo, yet many of them do. This is one of the biggest challenges faced by dentists and I opted to see fewer patients, make a little less money but deliver only fee-for-service dentistry. Many dentists in my town do not have this option and they struggle to balance business and health care. I do believe you can provide a service for patients that don’t have the money for premium dentists but we need to be careful not to treat patients like a paycheck – check this x-ray below a patient sent to me today with his dentists saying he should get gum surgery to fix the swollen gum issue…
    Bad Crown
    This is why I write this blog! Patients needs to get “acceptable” dentistry regardless of how much they pay…
    For all the dentists out there providing the insurance crowns at $600 per unit, I am not sure how you can do it, I sure could not…but someone has to.

    Keep smiling,

    Dr. Chris

  32. Rob

    Dr. Chris,

    I can not thank you enough for your insight on this problem of mine. So basically from what i understand the crown was way to big for the tooth from the get go? Would you say this is a typical case of poor lab manufacturing, or the dentist did not take a proper impression? Regardless of the crown being ill fitted, is it true the dentist should not have placed the crown & cemented it in knowing that it fit so poorly?

  33. Sue Taylor

    I had a ceramic/porcelain crown put on tooth #3 at a cost of $950. My dental plan doesn’t pay for that type of crown on that tooth-only pays for a high noble(gold) crown. My problem is I wore braces as a kid and before the work started I had 4 teeth pulled: #5 and 12 on the top and 21 and 28 on the bottom. So tooth #3 shows in my smile and I don’t want a gold crown showing. Shouldn’t they cover the tooth colored crown in this instance?

  34. Dr. Chris

    Dear Sue,

    It sounds ridiculous that they would “not” cover a crown on that tooth. A High Noble crown could be a High Noble Gold Crown with porcelain fused to it….They certainly would not be able to limit it to gold only. I would call them or have your dentist call!

    Keep smiling,

    Dr. Chris

  35. Rob

    Dr. Chris,

    If you had a previous dentist @ your practice that placed such a ill-fitted crown like mine & he was no longer @ your practice, even being it was 7 years ago would you replace it for free? Does it appear that malpractice is in play here as it took 7 years to pick up on this problem of mine? Also, for the sake of $$, would you say its safe that i now have the knowledge to make sure the crown is properly fitted to go back to the same practice that put my crown on & request some kind of discount for a replacement, or demand it replaced for free, one that properly fits?

    I know you said i NEED to go elsewhere, but financially i may not be able to if i am offered a discount for a replacement or replaced for free. Would you say this is safe to do as long as its a different doctor & i ensure its properly fitted before i leave?

  36. Mrs hutton

    I had veneers done 25 years ago I got new crown and to veneers done. My bite is off my teeth don’t match. Hat to get root canal in one tooth a little bit oh the nerve was left, hen tooth get taped it hits the nerve. My gum line is sore all the time and the dentist says it will all settle down. Got it done 7 months ago

  37. Rob

    Hello Dr. Chris,

    Thank you again for all of your advice. I went back to the dentist, WELL EDUCATED being what you informed me of, thanks again! Anyway, i went in & they admitted that the crown was ill fitted from the get go, the dentist that installed the crown for me is since gone.

    I went to my appointment, they cut off the permanent PMF Crown & discovered some decay, they got rid of that, then upon inspecting the root canal treatment found some moisture on one of the roots, i go in soon for a re-root canal treatment & they are doing all of this @ little to no charge.

    I figured you would want an update, but since you informed me that i needed to go in to get it replaced it sounds like I seeked your guidance at the right time, because there are some problems under the crown now being rectified, thanks!

    I have a problem going to the dentist, and was wondering if a re-root treatment is a fairly painless process, should i be just fine? I am scared & seeking guidance on what to expect.

  38. sophia meeres

    Dear Dentist,

    I recently had a lower first molar extracted because of a crack – followed by a bone graft, titanium implant and porcelain crown screwed into place. All expensive and seemingly well done EXCEPT the crown itself is quite ugly. It really does look a bit like a kernel, and the filled screwhole is grey/blue. It doesn’t look like the tooth it replaced. I complained immediately, and wrote to explain my dissatisfaction the next day. My dentist agrees that the aesthetic is disappointing but explains that a flatter tooth is necessary “to reduce stresses” and also because there is little room for vertical shape given the chimney and fixing system and my “short teeth”. He offers to redo a cemented crown but says not to expect a “higher” tooth, as there is no room for it. I do expect cusps and vertical shape within the height of my tooth, but have lost a bit of confidence now so feel nervous about having a bad crown cemented in!
    How to know that the new crown is OK before its finally fixed in place? And should I “manage my expectations” as the dentist says? There are almost no pictures of good-looking molar crowns – in mouths – on the internet, but lots of fuzzy photoshopped and computer generated images. Is it really possible that a flat tooth is my only option?

  39. Dr. Chris

    Sounds like your bite is off which means you are hitting the teeth too hard which can result in killing the tooth. Doing a root canal onyly takes away the pain from the tooth – if the bite is still off then the gums, bone and tooth will also continue to fail.
    You need to have your bite looked at and adjusted by someone that understands function! Then you need a nightguard :)

    Cheers,
    Dr. Chris

  40. Dr. Chris

    Hello Rob,

    Your welcome and you should be fine :)

    Cheers,

    Dr. Chris

  41. Dr. Chris

    Hello Sophia,

    So, lots of good questions. First, yes, you can have a good looking implant crown but there are limitations that can affect the final result. The space between the teeth is one of those restrictions. I don’t have a photo so I cannot comment on that in your case. The “abutment” on the implant has a certain height but if there is a room/space issue I would ask your dentist to use a UCLA Abutment method (attaching the screw retained implant directly to the implant without the middle part).
    Screw retained implant are better for many reasons. The screw access hole should be filled with an opaque white teflon material and then a matching composite color placed on top of that. This should result in a very esthetic (not gray or blue) result.
    Lastly, implant crowns should be slightly out of occlusion only – it still should look the same. You should expect a nice looking implant crown!
    I have many photos of good looking implant crowns but not here at home from where I am writing you :)

    Cheers,

    Dr. Chris

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