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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

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

  1. sammy

    When a crown is placed, how tight is too tight? Floss should fit between the crown and the adjacent tooth, correct?

  2. Dr. Chris

    When a crown is seated it should feel “normal”. Meaning, it should not feel tight and floss should snap trough. An open contact or a too tight contact are both bad.
    Most often contacts these days are too tight because labs make these block emax crowns and adjust them to fit on the tooth before glazing them. Once the contacts are perfect they bake a glaze on the outside which makes it easier for them with polishing. This of course adds some thickness to the crown and they forget to adjust the contacts again and voila you have a too tight crown. If the dentist does not adjust the contact properly you end up with a poor fitting crown that is either too tight or did not seat all the way down and leaves an open edge where decay and fluids enter. This causes sensitivity and often the dentist has to grind a bunch off the top. I hope this helps!

  3. Connie

    My crown doesn’t have contact with the next crown that my dentist did. Is my dentist legally obligated to fix the crown? It’s been about. 1 year since receiving the crown.

  4. Dr. Chris

    Dear Connie,
    Since it has been so long I cannot comment on that very well. The crown, when seated, needs to have contacts and fit correctly. Any issues should have been resolved at that visit. If you contacted your dentist right afterwards with issues and he/she did not resolve then the dentist should redo.

  5. Dr. Chris

    Since it has been 1 year no. These issues must be addressed at the seat appointment.

  6. Dr. Chris

    I am sorry you had a bad dental experience. It is really not acceptable that a dentist cements front teeth without getting your esthetic approval first. It sounds like the dentist was a bit in over his head. In my opinion it should be redone asap at no cost. That is where I would start.

  7. Mag

    Dr. Chris, On the last appointment my dentist prepared me for crowns and sent the order. When I came home I noticed something really black (it was not there at first) on my gum and on my lip right above my front teeth I am waiting my crowns for. Then my skin mostly died and fell off. However, the tooth I am trying to match my crowns to also got darker: right now it is the same as the one on the other side of my future crowns (which is a dead tooth, but the tooth I am worrying about is very much alive). It looks like a film, but I cannot get it off with brushing. It is very frustrating, since I did not ask for darkening my teeth. I don’t know what that is. The only thing that I know that I paid for the “Cosmetic enhancement” (which I did not even agree to and don’t know what that “cosmetic enhancement” really means… – maybe that was something else, I don’t know…) I am confused and frustrated. Do you know (any idea) what has been done and if this treatment will eventually go away? Thank you very much!

  8. Dr. Chris

    Dear Mag, the black you are seeing could be many things including the chemical we use to stop bleeding. It should be temporary. I hope you receive the esthetics you desire. Be sure to APPROVE the new crowns BEFORE they cement them, that is the most common problem patients have.

  9. Karen

    I have been having trouble with a crown on tooth #10 since it was placed three years ago. It has never felt like it fits correctly which is likely the reason why it has fallen out once and broke twice. This crown replaces one that I previously had for 15 years and never gave me a problem until I bit down on something hard one day and it broke. This new crown has never felt the same or looked the same as my old one. My tongue constantly goes to it because it feels so foreign. My dentist has attempted to fix it each time it has broken but now is asking me to have a crown lengthening procedure before she fixes it a fourth time. I had the initial consultation with the periodontal surgeon and that went okay except for the $2400.00 quote for the procedure. My dentist will also charge me $1300.00 to do the crown again. I am not happy about the amount of money it will cost to fix this of course, especially since I have already paid for a crown twice plus a root canal. However, I am most concerned about allowing my dentist to have a fourth attempt at this considering the three previous failed attempts and this time having a surgical procedure on top of it that could alter the appearance of my gum line, resulting in the need for another oral surgery. Simply said, I have lost confidence in my dentist. I am wondering if I should get a second opinion from another dentist? I do not want to have this oral surgery only to have an ill-fitted crown placed once again. I am feeling very conflicted about this and need to make a decision soon as my current crown is loose and I do not wish to cause any further damage. I would appreciate any advice you may be willing to give.

  10. Dr. Chris

    Dear Karen, it is very clear to me that you need a dental expert. This is your smile zone and confidence in your dentist is not optional, it is a must.
    I know that most AACD Accredited cosmetic dentists would be able to serve you well. Find the closest one and get a second opinion.
    Cheers,
    Dr. Chris

  11. Carol

    Dr. Chris:

    I have had 6 emax crowns placed in front (my dentist chose emax because of how dark my endodontically treated are). I will not go into all the details here but would would like your advice. What other material – in front – would you suggest using that would be more aestically pleasing than the bluish-gray emax and yet strong enough to protect my fragile teeth? I have been told not to use zirconia because they can be very opaque. But, then, so are the ones I have.

  12. Dr. Chris

    Dear Carol. I find emax to be the least esthetic material out there yet all dentists like to use it. Strength is overrated. Most porcelains, including feldspathic porcelain, will last very long when used correctly. Zirconium can be made to look very nice but for better esthetics I use either authentic or empress (or narotaki). It also depends if it is a cemented restoration or a bonded restoration that the dentists wants. Strength is the least important characteristic of porcelain.
    Just because a tooth has had a root canal does not mean it needs a stronger porcelain.
    That being said I prefer a cemented crown so I can try it in better and reduce the margin error that bonding can have. Bonded restorations will need the margins polished which is very difficult and if your dentist picked emax for “strength” on the front teeth because they were root canaled then I would really doubt that he/she has polished the margins.
    Cutting of emax crowns is very very difficult as the material is so hard.
    I would use a high quality lab technician (note I said technician, not lab) to make zirconium LAYERED porcelain crowns. This would result in predictable esthetics with much healthier margins (make sure they hand polish the crowns with no glaze).
    If you need me to recommend a few good technicians, let me now. They are not cheap but who wants to save some money and get ugly front teeth?

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