You Tube
image description

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

341 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?

  13. Jennifer

    Hi, I recently received a crown on my rearmost molar bottom jaw left side. As the dentist was applying it they ended up remodeling the grinding surface of the tooth above is this normal?

  14. ana

    hello, my dentist have modified the emergence profile on my crown and it’s so life changing because before a very bad odor was coming from this area now it’s better but there is still an odor and i have always my tongue between the 2 teeth i ask him to make the contact point less tight but he say it’s perfect and don’ t want to do anything more. any advise?

  15. ashish

    I have front tooth with dental crown cemented to it. Once I was eating it got detached and fell off. I am a bit worried as I fear it will detach again while I am out with my friends for dinner or during business trips as it is a front tooth. Is there any method method or cement out there which would make sure my tooth never falls off? please help me…I am always nervous while eating or going out with my friends…I feel everyone will laugh at me if something like that happens…please help!!

  16. Dr. Chris

    Ideally we tell patients if there will be a need to adjust the opposing tooth surface prior to cementing the new crown. This is occasionally done when the crown is thin, there is not enough clearance or the opposing cusp is too pointed. Usually we only take a small minor amount off and polish it up afterwards. I hope that helps!

  17. Dr. Chris

    Once a crown is cemented you really cannot make the contact any lighter. This has to be done before it is permanently cemented, sorry.
    The emergence profile has to be correct so it does not look like a big mushroom and traps food. This unfortunately is very common and requires a high quality lab and Dentist. An x-ray can often make the situation more clear if you want to send me one.

  18. Dr. Chris

    A crown should not fall off! You need to see your dentist to figure out what is happening before the problem gets worse…if you need more advice, let me know what happens after you saw your dentist.

  19. Celin

    Dr. Chris,

    I have two crowns done about two months ago. After the crowns, I have massive pain on my crowned teeth. I went back to the dentist, she adjusted both crowns for me; however, it didn’t help. I still have massive pain with my two crowned teeth.

    My teeth didn’t feel any pain before the crown. Now I cannot use the two crowned teeth because whenever I use them to eat, they give me massive pain. They are so sensitive to hot and cold drink and food. I try to just use them for warm and very soft food, they still cause massive pain.

    Did the dentist do a bad job? I feel like she may cut too much of my teeth away and damaged my nerves.

    Please advise why is that? I feel so sad. I don’t want to have root canal.

    Your reply and help would be highly appreciated.
    Celin

  20. Chris

    Dr. Chris,

    I had a crown put in about 2 months ago. Recently I bit into a small bone and possibly cracked my crown?

    Feeling increased cold air/water sensitivity, and also started to get bad tasting saliva in my mouth.

    Does it sound like a cracked crown?

    Thank you!
    Chris

  21. Dr. Chris

    Dear Celin,

    Clearly you are not supposed to have massive pain. I cannot give you a clear answer as I have too little information at this point. First you need to discuss this with your dentist and they need to give you options. A dentist must be able to come up with a differential diagnosis of the problem, or in other words, some ideas of what is going on. If you want to provide more information to me, that is good as well but don’t leave your dental office without either options or a solution. Cheers

  22. Dr. Chris

    A crack usually is diagnosed by having the patient bite on a piece of wood or plastic, isolating different parts of the tooth where the plastic/wood touches. Biting down usually is not as painful as when the bite is released. This is because the periodontal ligament around the tooth is pinched by the crack.
    An x-ray can help if it has been as while as often a lesion will form down to the crack as well.
    Lastly, checking the depth of the pockets around the tooth works well. Often the area where the crack is present will have a deep isolated pocket.

    I would assume it is more likely the tooth is bruised and I would see my dentist to check the bite asap. If the tooth is bruised it can be pushed slightly out of the socket and make it hit the top of the other teeth first which can crack or kill the tooth.

    I hope that helps!

  23. Dr. Chris

    Hello Celin. Not sure if I already replied, sorry for the delay.
    You should not have that much pain. It is very difficult to diagnose anything like this without x-rays but regardless there is something going on that needs to be repaired. I would ask your dentist to figure it out or get a second opinion. If you like you can send me some x-rays to review. Cheers

  24. Dr. Chris

    Dear Chris. You need to see a dentist to have some crack tests done. A crack hurts when you bite down and release the bite. That is the best test. It can be sensitive to many things so get it checked out – cracks can become fatal real quick!

  25. Alex

    I had braces before my crowns. The two teeth that I had covered are/were peg laterals. One of them was positioned behind the bottom teeth and the braces brought it forward. It has been about three months since I had this done, and my bite feels very uncomfortable on that one tooth, so uncomfortable that I feel like it is waking me up from my sleep and my teeth are bumping it. I’m not sure if it has shifted or I just noticed it. My two front teeth have veneers and are cemented together to prevent my teeth from moving. Should my dentist be able to correct this by sanding the back of the tooth down (I’m not sure of the technical term)? I’m not sure what to do, but this is very uncomfortable.

  26. Dr. Chris

    It is critical that the tooth is not hit too hard all the time or will die! Your dentist needs to adjust or open your bite with an appliance until the tooth has moved out of the point where it gets hit. Peg laterals are easy to work with so this should not be too challenging. Make sure that the orthodontist leaves space around the peg laterals so when you restore them they are the correct width. Also often orthodontists do not make the spaces where the two laterals will be the same size. Insist on them being identical so your cosmetic dentist can do an awesome job!

  27. Dona

    Dear Dr. Chris

    Hi there. I recently had three teeth prepped for crowns. Two teeth were broken and one needed a root canal. The teeth are prepped flat. Is this normal??? How will the crown adhere if there’s no anchor??
    Sincerely,
    Dona.

  28. Chase Reiner

    Hi Dr. Chris. I got a gum infection from a crown I got and I have no idea if it’s been placed correctly or not. Is there anyway I could send you an X-ray? I’d be happy to help consult you with SEO on you site, im currently the highest rated expert in the world.

    Chase Reiner

  29. Dr. Chris

    Dear Dona,
    We do not prepare teeth “flat”, there has to be something to hold onto. If you have a photo of the prep then I can comment more accurately. There is a “table top” design that was used by Jimmy Eubanks, a great dentist and technician. This design was flat but used is specific locations where porcelain would be only under compression force. A full crown would never be prepared flat.

  30. Clare

    Hi there
    I had my first crown fitted and I am really disappointed. I can see a black line of cement around the top of the tooth and the inside edge is smooth rounded and much wider than my other teeth.
    Is this normal?

  31. Dr. Chris

    Dear Chase,

    Absolutely. Send me your x-rays and anything else you may have. I am happy to help 🙂 And wow, that is a very generous offer. I could use all the SEO help possible 😉

    Send info to info AT idealdentistry DOT COM.
    Cheers,

    Dr. Chris

  32. Dr. Chris

    Dear Clare,

    Just like anything in life there are many different types of restorations, in respect of quality. It is a challenge for patients to know what level of care they are getting as most dentists seem to be experts at everything (so they say and advertise). This is very unfortunate. Still, each level of dentistry serves a purpose. How do you most easily determine which level of care you are getting and desire? Compare it to a car. If you are looking for a Ferrari then you know you will be spending a lot of money but you also expect Ferrari level performance, esthetics etc. If you are looking for a Toyota Camry then you are looking for safe transportation and know you will compromise a bit on performance and quality.

    In dentistry the only real guide the patient has is cost and insurance coverage. This means that if a crown is cheap then you will most likely receive a Camry and if a crown is expensive then you will receive a Ferrari. Not always of course, but often. Insurance in dentistry is a benefit – contrary to most patients belief it does not work like medical insurance. It pays a portion towards the dental procedure and has low yearly limits (less than 1 crown cost usually). The problem with dental insurance is that when a dentist signs up with an insurance company this dentist now cannot charge his/her regular fees but must charge what the insurance allows, which of course is a lot less so that insurances have to pay less. This cut in cost is a direct cut in quality. Sorry, but it is the truth. You get what you pay for in dentistry.

    So, when you mention a “line” around the edge of the crown and a crown that does not look right, it sounds like a cheaper, less artistic crown made by a lab that charges very little. I would assume that this crown was mostly covered by insurance and the dentist did not spend too much time on it. Now, you can of course have it redone with a Ferrari dentist but it will cost more. The dentist, regardless of cost or quality, should have shown you the crown first and received your approval of the esthetics prior to cementing it, especially if it it in the front.

    I have written many posts on this problem. Dental Insurance. I am here to help patients as much as I can, remotely, receive Ferrari care without having to see a Ferrari dentist.

    I hope this helps,

    Dr. Chris

  33. Lou

    Hi Dr Chris,
    I’m hoping you can help me. After having some periodontal work, my dentist replaced some older veneers with porcelain crowns. Six, total. I brush twice a day, floss & take a daily oral probiotic. I have cleanings every three months. The last cleaning was 4 weeks ago. Since then, I have noticed my crowns have become yellow. This is very disappointing as it has not even been 3 years since I had them done! I have been so careful not to stain them! I don’t smoke, don’t take medications, don’t drink soda & never have coffee without a straw. Any idea what could be causing this? I feel terrible!
    Thank you,
    Lou

  34. Dr. Chris

    Dear Lou, the porcelain won’t stain, at least not permanently. This leaves only one clear option which is that the teeth are becoming darker from the inside, which is not unusual. The color from teeth comes from the entire tooth, not just the outside layer. The porcelain crowns take into consideration the color of the underlying tooth. As the underlying tooth gets darker, or more chromatic, the teeth become darker and often a bit more yellow. The extend of this depends on the thickness of the porcelain. The thicker the porcelain the more it will block out the color below it. On a side note, I am not a fan of thick Emax porcelain as it turn gray/blue and looks bad. Not the most esthetic material in my opinion but it is used all the time!

    So, you are not doing anything wrong, per say, but even supplements such as colloidal silver can alter the tooth color.

    I hope this helps,

    Dr. Chris

  35. Darla Fites

    I got 11 teeth prepped for crowns. All on top. The model has half teeth big other half smaller. Said they didn’t want to send it back to lab, would critic it when temp was out on. Never did. My head hurts, my jaw hurts, it’s leaving, my bites off, and dentist said it won’t be perfect? I paid 8000.00, now I got anxiety crying and scared to have the rest finished and my daughters wedding in one month!!! Please help! I was told by dental assistant that she didn’t want to send model back twice and said we can’t b that picky! It’s a mess, I can’t sleep or eat and it’s a nightmare! What do I do now? It’s onky been 5 days. They want me to gone in tommow. But I’m afraid by what the assistant told me is I feel I’m just in a bad situation with this whole thing?

  36. Dr. Chris

    Dear Darla, remember this, YOU are the boss. YOU hired the dentist to provide a service for you, not the other way around. A dentist is not allowed to bully you into accepting anything. So, do not accept something that does not look good or fit good. A few guidelines:
    1. ALWAYS approve the fit and look of the restoration PRIOR to allowing the dentist to permanently cement it. Have them try it in. Look at it. If you don’t feel right or they are pushing you into it, say no. It must be right regardless of how many times it takes (within reason of course).
    2. Do not allow them to do ANYTHING else until what they have already done is correct.

    I am happy to help in any way I can. Send me photos, x-rays, whatever you need. I will give you an honest opinion.
    That being said, 11 teeth/crowns for 8k is quite cheap and while you need to be happy it would be impossible for me to do 11 crowns for that.
    Why did you need 11 crowns in the first place?

  37. Darla Fites

    I had 11 teeth prepped for crowns (all on top). First model came back bad, they sent it in again, second set- half teeth on right small half teeth on left big. The assistant said they didn’t want to redo it she said we r being too picky. There’s a huge difference. They put me in temps and said they would critic it, they didn’t cause the dentist and assistant didn’t agree on what needed done and wasn’t talking now. My bite was off, it wasn’t grinded down, teeth ugly, and I’m with 11 grinded down teeth with jaw pain, head pain, leaking temp and anxiety cause I have no idea what to do. They want me to come back in tommow and I’m freaking out u did all this cause I have a overbite and teeth r breaking off. They charged me 8000.00 and I only make 15000.00 a year and I will have to pay on this forever. Now I don’t know what to do. Please help me! I’m a disaster and have my daughters wedding in one and half month, and they know this. I’m in a panic. I can’t sleep or eat right my bite is a mess.

  38. Dr. Chris

    I am also concerned that you would spend half your income on teeth…please feel free to email me more details.

  39. D. Davis

    I have a dental implant in the very front bottom row of my mouth. I’m so very insecure about it as I smoked for awhile after getting it done and I feel like the color has changed. When I ask people straight up, the response is always, “I can’t see it” but when at work, where I speak to people in very close proximity I notice they always touch the area of their mouth where my tooth is. As a means of expressing that they see an imperfection. At least that’s the thought I have. People always tell me it’s in my head but I’m not making up the fact people always touch their mouths when I speak. Blows my confidence level. Is there any home remedies for cleaning an implant? I went back to the place I got it done, Clear Choice, might have been the wrong choice, and they too said it looked good. I am not crazy the tooth has a darker color tint than the rest of my teeth. Please help!!!

  40. Dr. Chris

    Dear D., generally speaking your own opinion and feelings are all that matter. That being said, could you send me a photo of the area so I know what I am dealing with? There are always things you can do and if this tooth is having this much of an impact on your confidence then it should be fixed :).

  41. Carol

    Dr. Chris thank you for all you do for others. Well, I’m still in the process of choosing the right material for front crowns. As I stated, my endodonticalkt treated teeth are very dark (think almost black) and my dentist believes feldspathic porcelain may be too thin and the black from my natural tooth will show through. He assures me his technician can make emax crowns that are not bluish/gray. But, then, that’s what the last dentist said and here I sit – new dentist, another decision. In your earlier response you suggested zirconia ‘layered.’ But when I parroted this info to my dentist he continued to say his technician has been with him for years. So my question: Since I would love feldspathic porcelain is it true they would be too thin to mask the black underneath? Should I insist NO emax regardless of my dentist’s technician’s unique skills? Should I still ask for layered zirconia?

Leave a Reply

Your email address will not be published. Required fields are marked *