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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

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

  1. Lida

    Correction…
    I can afford to get maybe just the two crowns. I don’t want an appliance since my bite only needs slight rasing and I hear horrible stories about those orthotics permanently opening people bites or leaving them worse off then before. I also hear you can get restorations for bites without using them and by adding to the teeth via crowns bonding …your thoughts please!?

  2. Dr. Chris

    Dear Sammi. Texture does usually help a lot with appearance and light reflection but you are the boss and your crowns need to look good to you. These ridges can often be polished down if needed so live with it for a while and then decide. Ideally this would have been discussed before the crowns were cemented.
    Keep smiling,
    Dr. Chris

  3. Dr. Chris

    Dear Barbara…
    This type of dentistry is routine and a general dentist should handle handle just fine.
    The dentist needs to get the crown right without trying to correct it by working on the tooth behind it. Don’t let them touch the tooth behind it and ask that the implant crown be redone until it is right. If they can’t deliver a correct crown then you should get your money back and see a more experienced dentist.
    Keep smiling,
    Dr. Chris

  4. Dr. Chris

    Dear Ingrid. It sounds like the bite is not adjusted correctly and you are hitting heavy on the front teeth. He dentist needs to get this correct or the teeth will move, break or fail with none loss. It is not “normal”. It annoys me when dentists try to avoid diagnosing the problem once they collected their portion by calling things “normal”. If it was normal then the dentist should have told you your teeth would be loose when you are done and how normal does that sound?
    Get the bite fixed before it causes problems and get a night guard!
    Keep smiling,
    Dr. Chris

  5. Dr. Chris

    Dear Marcus. Often we need to adjust the fit until it is perfect. I send back about 1% of the crowns I want to cement to the lab to be redone as most often they are nearly perfect but even the best labs can make mistakes – or your impression could have been distorted. If the dentist was able to get the crown to fit correctly great, but if there was a gap then he/she should send it back to be redone. Sometimes we dentists don’t want to send the crown back to look like we did a poor job so we are tempted to just make it work but really we should tell the patient that it just is not perfect and we will redo it 😉
    Ask you dentist and if you are concerned get a second opinion. An x-Ray should show how it fits if there was a gap.
    Keep smiling,
    Dr. Chris

  6. Dr. Chris

    Dear Lida. This is a complex issue and it would be impossible for me to give you a treatment plan with the limited information I have. But, here is the basic premise of what you need to do…
    First, the TMJ is the dictating force in designing how the teeth come together since we cannot change the position of a joint. Your teeth obviously are not in harmony with that position. So, often we use a night guard to slightly open the bite, remove any interferences and then determine where the teeth should be. Once the night guard has found a comfortable position (centric relation) then we see what it will take to make the teeth fit into that position.
    Over time our teeth wear down and shift, both of which can alter the TMJ position. When I rebuild smiles I often open the bite by working on all uppers or all lower, or both to re-establish that comfortable centric relation bite position.
    So, you need a sophisticated dentist to at least look at you and guide you along this path – drilling in a tooth or doing an only may make everything that much worse and cost you lots of water money.
    I hope this helps.
    Keep smiling,
    Dr. Chris

  7. Dr. Chris

    Dear Robbie,

    Sounds like you need a second opinion. First and foremost you lost confidence in your dentist and that is a problem.
    With regards to cementing crowns…. I am not sure what you paid for your crowns but my experience has been that cost is directly linked to quality, sorry. Time is expensive for a dentist and for that reason the cheaper the procedure the less dentist you get. The assistant will do more and more and the lab work will not go to a great technician/artist but rather something I would compare to a puppy mill. Sorry again, sore subject as I feel too many people are having these problems as quality gets worse, prices go down and the government tries to get its greedy hands into the insurance business.
    In your case the tooth should not have come apart (maybe the poorly bonded core came out) before cementing and the temporarily cemented crown should not have fallen off (most likely poor preparation design). So, to me it looks like you need to see a quality fee-for-service dentist (AACD accredited I would suggest) before your mouth becomes a mess. When poor dentistry goes bad, as it always does, the dentists answer almost always is a root canal or extraction. Ridiculous.
    I hope this helps,
    Dr. Chris

  8. Dr. Chris

    Sorry for your trouble.
    Let me address your issues one at a time:
    1. The crown margin should not be placed deep below the tissue, that makes things worse. Keeping the margin 0.25 mm above the tissue margin would be ideal.
    2. You should not be able to feel the edge of the crown, that indicates a poor margin.
    3. There should not be a black line. We don’t use porcelain junction margins (I sure don’t) but that is what it sounds like. Most dentists use zirconium or emax, both all porcelain. What type of crown is it?
    4. The bite or how the teeth touch needs to be perfect. It sounds like there is a problem with your bite and all my patients (85% plus) wear a night guard to protect their teeth and joint. Less than 1% of the crowns I place ever need a root canal treatment.

    So, you need to get a second opinion in my opinion. Root canals are not only costly but unhealthy. The problem is still there (probably due to the bite).

    Keep smiling,
    Dr. Chris

  9. Steve Brown

    I need advice. Two years ago my dentist removed an amalgam filling that was 30 years old, put in a composite filling. I went home and looked at the tooth, thinking I would see a pearly white tooth, but I noticed a line of dark beneath part of the filling. So, I called the dentist office and told them I thought he left behind decay. They said they would get back to me. They did, oh no, that is staining from amalgam. Well, it is two years later and now there is decay in that spot and the dentist says I need a crown. I don’t trust him now…. I have a feeling he did cover over decay with the composite filling. Too much of a coincidence for my liking. Thoughts? I googled cover decay with filling and there are dentists who do this! But, if a dentist is going to do that I would want to be told. Stuff like that bothers me, it is like shingling over a rotted house!! I don’t like it at all. But, it got me thinking what if he covers decay with a crown? I do not want a crown that fails or needs to be replaced early. This is a dentist who has a good reputation, however, I am not feeling confident and he seems to like to do crowns on people and other expensive treatments. Thoughts?

  10. Dr. Chris

    Dear Steve,

    If there was decay left under the filling you would probably be able to see this on an x-ray. Old amalgam does stain and we as dentists need to differentiate between “affected” and “infected” dentin. Dark color does not always mean it is bad in a tooth.
    The question is why after 2 years you have decay there…that is a problem. Your dentist should be able to tell you if this was from a new lesion or leakage under the filling – there always is a reason and you need to know.

    Secondly, a good crown works well but it needs to be a good crown. The blog above that you read does describe what a good crown looks liek so study this and discuss with your dentist prior to getting it done.

    I hope this helps.

    Keep smiling,

    Dr. Chris

  11. Dr. Chris

    Dear Steve,
    So, stain under a filling is possible and can make a filling look a little darker if it is thin. Amalgam, nasty things they are, can leave a dis colored tooth that is pretty healthy so leaving the stain is ok.
    That being said, the filling should be thick enough for strength and if a good “dentin” colored base is used you really should not see the color. Many dentists use “enamel” colored fillings all the time which results in translucent and consequent gray/dark teeth.
    Now the decay is a different story. 2 years is a long time and many things can happen in hat timeframe. It is impossible for me to comment on decay on a 2 year old filling as there are too many variables but if the dentist is suggesting a crown now then the filling must have been pretty large. Also amalgams fracture teeth so it is likely that a fracture was present allow bacteria into the tooth and this results in decay.
    A good crown is key and you are reading the right blog posts to understand what you need to look for there.

    I hope this helps.

    Keep smiling,
    Dr. Chris

  12. Steve Brown

    Thanks for the responses it all makes sense and I will make sure that I get a good result if I do get a crown.
    thanks,
    Steve

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