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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

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

  1. Brian

    I have 2 questions

    How do you feel about partial crowns onlays? I had a large silver filling replaced with composite and it lasted a year. The bonding has failed and its sensitive to touch. (2 side filling)My dentists wants to crown it and I want to follow up with him and ask him to just do a partial if he will because I want to conserve the tooth structure. I am 41 so I hope I have a lot of years left on my teeth.

    Also if I do crown a top back molar and I better to go with gold since it will last longer than a fused porcelain?

  2. hahndds

    Dear Ingrid,

    Cosmetic dentistry is an art that is very “subjective”. This means that I may love your front teeth while you hate them. The hardest lesson we need to learn as cosmetic dentists is that “your” opinion is really the only one that matters. It is for this reason that cosmetic dentists go through a lot of extra steps when making restorations on the front teeth – temporaries that need to be approved for shape and size.
    Furthermore, we are able to “try-in” crowns before permanently cementing them. Were you able to see your crowns before they were cemented? This is a critical step as after they are cemented it is hard to make any changes.

    That being said, if there is a yellow line that bothers you on the crowns, often the outside layer of the porcelain is “stained” or colored. Slight reshaping or polishing often makes the crowns more “white” as the underlying color usually is more opaque. This may be something you want to try first before asking the dentist to make a third set.
    If you do decide to make a third set of porcelain crowns, make sure you approve the temporaries and try the final restorations in before cementing them.

    Keep smiling,

    Dr. Chris

  3. hahndds

    Dear Brian,

    I am not sure why the white filling failed, but if it is due to size and a possible fracture related to the old amalgam then a crown or “onlay” most certainly would be a good choice.
    Onlays are partial crowns, and a large onlay essentially is a crown.
    Generally, speaking, gold will always outlast porcelain and is my first choice by a mile. If the esthetics don’t bother you (they don’t bother me) then I would suggest you look at a nice conservative gold onlay. Make sure your dentist and lab has experience with gold work – it requires burnishing, proper margin finishing and a very specific retentive design!
    Also Brian, make sure you really figure out why the white filling failed…they should last a lot longer than a year!

    I hope this helps.

    Keep smiling,

    Dr. Chris

  4. Maria

    Dr. Chris,

    I have had horrible experiences with my crowns. I had two done at once (a top and bottom one that are opposing). The first dentist did a horrible job and the top one was shorter than my other top teeth and the bottom one taller than my other bottom teeth. There was also a lot of pain and sensitivity.

    I had another dentist re-do them, and he assured me he would make sure they were right and would send them back to the lab if I was not happy with them. Well, he went back on his word. When the new crowns came and I tried them on, they still were not right (top one too short and bottom one too tall). I spoke up but I was immediately argued with, bullied, pressured, and criticized by the dentist. I tried repeatedly to say they were not right, but I got the same response. Under the pressure I made a horrible mistake and told him to cement them in (because I wanted out of there so badly).

    So now I wasted thousands of dollars plus more in travel expenses to see this out-of-town dentist and I did not get better results. Is there any hope for me to ever get these redone correctly? I do not have the money, time, or emotional and physical resilience to go through it again at this time. It’s questionable whether I will ever trust a dentist again. If I were willing to try again, would you advise that? And is this something that you could correct for me?

  5. hahndds

    Dear Maria,

    I am sorry to hear about your problems with the dentists…Do the teeth still hurt or do the new crowns feel better?
    First, let me say that most dentists will make sure the temporary restorations fit correctly, and, if those look good to you then you can have them take an impression of those temporaries so the lab can duplicate the height. I would assume a good lab should be able to follow them and give you what you want…
    Now, I would do just that – make temporaries that you like and then duplicate this with porcelain. You could have a local dentist do this and send the crowns to a good lab (if you need one, ask me).

    I could help you, but many dentists can do this for you :)

    I hope this helps,

    Dr. Chris

  6. Star

    Oooo Dr. Chris,

    I have horror stories..Im a disabled Veteran..and have 100% coverage at the VA Medical Center – Dental. Suffice it to say..they have fee’d me out to a Dentist. I was so happy after they have ruined my teeth. I finally got 5 crowns done. Three of them finally have permanent crowns. I looked at them and he asked me..”how do u like them” and I said…”What is this..Why do they look like bricks? What are they square and flat”…and are you ready for this…I guess I have STUPID written on my forehead..he said and I quote “That is the new style..they are flat to keep them more clean”..Im like …For an Italian woman..I have NEVER been so quiet…I told him “They are crowns..why do they need to be kept clean on the top of the crown”..and I told him that they need to be changed..To make this horror story cut short..I read ur article above..and realize the the “marshmellow” hit the nail on the head..and that him and the lab are taking short cuts on my teeth. I have a appt. to go back and they are replacing them BUT I’m sure they are sending them off to the same lab to do it again and im terrified. Do you have a name of a lab in the Colorado Springs, Co area that I can suggest they send them to and I spend a little bit more money so I know I can get them back looking like teeth and not BRICKS :( Please help me…thank you in advance…:(

  7. Anthony V

    Hi Dr. Chris,

    I’m 34 years old. My number 7 and 8 had root canals (with posts) and crowns in 1999. Last year I developed throbbing pain from them and I just had an endodontist perform an apico on both of them (he said 7 had a large apical infection and both canals had bacteria in them which he cleaned). He said neither teeth had fractures or anything and I should be great. That was 5 weeks ago. I’m still getting the throbbing and burning up my crowns into my nostril (like before the surgery). What are your thoughts on this? Dr. said it might be “phantom pain” but it really does hurt still (with no provocation really). I have xrays if interested. Thanks, t

  8. hahndds

    Dear Anthony,

    This is a complex issue…sending me x-rays may help a lot! I look at things a little different than most dentists…
    First of all your body needs to be rid of infections in the mouth, that is critical. I would look at the quality of the root canals and the apico and then decide if I want to “keep” the teeth. Was the apico with MTA or amalgam?
    No matter how good the root canal there will always be a certain amount of infection in those roots. Ideally you want to avoid root canals, but if you can’t then you must have a super healthy immune system and premium quality root canal treatments.
    So, this leaves you with 2 options, basically. First, keep the teeth and second place an implant (never place 2 implants next to each other in the front of your mouth! It is an esthetic nightmare, so we place one and attach a cantilever tooth, #7, to #8). X-rays will help.
    Phantom tooth pain? Phantom means that the tooth/teeth would be missing and they are still there. The feeling you have probably is from infection or your body simply not being happy that there are foreign bodies in it and it can’t get rid of them.

    Keep Smiling,
    Dr. Chris

  9. hahndds

    Dear Star,

    Sorry to hear about your bad experience…
    For the new teeth, make sure you like the “temporaries” before the dentist proceeds to the final restorations. The temporaries can be adjusted until you like them, then the dentist can take an impression of the temps to help the lab technician deliver the result you expect.

    When it comes to labs, us dentists send work to labs all around the country – it does not need to be a local lab :)
    So, obviously a dentist that charges less than 1200 per unit will not be able to use the same labs I would use as they are too expensive (but incredibly good). For a good lab that charges dentist approved fees I would use World Lab USA in Irvine, CA. Make sure your dentist does not place full contour zirconium or emax on the front teeth, that never looks good! You should ask them to make Katana crowns :)

    I hope this helps.

    Keep smiling,

    Dr. Chris

  10. Jan

    I have had 3 crowns and a veneer replaced – the dentist decided to do the implant crown separately from the others – the first 3 are fine but he cannot get the implant crown right – it went back to the lab 3 times – after this it has had modifications made to it 5 times and is still not acceptable – in fact I cannot imagine there is any porcelain left to it – is it normal for a dentist to modify a procelain crown in their surgery and not send it back to the lab, he has used so many different materials on it trying to alter the shape and colour himself. thank you

  11. hahndds

    Dear Jan,

    5 times is a bit much…making modifications can involve a simple change in color or shape. You can adjust a porcelain crown a few times, but after too many adjustments the porcelain begins to look too “glassy”.
    On the other hand, it is kinda good that the dentist is taking the time to make it right. I understand it can be frustrating, for both you and the dentist, but you want to end up with a good looking and fitting tooth. Just make sure neither one of you settles…these implant crowns last a long time!

    Keep smiling,

    Dr. Chris

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