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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

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

  1. hahndds

    Dear Mom,

    A veneer should not come off! Is it a porcelain veneer? Once a veneer is bonded on it should break before coming off. If you send me more information about the procedure I will be happy to give you more advice. Some questions to ask: What material is the veneer made of? Why was it placed? What was used to cement it?

    Keep smiling,

    Dr. Chris

  2. hahndds

    Dear Carol,

    Sounds like you had a dental crown nigthmare! Sorry. It is difficult to give an exact answer as I really would need to see a good x-ray for this one…but, I am not a huge fan of bonding teeth together for many reasons, especially on the front two teeth.
    So, if they look bad and you can’t speak correctly I would remove them and fix it. Implants are a good solution but you would never want to place 2 implants next to each other on the front teeth either…
    Look up a AACD Accredited dentist http://www.aacd.com and they can help you :)

    Keep smiling,

    Dr. Chris

  3. hahndds

    Sorry I just got this email Ann Li, there are literally hundreds of questions :)

    You can send me a picture to chahn {@} idealdentistry.com (wrote it like that to avoid spam bots).

    Keep smiling,

    Dr. Chris

  4. hahndds

    Dear Rachel,

    The smell probably is from the crown – if it does not fit right then stuff gets under it and causes a rot smell…Anyhow, I would see a quality dentist (ideally someone that does not take insurance) and get a second opinion. Most top dentists will do that for you for a nominal fee.

    Keep smiling,

    Dr. Chris

  5. hahndds

    Dear Susan…..

    You are in the prime location for cosmetics :) There are a lot of good choices.

    I like Brian LeSage, he is a great dentist and a nice guy.

    http://www.cosmetic-dentistry.com

    Keep smiling,

    Dr. Chris

  6. Susan Bourg

    Thank you for your reply. When I read these posts I have had all these problems with my crowns. Too big, redone too small, Foul smell coming from the gum line of my two front teeth. I am not going back to the denist that has created these problems.
    I went back to my old denist. Dr. Masliash on Wilshire. He sent me to Dr. Bustomonte he just finished doing gum surgery to clean underneath one of my crowns because I had a bad infection. I don’t understand how some dentist just don’t think long term. They just don’t care. I am debating to have my two front crowns done (odor under gum line) for a 3 rd time with Dr. Masliah whom I trust. He just fitted me with a night guard to help with the stress I have been feeling because of bad dentistry. Then we are going to figure out what to do. My insurance said that if Masliah can make a case for bad workmanship they will cover them being redone. I will also research the dentist you recommended. Thank you so much for your website to help all of us.

  7. Carol

    Dr. Chris – thank you for your response. Perhaps, I didn’t indicate in my previous question that I will do anything to avoid dental implants – particularly, in the front. I had a failed dental implant (lower back tooth) that left me with partial numbness on my bottom lip. As I mentioned in my earlier comment, both teeth in front are endodontically treated with one having had a pin/post inserted – so it is even more fragile. Since dental implants are my absolute last choice, could these fused crowns be removed safely without breaking natural teeth – then affix new “layered” zirconium crowns to my teeth by bonding them on? (I believe you mentioned herein that “if little tooth structure was left then the crown needs to be bonded on.” ) But, you went on to say that a correctly bonded crown will last a long time but “make sure the dentist has enough experience to place bonded restorations.” Since my treated teeth are much darker, your suggestions to one commenter regarding placing a layered (not just stained) zirconium crown might offer better esthetics – sounds like the route I’d like to take. Not only do these two crowns look totally unnatural, but, after two years, they are still terribly uncomfortable (tight), stick out from the rest of my teeth and cause increased saliva (feels like I’m always about to drool) . In addition, because of the bulkiness of these teeth, my overbite has created additional problems: bruxism and TMJ problems. With that being said, can you suggest an accredited cosmetic dentist (I tried searching on http://www.accd.com, to no avail) who has vast experience in bonding crowns (as opposed to cementing) who is interested foremost in saving natural teeth and who has a good lab? Although I live in Alabama, I am willing to travel to obtain the best treatment. Thank you so much.

  8. Gail Fauntleroy

    I just had a cerec crown placed, and I get this “pulling”sensation around the tooth/gum area whenever I sip through a glass or a straw. I don’t notice it every time, only occasionally. I’ve noticed this type of sensation with another crown I had years ago, but other crowns I had done in the past, nothing at all. I know it sounds strange, but has anyone else ever experience this type of feeling with crowns? Could it be a sign of poor fit or the crown just being too big? Thank you.

  9. hahndds

    Dear Gail,

    That is a new one for me :) But, as I tell all my patients, it is not your imagination. If something feels “off” it mostly likely is. It could be a fit problem – open margins, too close to the bone level, or too big around the gums. Certainly worth talking to your dentist about!

    Keep smiling,

    Dr. Chris

  10. hahndds

    Dear Carol,

    Ok, implants would work but are a last resort and you certainly don’t have to use them :) For your front teeth…having a post and a buildup in the tooth does not equal weak or broken tooth. I would remove the crowns, see what I have to work with and go from there. Sometimes I replace the post and core, sometimes I leave it.

    Depending on what I find I would go with “cemented” zirconium (you cannot bond zirconium) or “bonded emax”. Either way, if you layer the porcelain (both can be layered or stained) then you will receive a better esthetic result. Layered zirconium is slightly weaker than stained zirconium though…there are benefits and drawbacks for each combination and a good dentist will be able to decide one the one for you.

    Please give me your ZIP code so I can recommend the closest dentist I feel could help you!

    Keep smiling,

    Dr. Chris

  11. hahndds

    Your welcome :)

  12. Carol Greenwood

    Thank you, Dr. Chris…at least you have given me hope! My ZIP code is 35763 BUT I will travel either to Nashville, TN (about 2 hr. drive) or Atlanta, GA (3 1/2 hrs) (my daughter lives there). In other words, I want this done right and am willing to travel. I certainly wish you weren’t so far away.

    Thank you so much!
    Carol

  13. Susan

    Hi, I’m considering going to a prosthedontist for a second opinion
    due to a space issue I have between two crowns
    that were placed over anterior teeth, using temporary cement, a month ago. I am unhappy with the look and placement. My dentist seems satisfied with
    the whole thing and has discouraged me from having new ones made. She told me that I would need to go to the lab myself for this fix, and I’m not sure why. From everything that I’ve read, a space like I have between the crowns could lead to food impaction issues and possibly further decay. Sorry if this is an unmentionable, but I can also blow tiny saliva bubbles through the opening which annoys me. Only rarely is my speech strangely affected with the very occasional word sounding a bit slurred, I’m told. I would like to send you two pictures if I may? One taken by my dentist post crown application; three in the front altogether, problem with the two front – and the second taken today, so that you can see how my gums have responded to the crown placement. My dentist told me that my gums will never “grow” to fill the hole. Thank you. :)

  14. amy

    My temporary crown does not allow any of my teeth (except the one right above) touch at all. I could pass a credit card thru my teeth when jaw closed. The dental assistant said it can’t be filled down anymore, this is how it will have to be. I wish I could ask the dentist but he’s not accessible. Is it okay for this temp crown to remain like this for a few weeks? Thanks

  15. Quentin Reidy

    Hi Dr. Chris,

    My dentist recommended I get a crown for a cracked tooth that did not hurt. He said it could break and/ or cause worse damage by leaving as is. I did approve my dentist’s recommendation since he is a doctor, etc. After six months of the new crown, my tooth aches throughout the day especially when I drink something cold. Do you recommend I go back to the same dentist to repair? If so, is dentist liable to correct for free since I already paid but not done correctly the first time? Thanks for your help.

  16. Robert E.

    Hello,
    I realize you’re exceptionally busy but I hope you can answer these questions for me :)
    I had two Porcelain-on-Metal crowns started yesterday, Near Walnut Creek, CA. of my Two Front Upper Teeth. They seemed to do some sort of ‘mold’ BEHIND my teeth first, then did a couple large full upper molds that took 5 minutes to set. I can’t remember when in the process they did this, before or after drilling… I mentioned that the mold would make a good custom bleaching tray and she said I can keep it if I want. (I didn’t bother). So, my question is, How Will The Laboratory know what they are supposed to look like if I was going to be allowed to keep the mold? Will they use the first ‘behind the teeth mold’? (Maybe she meant I could keep the full one AFTER the crowns were fabricated at a Lab…)
    The Temporaries look Reasonably Good, They had asked if I wanted to keep my ‘Madonna gap’ I said yes, so the temps look ALMOST exactly like my old teeth except for a bit of a larger bulky non-symmetrical area on the upper-left of the left tooth from my POV. My second question, Will the CROWNS look as good as the TEMPS? or will they be Very Different coming from some Lab tech who knows where? (Probably China. I don’t want to know LOL) If the Non-Symmetric Bulky area near the gums is still there, can they shave and shape the Porcelain the day of fitting or is that impossible? I am so afraid I will not like the crowns and they will NOT redo one of them right? It was only yesterday, should I ask them to ‘stop the presses’? Or assume a Lab Tech who makes teeth will know that a tooth should be symetrric and not have unusual mounds of additional bulk near the gumline? Here is a Before / After pic (I am a cancer survivor and was in hospital for 3 years and in intensive care for 10 months, during which my teeth were allowed to rot (no one expected me to survive and told me so often as during a completely unnecessary open lung biopsy, they nicked my ‘Aortic Arch’) They also told me there were no ‘showers or bathtubs’ so I was unable to wash for 3 years, one day while wandering the halls with my IV I opened a door and there was a beautiful Jacuzzi Bathtub (WITH AN ORDERLY ASLEEP IN IT). So if they were too lazy to help me have a much beloved bath during this nightmare they surely were not going to help me maintain Dental health! (and this was a RELIGIOUS HOSPITAL in Los Angeles (the same one the Killed JOHN RITTER!) I can’t imagine what the non-religious ones are like LOL! Anyways that’s to describe why my teeth ended up in such bad shape, Simply and Only, because I was SUBJECTED to the BARBARIC Medical Practices of HOSPITALS IN MODERN America! Here is Before After photo from yesterday:
    http://s3.postimg.org/67dunxn9v/crowns.jpg
    I hope hope hope the Lab tech will know to shave off that bulky part that is shown with the green arrows. I wish I could send the LAB this photo LOL :) THANK YOU!

  17. hahndds

    Dear Robert,

    It is important that all the questions you posed to me be directed to your dentist as he/she is only able to help you if you communicate this with them.
    Only your dentist knows what lab is making the crowns, what guide they are using to make them, and what to expect.
    The one thing I can tell you is that you do not need to accept anything during the try-in day if you do not like it. Once you approve the crowns and they cement them then it is a done deal.

    Keep smiling,

    Dr. Chris

  18. hahndds

    Hello Carol,

    Dr. Mark Sayeg in Atlanta is wonderful. Contact him and you will be well received.

  19. hahndds

    Dear Susan,

    When I have a patient that is unhappy and I feel I did the best I can then I recommend a second opinion. You could do that as well just to settle your nerves :)

    Keep smiling,

    Dr. Chris

  20. hahndds

    Hello Amy,

    In short, no, not acceptable. Your dentist needs to always address your concerns.
    I hope it worked out…

    Keep smiling,

    Dr. Chris

  21. hahndds

    Dear Quentin,

    Pain is not always a good indicator of when dentistry is needed. Actually, pain means it is almost too late. A crack is unpredictable and even a crown is not 100% able to fix that. There is a chance that a root canal treatment is necessary or that the tooth is even fractured beyond hope. I would give you dentist a chance to review the tooth and it is highly unlikely that he/she is liable unless the crown is absolutely terrible.

    Keep smiling,

    Dr. Chris

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