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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

121 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

  12. SciResearcher

    Hello there, thanks for writing about this. Unfortunately you are missing another point. Shouldn’t the mating surface of the prepared tooth have no black stain on them? I am arguing about this with my current dentist. He says it’s ok and I dont say it’s ok. First off you want the prepared surface clean of any fungal matter, wouldnt that be common sense? My dentist says the black stain goes too far deep to get it all out. Even though i’ve already had the root canal, whatever this black stain is (caries or fungus) it is living there on the surface of my tooth and everything that i do won’t get rid of it. What if he does place the crown and adhesive over this black stain? Aren’t you giving the black stain a nice little house to grow downward? Eventually causing Advanced Perio which is something no one needs. I need answers. Thanx for ur time if you can help.

  13. hahndds

    Dear SciResearcher,

    The “black scuz” layer that you are talking about is often seen under temporaries and is easily removed by allowing hydrogen peroxide to sit on the tooth for a minute or so. Yes, if it is present it should be removed – it comes of very easily.

    Keep Smiling,

    Dr. Chris

  14. bedro

    hello Dr. chris
    i went to a general dentist 7 months ago for a problem of bad smell between two of my teeth upper second premolar and first molar
    my first molar had root canal treatment and it is restored with amalgam
    i had not any problem with it before.
    However, the dentist decided to place a crown on this tooth
    and he put a pin in it to reinforce the tooth like he said
    the crown was made of zirconium
    after that it cause food impaction , the dentist replace the crown tow times but it still have the same problem.
    One week ago i went to a another dentist and she removed the whole crown and made a new one but this time i chose metal fused to porcelain
    but the problem is still and there is a food impaction

  15. hahndds

    Dear Bedro,

    Sorry to hear about the trouble you have had with your tooth. I can’t see your tooth so I will do my best to give you some advice. First, since you had the crown redone several times I will rule out poor fit…that would be truly rare. The next issue is probably related to the space between your teeth. If you had gum disease or bone loss the tissue between the teeth goes away and food traps arise. Redoing a single contact (crown) will not solve the tissue trap issue. That is what I would bet is the problem. Consider looking at this and let me know what the dentist says!

    Cheers,

    Dr. Chris

  16. bedro

    Hello dr. chris
    I am very thankful to you for replying my post .
    In fact i went to the dentist today and she decided to take off and send the current crown to the lab again to remodeling the contact point . I hope that she can solve this problem , and thank you again .

  17. Stephanie Goldsberry

    I had a front tooth crown put in. I have a two crowns in the back of my mouth and never thought to ask many questions because I never saw them, they feel right and look right. Now, my front crown was cemented in and during the appointment I noticed it was larger than my other front tooth. They said there is nothing they can doabout that because they ccouldn’t go any smaller because the croen needed more material around the tooth. They also wanted to fill in the between my two front teeth. Well, they said that is how the tooth had to be made and I was hesitant because of the size and they told me I was the only one who would really notice. Well, two weeks later, I hate my crown. It doesn’t match my teeth, it’s much bigger than my other tooth, and its a completely different shape. I’m really self conscious of it now and I’m embarrassed to smile. Is it true that they had to have material around the base? I can’t seem to believe that. What can I do to fix it? Do I need to get my other front tooth fixed to match? I have a dental plan and paid almost $750 for two visits, and I can’t really afford to pay for my other tooth to match. Please help.

  18. hahndds

    Dear Stephanie,

    I am sorry to hear you went through that. Let me give you my insight…
    First, a dentist should never cement a crown that the patient does not like, period.
    Secondly, we have great control over the shape of crowns for several reasons. Number one is that the dentist prepared the tooth below the crown to specifically give the laboratory enough room to make a properly shaped tooth. Secondly, the technician has to have the skill to match the adjacent tooth.

    It is YOUR tooth and you get to make the decision if you want to close the space between the teeth, not the dentist. If you have a natural space between the front teeth and you close it by making only 1 of the two teeth then of course that tooth is going to be wider! Not a very smart idea.

    I would not settle. You expressed your concerns at the seat appointment. The dentist needs to redo this correctly.

    Cheers,

    Dr. Chris

  19. bedro

    hello dr.chris
    i wish you have a good times
    thank god , my problem is solved
    thank you for help … your diagnosis was right
    it was a probles with crown fit ..

  20. Peggy O

    HELP Dr Chris: I am 69 years old and have burning metal taste in mouth. I had two front crowns replaced and they do not look like the other four crowns from 20 years ago and the same lab did the work. The new crowns show very little margin of porcelain and lots of gold. constant pain food shoots right up to the gums. The dentist insists it is my imagination the taste and has not offered to do anything with these. The other crowns show a lot of porcelain. Constant burning, mouth, lips and metal taste are driving me crazy. She polished the two crowns as my lip gets stuck to it when I talk, again, told me that was a muscle reaction in my lip. Do I have any recourse of recovering my expenses for these crowns and go to someone else or is this how crowns are made. I looked in a mirror and it is very visible the difference in thickness of porcelain on new ones is very thin ring. thanks I hope I can find someone soon.

  21. hahndds

    Hello Peggy,

    If you have had crowns on those teeth for 20 years that were fine and the new crowns have the issues you mentioned, then it would make sense that the new crowns are part of the cause!
    When making new crowns, especially ones on the front teeth, we make them out of a composite material first as a temporary measure. This temporary crown tests the fit and look of the new crown as the new crown should be made similar to the shape and size of the temporary. If the temporary worked out fine for you then the final should as well. I hope they did it this way for you.
    The metal taste can be related to many things, including base metal on a crown.
    Your lip should not stick to your new teeth any more than it did with the old teeth – blaming your imagination is just ridiculous.
    Long story short, those crowns should be redone from what you have told me, either using all porcelain or a high noble metal base (not simple base metal). That being said, if the dentists does not agree to do this for you, then you will need to contact your local dental society that will contact your dentist, possible initiating the peer-review process.

    Keep smiling,
    Dr. Chris

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