For whatever reason, your tooth needs reinforcement and restoration. Perhaps it’s an unsightly color. Maybe you cracked it on a popcorn kernel—or it’s been weakened by several fillings. Maybe you’ve had root canal therapy. You’re probably going to need a replacement crown on that tooth. If two or more teeth are compromised, or there’s a gap where a tooth is missing, you’ll need the crown’s cousin—the bridge. Do I have choices? Definitely. There are four categories of crowns, or caps, as defined by their composition: the all gold crown, the porcelain covering gold crown, the porcelain covering non-precious metal crown, and the all-porcelain crown.
Up-Sides and Down-Sides
All-gold:
UP: Outstanding from a dental health standpoint. Durable, fits tightly to the tooth, well tolerated by gums.
DOWN: Not cosmetically acceptable to many patients. Gold virtually shouts “false tooth”!
Porcelain covering gold:
UP: A good compromise in terms of durability and natural appearance.
DOWN: Over many years they can cause wear on teeth they bite against.
Porcelain covering non-precious metal:
UP: A less-expensive combination of durability and natural appearance.
DOWN: The nickel content can cause metal allergies in some patients.
All-porcelain:
UP: The superior cosmetic choice. Virtually indistinguishable from natural teeth.
DOWN: Tends not to be as durable as metal-containing alternatives. Also the most expensive choice.
Which goes Where?
Crown and bridge decisions are very personal ones that our team and the patient make together. In general, though, the more visible the tooth, the more critical the cosmetic appearance. An all-ceramic or porcelain crown gives the translucency and subtle coloration that duplicates a natural tooth. Further back in the mouth, durability becomes more important. And while today’s high-tech all-ceramic restorations are appropriate even for molars, many patients opt for ceramic fused to metal for both beauty and increased strength.
