Porcelain fused to metal crowns

Question:

My husband recently had a root canal treatment done on one of his front teeth. Our dentist recommended a porcelain fused to metal crown. While looking online, we learned about porcelain veneers and all-porcelain crowns. We thought for a front tooth, the porcelain all-porcelain crown would be a better choice.

When calling the dentist back, he informed us that an all porcelain crown would involve more tooth reduction than a porcelain fused metal crown. He said it was because the porcelain fused metal would be stronger near the gumline.

Additional tooth reduction for the all-porcelain crown is a major concern. Our dentist will do the type of crown that we prefer, although we know his preference is the porcelain fused to metal. Since this is a front tooth we want to make the best choice.

How much tooth reduction is needed for the all-porcelain crown? How much tooth reduction is needed for the porcelain fused to metal crown?
                                                                                                         —Diane in New Jersey.

Dear Diane,

Your dentist is sending you a signal that he is not comfortable doing an all-porcelain crown. My advice is to not press him on this matter. You surprised him with your Internet research. Yes, he says he will do what you want, but he is a general dentist, not an expert cosmetic dentist, and I'll tell you in a moment how I know that he's not confident in his skills with an all-porcelain crown. Don't push him out of his comfort zone. Dentists are trained not to let the patient know they're uncomfortable doing a procedure because it causes anxious patients.

So, you have two realistic options. You can stay with this dentist, and do the porcelain fused to metal crown, or you can go for the perfectly natural, perfectly matched, beautiful all-porcelain crown from a different dentist--an expert cosmetic dentist, such as we have listed on our site. We have several listed in New Jersey, and I'll guarantee you that not one of them would dream of putting a porcelain fused to metal crown on a front tooth. It would be like buying a beautiful new car and painting it with Rustoleum®.

Here's the reason for this. When a dentist really knows how to do a beautiful crown and has had that experience of placing one that is absolutely natural looking and perfectly matched to the other teeth, that is the only kind of crown on a front tooth that he or she wants to place. The fact that your dentist prefers doing a porcelain-fused-to-metal crown on a front tooth says volumes about his esthetic skills and desires. Read about the total difference in approach between a cosmetic dentist and a general dentist at www.mynewsmile.com/cosmeticdentist.htm.

And then here's another little secret: an all-porcelain crown does not necessarily require more tooth reduction than a porcelain fused to metal crown. It depends on the type of porcelain. Some porcelains can be made very thin. Think this through and you'll see that it doesn't make sense: with a porcelain fused to metal crown, there has to be space for the metal, then there has to be an opaque layer over the metal so the metal doesn't show through the translucent porcelain, then there has to be enough depth of porcelain to create some semblance of a life-like tooth. But with a pure porcelain crown, you have pure porcelain over natural tooth structure. There's no thickness of metal, no opaque layer required. So the crown can actually be thinner.

Then you have the black line at the gumline that the porcelain fused to metal crown will eventually develop. There are techniques to minimize that, but not to eliminate it.

It's your choice. Make it carefully.

I hope this is helpful,

Dr. Hall

Related information about porcelain crowns:

For referral to an expert cosmetic dentist, click here.