Crown Types - Advice asked

rationalpsycho

Hello,

This question is asked to any dentist member or one of the moderators - presumably dentists! I am in the process of organising to have one upper front tooth implant and two upper front crowns. Issue caused by sporting accidents. I live in the Netherlands and will prob. get the work done in Germany. I am seeking advice re. which type of crown material is best to use, from the various possibilities. I am interested in appearance, longevity, mouthfeel and compatability. Cost too, but that is not the primary consideration. Obviously the dentist I will use is the primary source of info. But I'd like to be self informed in the first case. If there is an existing thread on this topic, then a link to that thread will do. I had a look at the existing threads but did not find the specific info I am looking for. Cheers.

georgieporgy

There is no single material that will suit all purposes. You can get excellent aesthetic results from most materials if they are handled well.

What you need is to find a good dentist and and tell him you want something that looks very good that will last a very long time. Let him/her worry about the details.

Tell the dentist up front you want excellent results and ask if he feels confident enough to deliver.

Big_G

Agreed. I've seen excellent and long lasting results that look really good from almost any of the currently accepted materials. I'm not a huge fan of pressed ceramics though. Much prefer good old fashioned layered feldspathic porcelain over the substructure of your choosing.

rationalpsycho

Thanks to GP & Big G for their input. I agree that the priority is to find a dentist that gives me good advice, but in this case I am living abroad and I am selecting a new dentist and wont have prior experience with that person. Also I suppose have the countrymans suspicion of being 'sold a pup'.

By your answers I interpret that there is no one technology or material which is sticking its hand up saying, I am the best?

THis guy reckons Gold is still a good bet, but its obviously not on for front teeth. He's not a fan of all ceramic & says PFM can be brittle under tension.

Should say that I relaise that Wikipedia is not a medical dictionary.

http://en.wikipedia.org/wiki/Dental_crown

ballsymchugh

ask fitzgeme!!

btkm8unsl0w5r4

This is a complex issue there are basically three types of crowns:

1. Metal Ceramic crowns (aka: PFM, bonded crown, ceramometal crown)

2. All ceramic crowns (aka :felspathic, Empress crowns, E-Max, Empress aesthetic, 360 veneers, PJC,)

3. High strength ceramic crowns (aka, procera alumina, procera zirconia, lava, Zirconia)

The choice depends on the clinical situation, if the underlying tooth is dark and the bite is tight then metal ceramic is a good choice, if aesthetics are paramount the a all ceramic crown, and every possible itteration in between.

All crowns can look good if the dentist does a good job and the technician takes time and respects the material being used. An average skilled technician will however make a all ceramic crown look better than a metal ceramic crown (IMHO).

The cost can vary depending on the type of crown used and the skill of the technician and dentist. traditionally metal ceramic crowns are cheaper but this is not always the case.

Best to trust your dentist to choose the best type for your specific situation. Tell the dentist what your chief concerns ie. I care most about aesthetics, or I care most about long term stability and he or she will guide you. Dont get too caught up in the advertising regarding certain brands of crown as any crown can look bad or good depending on the care and attention to detail.

Good luck.

rationalpsycho

Alright fitzgeme, sounds indeed like there is no one clear choice, as I suspected. Its clear, No 1 job is to get a guy who knows his business.

Thanks for the instructive info and to the others who posted.

I am just going outside now...

I may be some time...

nettlesoup

To make a crown I believe there is another way to get an impression of a tooth and this is by using a scanning machine to scan the tooth and send the digital image to the dental technician who works off the image. I am just wondering if this method is very common in ireland and if the resulting crown will be better than the crown made from the traditional way using a mould?

btkm8unsl0w5r4

Yes very common, dentist who have a cerec machine use this method. Personally I feel this technology still has a long way to go, while it works OK for simple cases, I dont think it will replace impressions and lab technicians for many years to come.

georgieporgy

I think nettlesoup is referring to iTero and not Cerec. It's a relatively new scanning system which will scan a full mouth together with bite registration and sends it to a central lab where articulated models are constructed and forwarded to a lab of your choice to make the final restoration. It means impression taking and stone models are no longer used and the errors that sometimes creep into those 2 steps are eliminated. There are some other advantages also.

The system retails at approx $20,000 in the US. I placed an order 3 months ago but am still awaiting delivery. I am not sure how common they are in Ireland. I know of a couple in the UK

btkm8unsl0w5r4

georgieporgy wrote: »

It means impression taking and stone models are no longer used and the errors that sometimes creep into those 2 steps are eliminated.

And the millions of errors of 3d image acquisition are substituted in their place. I am sure these technologies are the future, however at the moment I am waiting before making the plunge, its from experience with cerec that I have made this decision, although the later versions are much better than the older ones. The laboratory CAD-Cam systems are all mature technology now and turn out consistently good coipings and frameworks. The optical impression acquisition is still an emmerging technology and does not have the flexability, dynamic articulation accuracy, marginal accuracy, contact acuracy or artistic flare of a technician working with gypsum.

I cant wait until a system comes along that is better than a standard impression cause I for one hate having impressions.

Big_G

The new 3m optical scanner is very impressive. Had a look at it at Identex, my principal was looking to buy it. However, 25 grand plus a fee for each scan and each resin model. Rip-off as far as I'm concerned. So now we're looking at cerec 3 with bluecam. It's the future. Especially now the way that bonding technology is improving so quickly. It won't ever replace a tech for making crowns though. An expert ceramist is an extraordinary artist...

btkm8unsl0w5r4

Thats the thing for me, if its not the best way then why do it that way.

Its also a sloppy thing the get resin models from the scan, the need for a model shouldn't be there, the work piece should be made on the computer. entirely Also the cost of these units and blanks is astronomical (esp cerec). I know that with this attitude no new technology would ever develop.

Beware steriolithographic models tend to round off and sharp edges.