What are your expectations?
- How important is the look to you?.
There is no doubt that certain crowns are superior in looks to others and this comes down to not just the material but the way the shade is taken and communicated with the lab and also the technician responsible for creating the crown.
All porcelain crowns have the advantage that even if the gum shrinks you don’t see the dark line of the metal core of a PFM crown. Sometimes if the tooth underneath is very dark (more likely to be the case with root treated teeth) this shrinking of the gum may still pose a cometic problem.
Some crowns are milled out of a single block of coloured porcelain, often zirconia. Whilst being very strong they do not match the multiple shades and flow of colour seen in most natural teeth very well. Various different shades of porcelain blocks exist but because teeth themselves are rarely one colour, they tend to be reserved for the back of the mouth.The cost of dental crowns
like these, tends to be a little cheaper.
We often see a progression from a slightly darker base near the gum to an almost translucent edge at the tip. So having a crown that allows for this artistic interpretation and the ability to add in stains and colour will provide the most natural appearance. This is even more important if you are matching a crown to existing teeth.
Some crowns will have a milled core and a different type of porcelain built up on the outside, which can be modified by the technician before being glazed and fired (e.g. LAVA crowns). This has the advantage of the strength of the strongest porcelain for the core and the flexibility for the technician to get artistic with the overall shade.
There is a balancing act between the aesthetics required and protection of the underlying tooth and the amount of tooth removed. The more of your tooth that is removed by the dentist and the more space the technician has to play with- the more layers they can build up and the better looking the final result tends to be. However, the more tooth that is removed, the greater the likelihood of |damage to the nerve
and the weaker the core becomes.
The dentist must make a judgment call and every situation is different- do they potentially compromise the long-term health for the best-looking result?
- Are your expectations realistic?
It is important particularly when considering multiple crowns and veneers
that you and the dentist are on the same page when it comes to the look of the treatment. What the dentist considers to be a nice natural result may be quite different from what you had in mind. This problem is most obvious with full denture patients
, who often insist on the whitest of white teeth, which in my opinion makes it quite clear they are fake. However they may object profusely to the suggestion of a moderately dark tooth, which would be suitable and natural to a patient of their age and complexion.
Ultimately the choice is yours but a good chat about it is important so there is no confusion.
There are many different factors that make up getting the aesthetics right.
Matching other teeth is always a bit tricky since no two teeth are the same. Only when a number of crowns or veneers are made all at the same time from the same batch of porcelain do you get a perfect result. This can involve the preparation of multiple teeth and can be quite destructive, so at least consider more minimal cosmetic treatments before deciding this is right for you.
Sometimes your dentist may advise that you crown or veneer the other central incisor, if this is the tooth in question, as the eye notices asymmetry more than anything else. This can provide a more predictable aesthetic outcome but may involve drilling on a healthy tooth. If the other front tooth is also damaged then it would perhaps make more sense.
Most long-term data as we have mentioned exists for gold crowns and VMK’s which have proved very successful over many years. The newer materials obviously have less data to prove how long they will last and they tend to be heavily marketed by the dental laboratories and companies that develop them. The proof is always in the pudding as they say- how these new crowns perform ,only time will tell.
When it comes to the cost of crowns
unfortunately they are all quite expensive. Generally there is only a difference of a couple of hundred dollars between all porcelain crowns and VMKs. Often this reflects the extra money the dentist has to pay the lab technician for the more expensive crown. The actual procedure and time taken for the dentist is the same regardless.
Don’t be afraid to ask questions! As dentists, we want to do what is right for you and for you to be happy… this involves a two-way conversation! It is our job to answer your questions and concerns and educate you on the reasons why something is or is not advisable or indeed possible.
Some of my favourite questions you can ask your dentist are; ‘What would you do if it was your tooth?’ or better still, ‘What would you do if it was your daughter's tooth or smile?’ or ‘What would you do if money was not a factor?', ‘What is the worst case scenario?’, ‘What will give me the best long term result?’, ‘What is the most predictable treatment?’.