What kind of crown should I get?


How many crowns are there to choose from? A lot!. Lithium disilicate (cad cam or pressed, mono block or layered with porcelain), Zirconium ( monolithic or layered with porcelain), Feldspathic porcelain jacket ( made with swedge foil or on a refractory model), Porcelain fused to metal or full metal crown (Gold or semi-precious) , Porcelain fused to metal (non precious) . Based on my list I count 11 different types of crowns, but there are more, but they are no longer popular with dentists.

Which type is right for a patient. It depends on the position of the tooth in their arch and my patient's  priorities. That being said ,I have my favorites.

At the moment, in my practice, most of the crowns I make are either Porcelain fused to metal (semi precious and full metal crowns). Maybe I am old fashioned, but these crowns have stood the test of time since they have been around for over fifty years.  For second and third molar crowns I encourage my patients to have full metal crowns made due to the high forces these teeth tend to experience. For patients with a desire for more cosmetic crowns on these most posterior teeth I will  make a monolithic zirconium crown or a porcelain fused to metal crown( often with a metal occlusal stop on the distal marginal ridge).

For more anterior posterior teeth ( first molars and premolars) I often opt for porcelain fused to metal crowns ( these have bevels and will grab onto tooth using a subgingival margin. For teeth that are not badly cracked ( sometimes opt for a monolithic lithium disilicate crown. These are great if the gingival terminus can be left at the level of the gingiva or even better, or only slightly subgingival.

For anterior teeth, if they have sufficient tooth structure, I usually use a lithium disilicate crown layered with porcelain or a bonded all porcelain crown. Both of these restorations are beautiful, translucent and work well. The Lithium disilicate crown, if made properly is stronger than a purely feldspathic porcelain crown. The feldspathic porcelain crown has the advantage that it requires less tooth reduction, especially at the gingival margin.

Of course this post is based on my personal preferences and many of my collegues have their own  preferences. Usually all crowns can work well in the correct situation, as long as they are correctly made. As it is with most things, the devil is in the details.






from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/09/what-kind-of-crown-should-i-get.html - http://lspindelnycdds.blogspot.com/

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