There are a few types of dental crowns available for patients. Typically, when a patient is told that they need a crown, they aren’t told which type of crown they are getting. This is a decision made behind the scenes, without the input of the patient, based on several factors that the dentist must consider.
For an educated patient, I think it’s important to understand the four types of dental crowns uses by most dentists. These include:
- Gold crowns
- Porcelain fused metal crowns
- Zirconia crowns
- E-max crowns
In the list above, these progress from the strongest to weakest, and from the least aesthetic to the most aesthetic. Determining which crown is best for a patient will come down to placement in the mouth and several other factors.
When is a Gold Crown Best?
When a crown is needed in the back of your mouth – for instance a 12-year molar – a gold crown is the gold standard. Gold crowns are the strongest of the four types of dental crowns and are best in areas of high stress, such as your molars. Gold does not chip or fracture, it offers the best fit, and preparing the tooth for a gold crown requires less tooth structure be removed, which decreases the risk of sensitivity or decay after it is placed.
Aesthetically, gold crowns are the least attractive. However, I tell patients that these crowns are our little secret because we are the only ones who will ever see that far back in the mouth.
When is a Porcelain Fused Metal Crown Best?
When a crown is needed on a posterior tooth – teeth that are posterior to the canines – typically a dentist will recommend a porcelain fused to metal crown. These crowns are prepared by baking porcelain onto a metal substrate containing gold, meaning they are the next strongest option behind a gold crown. They are also resistant to fracture and fit well, like gold crowns.
Aesthetically, these are more attractive than gold crowns but less attractive than the other two. That’s because you must submerge the crown under the gum, so the transition line doesn’t show. If your gums recede over time, this line may begin to show. Given the strength and aesthetics of porcelain fused metal crowns, I typically recommend these for patients who have a strong bite or grind their teeth and don’t show their gums when they smile.
When is an E-Max Crown Best?
When a crown is needed on a front tooth, E-Max crowns offer the most aesthetic option. These crowns are entirely made of porcelain and can easily be mistaken for a tooth. There is rarely a transition line, and these crowns blend seamlessly with the smile to create a harmonious look. However, the aesthetics of these crowns come at a price. The mode of failure is most often fracture, requiring a full replacement and causing tooth sensitivity.
While E-Max crowns are the most fragile, it’s important to remember that the amount of force you apply to a front tooth is much less than a back tooth. For patients who do not have a strong bite or grind their teeth, these are also suitable for pre-molars (middle teeth) or molars when a more aesthetic look is desired. However, the patient must understand that these may need to be replaced in 10 years when placed on these teeth.
When is a Zirconia Crown Best?
Zirconia crowns have become a popular option among dentists in the last five years. These crowns are made with a very hard tooth-colored glass and contain no metal substrate or porcelain. They offer the strength of a porcelain fused metal crown and are a close second to the aesthetics of an E-Max crown, making them a good option for many areas of the mouth.
The disadvantage of zirconia crowns is they don’t fit as tightly on the tooth as other dental crowns, which can result in loosening or decay. They are also very difficult to adjust because they are so hard and replacing them can be difficult because of the strength of the restoration. Typically, I will not place zirconia crowns on someone with small teeth because they lack the tooth structure to retain these crowns.
In most cases, zirconia crowns are a good option for patients. However, talk to your dentist about the pros and cons of each dental crown option before deciding. Ask which type of restoration is appropriate for you based on your bite force, placement of the crown, and other dental risks. Your dentist should be happy to have this conversation and may be impressed that you’re educated on the four types of crowns.
In need of a dental crown?
Schedule an appointment with our dentist office in Brandon, FL. We’ll be happy to go over your treatment needs and establish a plan that works for you.