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About Zev Kaufman, D.D.S.
Expertise
I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.

Experience
Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Organizations
Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Education/Credentials
Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

You are here: Experts > Health/Fitness > Dentistry > Dentistry > Crowns

Dentistry - Crowns

Expert: Zev Kaufman, D.D.S. - 11/5/2009

Question
I am getting ready to have a full dental restoration. I need to select between 4 types of crowns:

Pure Porcelain
High Noble metal crown
Zirconium crown with pure porcelain
Captek crown

The price difference is wide between the options. I want something strong (I tend to clench my teeth), natural looking, and in the past I had allergies to the old metal fillings so I'm not sure if the crowns with metal would give me the same reaction. Can you weigh the pros and cons of each?

Thank you!

Answer
Dear LaDonna:
The four styles of crowns have distinct differences. I am assuming that by "high noble metal" you are referring to a traditional Porcelain fused to metal crown. I will start, though with a type you have not mentioned, but is very important to severe grinders:
1. Full metal (gold) crown:
This is the most durable of all full coverage restorations. It is commonly made of yellow or white gold. It is most durable, since there is no porcelain to break. The abressiveness of gold is similar to tooth structure, and thus, the teeth opposing the crowns do not get worn down as they do with porcelain, which acts, essentially as "sand paper". It is also easy to see, for a dentist who has proper knowledge, the wear patters on the teeth. The gold shown to us how you grind your teeth. The biggest draw back is, obviously, the esthetics. Most people do not want metal teeth. However, if one is a severe grinder, it is by far the best option.
2. The traditional PFM crown (Porcelain fused to high noble metal) has been the "work horse" of our profession for over 60 years. It is the most predictable of tooth colored crowns. We have tons of research and follow ups over the years. The metal provides strength and the porcelain provides reasonable esthetics. The problem is that, if it is not done to the highest standard, the thicker margins of any crown will cause for bacterial accumulation at the gum line, that is difficult to clean. When the gum tissues recedes, you will see the metal margin of the crown. Over the years, techniques have been designed to avoid this situation predictably, however, it they require a very skilled dentist and laboratory. This also escalates the cost, since the better labs charge much more, and consequently, the better dentists do too.
3. Up to recently, the full porcelain crown was the solution to the "black Line" problem around the PFM crown. With a distinct disadvantage: questionable durability. The full porcelain crown has to be bonded (glued) to the remaining tooth, like a porcelain laminate veneer. The very brittle bond can give way easily and the crown can fracture. Different types of ceramic have been tried over the years, but most are must too brittle to serve on the biting surfaces of the back teeth. Even anteriorly (in the front) they have not proven to be too durable. They also required a very skilled dentist to prepare (cut down) the tooth properly. It is best indicated in situations where we need to match thin porcelain crowns to other teeth which only have a veneer coverage. Most dentists avoid these crowns, especially on bruxers (grinders).
4. Captek Crowns are only one type of PFM alternatives. They use a very thing gold substructure with porcelain on top. The gold color gives the porcelain a very warm glow. However, the support for the porcelain is not quite as strong as a traditional PFM and the metal line can still show. It is basically a variation on the PFM.
5. The newest addition to the tooth colored crown is the Zyrconia based crown. Up to now, all the crowns I mentioned are made on a stone, or a plastic model made from an impression of the tooth preparation. The Zyrconia crown is made by a computer milling process. After the impression of your tooth, a model is made, but it is scanned into a computer, and the crown is designed by the dentist or the technician on the computer. It is then milled by a machine. This is a process that replaces the metal substructure of the PFM. Traditional porcelain is then applied to the Zyrconia substructure to form a tooth colored and shaped crown. The strength of the Zyrconia substructure is unsurpassed. It is as strong, if not stronger than the traditional high noble metal. It also eliminates the "black line" at the margin, since the Zyrconia comes in white shades. The latest studies are very promising and they can be used in anterior (front) teeth, as well as posterior (back) teeth. I have, and use Zyrconia based crowns routinely on anterior teeth, at this point. They give a tremendous result. I am slightly reluctant to use them posteriorly, since I get a wonderful result from my technicians with a traditional PFM crowns, which are time tested and true.

As to the cost and material selection...
Most Prosthodontists (the specialists in restorative, cosmetic, and implant dentistry) do not leave the decision to the type of restoration to the patient. You should be advised to the options in your case, the pros and cons, but ultimately, the dentist should recommend to you the most durable, and best choice for your requirements. You are by no means qualified to make this decision yourself. You wouln't dream of telling your heart surgeon which type of valve to use, would you? However, you can object to use of a pig valve (due to religion) and the doctor will offer you the next best choice. It is up to the doctor to decide what is the appropriate material for your situation based on knowledge, expertise, and experience (in that order... experience without knowledge and expertise is useless). This is why, most Prosthodontist, including myself, will price the restorations very comparably. In my office, I charge you per tooth, rather than the type of restoration. The difference in laboratory costs is minor. A quality laboratory will charge essentially the same amount for a PFM vs. Zyrconia. The Zyrconia process is more expensive, but it does not require gold. The PFM is cheaper to fabricate, but the cost of gold can be a factor. The problem is that many times a dentist will select a cheap lab for a PFM, since most labs know how to make it, but they have to pay top dollar to an expensive lab for a Zyrconia (a laboratory has to be certified by a Zyrconia manufacturer, and needs special equipment). So many times you are comparing an expensive, excellent quality lab to a lower end, cheaper laboratory, rather than comparable work.
If you had to have one, or two crowns made, I would select the more expensive option and go for it. You do not have much to loose. However, if you are going for a full mouth reconstruction, I would strongly recommend going to a Prosthodontist for an evaluation. I know nothing about your dentist, but if I assume that your dentist is of average knowledge, skill, and experience, I would recommend that you see the best qualified person for your situation--the Prosthodontist. A prosthodontist gets special training for three years after dental school to address situations such as yours. www.prosthodontics.org will have a link to locating a Prosthodontist near you, or just call my office, and I'll refer you to a colleague in your area.
Best of luck,
Dr. Zev Kaufman

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