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Dentistry/Crown replacement

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Question
I have had a crown on one of my bottom molars since 2000 (#19). The crown was placed originally bc of having too large of a cavity. About 2 years later an endodontist had to drill through the top of it to perform a root canal. Now I have a crown where you can see the metal showing at the gumline and a translucent hole showing through where my dentist then filled it. I didn't want more metal showing through the top of the crown so my dentist filled it with a composite filling.

Anyhow, I didn't want to be too aggressive with replacing it so I have waited until now to have it replaced since it has been 12 years. Which type of crown should I have it replaced with? My dentist told me I can get another porecelain fused to metal crown or just a porecelin crown. I am leaning towards getting the metal with porecelain crown again because it seems logical that that type would be the strongest and the porcelain fused to it would help it to still look natural. I don't care for how the all metal crowns look. Any suggestions? Which type of crown would protect my tooth the best but give me a more natural look? What are my options on types of metals for a metal with porcelain fused to it? Is gold or palladium superior for durability etc? Thank you!

Answer
Dear Susan,

Porcelain fused to metal remains the standard crown in our industry.  However, it has been slowly and steadily losing ground to zirconia.  Zirconia is a material that has much of the strength and resilience of metal, but has a uniform white/tooth color thru and thru.  It is milled by machine from a block to fit your tooth, rather than cast and then glazed like porcelain/metal.  It is virtually unbreakable, and is about the same surface hardness as porcelain.  Often it requires less tooth reduction, depending on your tooth size and position in your mouth.

Another, newer material comes from 3M.  They call it Lava.  It is also milled from a block of material that is a uniform tooth color throughout.  I perceive it is somewhat similar to Lucite or Corelle in chemical makeup (don't quote me here).  It's surface hardness is less than that of porcelain, zirconia, metal, and most tooth enamel.  This can be a good thing if you are considering the wear that your crown causes the tooth it chews against.  It is easier to mill, easier to adjust, easier to polish, and probably easier to fit to your tooth and its surroundings.  Because it is so new, as of right now, 3M provides the dentist with a 10-year warranty against breakage.  I do not know how long they will offer this warranty.  But it shows me that 3M is confident that their product will last in our environment under our uses for a very long time.

I have not used it yet, as I like to wait for my fellow dentists to tell me how this product is working for them before I try it.  I have just recently received my first dentist's report, and he was very enthusiastic.  So I've bought the scanner and the mill, and I will begin making Lava crowns for my patients right in my office as soon as it is delivered.  This way, I will have my patient's crown completed and cemented before they leave my office.  No more temporary crowns.  No more second visit to remove the temporary and cement the permanent.

But I digress.  If you're interested, ask your dentist if he is willing to try a Lava crown on you.  I believe that you will be very happy with the result, and your dentist can be confident that you will wear his creation happily, for many years.

A more natural look will come from all-porcelain, zirconia or Lava.  If you choose to go with porcelain/metal, choose any HIGH NOBLE METAL.  Non-precious metals have a higher incidence of allergic reactions.  Titanium tends to be very expensive and difficult to work with, but is also the most biocompatible.  

I hope I've helped.  Let me know what you've decided to do.

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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