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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
Hi susan
If you want to get your crown changed your options are:
A) all ceramic crowns like IPS EMAX
B) zirconia shell layered with ceramic like CERCON OR LAVA OR PROCERA OR DA VINCI CROWNS
C) pure zirconia crowns
D) gold layered with ceramic
E) co- cr metal layered with ceramic
F) ni - cr metal layered with ceramic

all of them are good.
The order of preference is the same way they have been listed.
If however you have a habit of grinding your teeth in the night/day then pure zirconia crowns are indicated.

Unlike common belief pure ceramic crowns are stronger if made in adequate thickness.

Life like appearance is better with all ceramic and zirconia layered with ceramic crowns.

Metal alloys layered with ceramic (gold or cr co or ni cr) are no longer the preferred method of  making crowns as they are based on an old technique dating back to 1960s. Metal layered with ceramic crowns has palladium as a constituent.  i have not come across any ceramic crown which uses pure palladium as a shell yet ; either academically or clinically ( i am a professor in a dental school too!)

The all ceramic and zirconia layered with ceramic crowns are fabricated by laser scanning and computerized fabrication and hence have a better fit.

I hope i have answered ur questions.
Best wishes
Dr mayank kaurani
India

Dentistry

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dr mayank kaurani BDS, MDS

Expertise

rootcanals, cosmetic dentistry, dental pain, cavities, tooth colored fillings, endodontic diagnosis, post & cores, ceramic veneers, composite fillings, dental whitening, bleaching etc. please remember: i cannot treat you online and neither can i touch your teeth or test their health! i can give you general suggestions and critically evaluate various treatments and offer my advice.

Experience

14 years of clinical experience. i am a professor in a postgraduate dental school, in the department of endodontics. my primary field of specialization is in endodontics and conservative dentistry. i am a consultant endodontist in private dental clinics and run my own clinic restricted to conservative dentistry & endodontics since 2006.

Organizations
DENTAL SPA, JAIPUR (INDIA). Mahatma Gandhi Dental College, jaipur(india)

Publications
new york state dental journal journal of contemporary dental practise

Education/Credentials
BDS, MDS (conservative dentistry & endodontics)

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