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Question
Hi,

I recently had an implant-supported splinted porcelain-fused-to-metal crown placed on the first molar and second premolar on the lower left side. The size and shape of the crown is noticeable smaller than the size and shape of the same teeth on the right side. This took me by surprise as I thought the crown would be around the same size and shape as the same teeth on the right side. Is this normal? I would think that crowns should look as close to real teeth as possible.

Another thing that took me by surprise is a metal border that is visible around the base of the crown, particulary on the side facing the tongue. What's the purpose of this metal border. Is this normal? Why wouldn't all the crown be covered with porcelain?  

I look forward to your reply.

Answer
Dear Kerry,
   Sorry for the delay in answering your question. Sometimes questions go into the spam folder and I had to go look for them. The questions you have raised are very important and have given the field of implantology plenty of arguments and food for thought. Originally, when implants were at their infantsy, standard protocal was to make to occlusal (biting) surfaces narrower than the regular tooth in order to decrease the lateral (side to side) forces on the implant. The original implant designed is pushed laterally, with caused the retaining screwes to unscrew or worse yet, since there was only one diameter size for the implant and it was farely narrow, implants fracture. Since then implant design has changed and today there is no reason for implant crowns to look any different than your average tooth. As a matter of fact, our patients expect their implant crowns to look perfect just like regular teeth. In the same spirit, the metal on the tounge side is there for strength since porcelin can fracture. If the porcelin fractures on the cheek side, it will iritate your cheek. However, when the porcelin fractures on the inside, it is way worse. It iritates the tounge to the point where the individual cannot function. And that is why commonly the inside of the crown is made out of metal. Again as in the first point, todays ceramic material and metal alloys are far stronger and are able to much better withstand the forces exerted on them. Since I cannot examine you and look at the force perameters, the implants and other conditions in your mouth, I cannot tell you if the crowns could have been done differently. However, with the information I've given you, you should be able to diligently talk to your dentist about it. Please talk to your dentist. I am sure he/she has the porper rational for your treatment. I wish you the best of luck and again sorry for the delay.  

         Sincerely,
         Zev Kaufman

Dentistry

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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.

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