[Cyclopath]

Help! I had the worst root canal ever yesterday, and now I need to decide what to have the crown made of. Dental pain had been keeping me awake for several nights so I'm not really "here" enough to do much research. Can anyone give me a reason to choose one over the other? It's a molar, in the top/right corner of my mouth.

[gray matter]

Hey Cyclopath, here's the rundown: Gold Pros: wears at almost the exact same rate as enamel. Superior fit on the tooth. Cons: ugly (ymmv), expensive. For this reason, gold crowns are going out of style. PFM (porcelain fused to a metal substrate) Pros: tooth colored Cons: the weak link in this crown is the fusion between the metal and the porcelain. The fracture resistance of the porcelain is in the neighborhood of 190 mPa. For reference, biting an almond or an ice cube takes around 80 mPa. However, these were the state of the art "esthetic" restoration for quite a long time, until some newer materials were developed. Another con is that this crown requires more reduction of tooth structure to make room for both the metal and the porcelain (1.2 mm on the sides and 2 mm on the top). All porcelain * there is more than one type of all porcelain crown. For a back tooth, which is subjected to different forces than a front tooth (more compressive loading) the only type of all porcelain that I recommend is lithium disilicate, trade name Emax. Emax is about 4 times stronger than the porcelain found on PFM crowns, and is also less abrasive to opposing tooth structure than other types of porcelain. It is more esthetic because of its translucency, and it requires less reduction of tooth structure (0.9 mm from the sides and 2 mm on the top). And that extra natural tooth structure can make a big difference in the long term prognosis of your tooth. This is the material that I choose for my patients on a regular basis unless there are other factors that are at play. Now, if you have any brain-mediated parafunction, like night time clenching or grinding, I would suggest a full contour zirconia crown. Zirconia is insanely tough, but not particularly esthetic, and it does sometimes take a special lab to make these crowns. But they are basically indestructible. I only use these in very rare cases. So, to recap, here's my order of preference. Emax, gold, full contour zirconia, PFM. What's interesting is that if you speak to 5 different dentists, you will probably get 8 different answers, and in at least half of those cases, the PFM will be the crown of choice. I will say that all of my decision making and recommendations are based upon my study at an advanced learning center in Seattle called the Kois center, and I can back everything up with published data. I hope that this helps you out a bit. -Matt

[gray matter]

Oh, and I'm sorry to hear about your toothache! Absolutely no fun. I hope you feel better soon.

[Cyclopath]

Thanks so much for the rundown! It sounds like ceramic isn't on your radar? Those were the two choices they gave me after the root canal ... I wasn't really present enough to ask questions so I'm not sure if there are other options. They told me it would be ideal if I could call them today with a preference so they can send it off to the lab to have it made. I feel 100 % better. Having a root canal isn't so bad, needing one is torture. I spent the last several nights sitting upright in a chair wishing I could sleep. I need to catch up on my Zs, but otherwise I feel really good.

[Randito]

I have gold crowns on most of my molars. My dentist is pretty progressive and a about ten years when I needed a crown on one of my molars he convinced me to try a ceramic crown instead of gold -- with his hi-tech in-house machine he could do it all in one sitting. Except that while fitting the ceramic crown it broke! His machine fashoned a second in about 20 minutes, so no BFD. That crown lasted about seven years and then failed -- I had him replace it with a gold crown. My oldest gold crown is 32 years old with no problems. I don't have any crowns or caps on any visible teeth -- for those I would consider ceramic -- but only gold for me on my molars.

[jinx'sboy]

I got my first crown - gold - on a back lower molar about 6 months ago. I really like how it feels, mostly. My Dentist says he will not use porcelain on the back teeth: "pressure and leverage on those back teeth breaks everything else but gold". I like the look of gold. I recall seeing a woman with a front tooth made of gold that had a 5 pointed star cut all the way through! Made quite an impression on me at 14....

[coldrain108]

I've got 3 gold crowns on molars - they are 20 years old with no signs of any problems. One is partially visible - gives me some street cred - not. I was the victim of experimental dentistry in the 70's when I was 12ish. Non-amalgam fillings that failed dramatically all at the same time when I was 25, on a long backcountry trip - trail mix tooth breakage. Talk about a miserable 25 mile death march. Lesson learned - do not be on the fore-front of medical device experimentation.

[wolffie]

My crowns/bridges are metal. Some have a porcelain veneer, just for looks. Part of the porcelain veneer fractured off one; luckily this was of no consequence. Get metal teeth so you can look like a pirate, arggh. Don't chew on beef bones; your dog neither:

Not our dog, but Al did lose a carnasial tooth to a beef bone, $300.

[mike]

Stainless steel Russian mafia look

[DIYSteve]

ask over on TGR. Lots of dentists there

[Cyclopath]

What's TGR?

[coldrain108]

[HitTheTrail]

Make sure you have enough tooth left to hold a crown for any length of time. I had three gold crowns on my molars until the newest one started having trouble. To make a long story short they had to take the tooth out and install an implant in my jaw to hold a new porcelain crown. The other two had been in for over 20 years and I loved them for being trouble free. That remains to be seen on my new implant

[gray matter]

To clarify: Emax (lithium disilicate) is an all-ceramic crown. There is another type of ceramic called feldspathic porcelain that is also all-ceramic that I absolutely would not use on a back tooth. This is the type of porcelain that is veneered on a PFM crown and it just doesn't hold up well in the back without metal underneath it for support. If you choose an all ceramic option, please clarify that you would like Emax. It is very interesting to read about the patient perspective. There seems to be quite a few success stories with gold here. Food for thought. Good luck, and good to hear you are on the mend. -Matt

[meandering Wa]

I have gold where positioned in the back ( on one will see) they are most durable