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Crowns: Porcelain vs. Gold?


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12 replies to this topic

#1 of 13 DavidY

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Posted August 17 2002 - 07:05 PM

I will soon have to decide if I want a porcelin or gold crown. It's the second to the back molar of my mouth. I already have two gold crowns (one of which is an onlay)...both are molars which hard to notice. My new dentist (moved to a new city this year) highly recommends a porcelin crown. 99% of the crowns he does are porcelin. My past dentist had recommended gold crowns for my past situations. What to do?

I think that I'm getting conflicting info (advantages and disadvantages of gold vs. porcelin)....could this be due to new technology for the porcelin? BTW, I have been very happy with my two gold crowns....therefore, I am definately leaning that way...but my new dentist still recommends porcelin crowns. Cost is not an issue.

Some of advantages for latest porcelin crowns as I understand it:

1. Can x-ray thru
2. Better asthetics (not a big deal as it's a molar)
3. Removes less tooth structure (this appears to be different from the "older" technology?)

Advantages of gold crowns to my understanding:

1. Coefficient of expansion and contraction of gold is similar to teeth
2. Removes less tooth structure vs. "old" porcelin.
3. Matches my other two crowns.

Thanks for any help.

Dave

#2 of 13 Drue Elrick

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Posted August 17 2002 - 11:14 PM

When I asked my dentist about which to get for my tooth, he basically said, porcelain if its near the front, gold if its on a molar or unobtrusive. The gold is better, imo, for grinding surfaces like molars. I love my gold crown - works great, feels smooth 24x7. Posted Image

#3 of 13 Patrick Sun

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Posted August 18 2002 - 02:20 AM

I got gold on my upper molars, and porcelain on my bottom molars (a vanity thing, for sure).

After paying for my dentist's vacation somewhere tropical and remote, he was nice enough to send me before and after pictures of my dental work for my bottom molars. Sheesh!

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#4 of 13 Niel_JL

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Posted August 18 2002 - 04:30 PM

David
you got those advantages pretty much right except for tooth structure removal. In order to have a porcelain crown, you need to remove much more tooth.

If it's a molar and you're not worried too much about esthetics, go for gold. A properly made gold crown will last you the rest of your life. 90% of the crowns I have had to redo on my patients were porcelain crowns. It all depends whether you want to spend another $700 dollars 8 years from now.

JL

#5 of 13 Yee-Ming

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Posted August 18 2002 - 09:07 PM

Quote:
A properly made gold crown will last you the rest of your life. 90% of the crowns I have had to redo on my patients were porcelain crowns.

funny, I've had porcelain crowns on my incisors (literally "two front teeth" as per the song) for over 16 years now. although they're hybrid or something, they're metal on the back, porcelain on the front for appearances' sake. have literally had no trouble. when they were installed, I was told that after about 10 years they should be checked carefully to see if they'd worked loose or the glue had deteriorated, but so far nothing.

#6 of 13 Adam Barratt

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Posted August 18 2002 - 10:55 PM

Gold be da shiznit. www.gangstagold.com . Posted Image

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#7 of 13 Niel_JL

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Posted August 18 2002 - 11:40 PM

Yee-Ming,
The average lifespan of a Porcelain crown is 8-10 years. I've seen some last 20 years, and I've seen some last 1 year. Looks like you got the better end of the deal.
BTW, all porcelain crowns have metal underneath them, it is to provide strength for the porcelain. It is a common misconception that people think porcelain crowns are all porcelain. Posted Image
They do make porcelain crowns without metal. Instead of metal they use acrylic fibers intertwined within the porcelain. The result is better esthetics with just about the same strength.

#8 of 13 Stan

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Posted August 19 2002 - 09:25 AM

Porcelain all the way.

I've had three onlays/crowns, the oldest one about eight years old, all porcelain, and am very pleased with them. It's pure vanity of course and they probably won't last as long as gold, but I couldn't face having that metallic look, no matter how far back the teeth were.

The first one was to replace a gold onlay that needed to be replaced after just a few years. Can't remember exactly why, but my insurance company had no problem with it. I was so thankful to get it out and replaced with porcelain.

My dentist will do whatever the patient wants. His only recommendation is if you already have gold, and your doing a tooth above/below the gold one, porcelain is harder and will damage the gold tooth eventually.

The only thing I don't like with porcelain is that there's a tiny little black strip just above the gum line on the inside of each one. This is part of the metal Niel mentioned. Not sure why this little section is left exposed, but it's barely visible. I'll have to ask for the acrylic version next time.

Anyhow, my opinion is porcelain, you'll be much happier.
Stan

#9 of 13 Michael Reuben

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Posted August 19 2002 - 09:57 AM

What is the condition of the tooth that will mesh with the one that's getting the crown? Is it still original tooth, or is it gold? If the latter, do NOT get an all-porcelain crown. Porcelain is harder than gold; if you have, e.g., a porcelain upper crown meeting a gold lower crown, you risk wearing through the gold on the lower tooth (I speak from bitter experience).

I prefer gold, as long as it's not visible. Some of my gold crowns have porcelain facings for aesthetic purposes, but the biting surfaces are all gold, or a gold/platinum alloy.

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#10 of 13 DavidY

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Posted August 19 2002 - 04:28 PM

Niel_JL:

Quote:
you got those advantages pretty much right except for tooth structure removal. In order to have a porcelain crown, you need to remove much more tooth.

If it's a molar and you're not worried too much about esthetics, go for gold. A properly made gold crown will last you the rest of your life. 90% of the crowns I have had to redo on my patients were porcelain crowns. It all depends whether you want to spend another $700 dollars 8 years from now.

JL

Thanks, JL...you've been very helpful in the past....confirming some of my thoughts.

I'm pretty sure that my new dentist says that the newer porcelain takes out less tooth structure than gold. This contradicts my old dentist (both are about the same age...both fairly young). Anyways, the molar in question has a massive filling in it. So I'm going with gold over porcelain. Hope that my dentist will do a good job....even though he has only done one lately. He does cosmetic dental surgery too...probably why he recommends porcelain so much.

Dave

#11 of 13 Yee-Ming

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Posted August 19 2002 - 04:53 PM

thanks, Niel, for the insight!

I suppose I am lucky then. perhaps incisors don't get as much wear as molars? hard stuff tends to get crunched up, for that matter even bitten (ripped?) off, by molars rather than incisors.

#12 of 13 Niel_JL

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Posted August 19 2002 - 10:22 PM

David,
Sorry to say this but your dentist is wrong. To double check, I confirmed this with a few textbooks. They basically stated the same thing I stated: there is much more tooth taken off when doing a porcelain crown. The reason is actually very easy to understand.
Let's take a gold crown:
In order to make room for a gold crown, a minimum of 0.8mm needs to be taken off the tooth, and that's it, nothing else. The gold will be strong enough if it is that thickness.
Now let's take a porcelain (PFM)crown:
All PFM(Porcelain Fused to Metal)crowns needs a initial layer of metal to provide strength and bonding for the porcelain. As stated above, that needs to be a thickness of at least 0.8mm. Next comes the opaque layer, which is usually 0.2mm. This layer is extremely important because it blocks out any metal that may show through the porcelain since porcelain can be somewhat translucent. The last layer is the porcelain layer, and this is where everything changes. Porcelain is very brittle, but when placed in a thick layer is very strong. Also, porcelain needs to be thick because the thicker the porcelain, the more esthetic it becomes. The minimum thickness of porcelain required for any tooth is 1.2mm. For front teeth, that number can increase.
So, after adding the layer of metal, the opaque layer, and the porcelain layer, that gives 2.2mm minimum for a PFM crown, compared to 0.8mm for gold. That's almost a 3 fold difference.
So basically, your dentist is either lying to you to try to get you to accept a PFM (that probably costs more)or he just doesn't know the fundamentals of prosthodontics Posted Image
I work for the Air Force and we are pretty strict on standards, and I have nothing to gain from anything I do because I get the same pay check every month. So all I can tell you is that unless you really want good esthetics, go for a gold crown. If it's a top tooth, I would actually recommend he does half metal on the biting surface and half porcelain on the outside (facing the cheek) The way when you smile, you can still see porcelain, but you will also have the advantages of having metal occlusion(biting).

On a final note, private practice is very different than what I do. Unfortunately there are dishonest people everywhere, even in dentistry. I would always be careful when choosing a dentist and definitely not take everything he/she says like it is written in stone. Ask questions, and get answers, don't get the runaround, and if you feel uncomfortable or not sure, get a second opinion. You only have one set of teeth, so it is not something that should be taken lightly.

We, in the dental community, hear and read stories about dentists all the time, and it can be frightening the degree of ignorance some of them have Posted Image

Hope this helped

JL

#13 of 13 DavidY

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Posted August 20 2002 - 02:16 AM

Niel_JL:

Sorry, all I know is that my dentist recommends almost always porcelain crowns.....only 1 gold lately kinda confirms it. As for the tooth structure comment, I am pretty sure that it was someone else at the dental office, either a dental assistant or hygenist. Anyways, I will bring up this discussion with my dentist on my next appointment for air abrasion on various teeth.

Quote:
On a final note, private practice is very different than what I do. Unfortunately there are dishonest people everywhere, even in dentistry. I would always be careful when choosing a dentist and definitely not take everything he/she says like it is written in stone. Ask questions, and get answers, don't get the runaround, and if you feel uncomfortable or not sure, get a second opinion. You only have one set of teeth, so it is not something that should be taken lightly.

We, in the dental community, hear and read stories about dentists all the time, and it can be frightening the degree of ignorance some of them have

I am sure that this occurs in every profession. That is unfortunate as I am a professional...a civil engineer.

Thanks again for the detailed insight on crowns.

Dave

PS. My materials course at university finally comes in handy. Posted Image





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