Porcelain fused to metal crowns for front teeth?

May 31, 2010 – 4:49 am

I recently asked my dentist about getting veneers for my top front teeth, which are quite worn and have a gap. He recommended porcelain fused to metal crowns, which I had never heard of. I did some research, and it seems to me like this is the LAST kind of crowns I would want on my front teeth. I read everything I could about the different kinds of crowns available, and asked him (tactfully, of course) if he could do something like Zirconia, or some other kind of all-ceramic crown.

He was rather abrupt in his reply. He said that he and his partner will only do porcelain fused to metal crowns, period. I tend to grind my teeth, and would prefer not to wear a night guard, and for these reasons he will not even discuss porcelain crowns with me, saying they will not hold up.

My dentist and his partner both have very impressive credentials, and their prices certainly seem to indicate that they are top-of-the-line. I’ve never had any reason to doubt him before, or question his judgment, but everything I’ve read about crowns indicates that porcelain fused to metal crowns on the front teeth never look realistic.

Is it true that occasional teeth grinding without a night guard rules out ceramic crowns for me, such as Zirconia? I have been wanting to get this done for years, and I want my teeth to look good when we’re done. Can you offer any advice?

Wilson in Sacremento

Dear Wilson,

My advice is to get a second opinion.

Even under intense stress, Zirconia crowns are strong enough to work on your front teeth. As an additional selling point, Zirconia crowns can be made thinner than porcelain fused to metal. This means that less of your teeth must be shaved away to place them, which will leave your tooth structure stronger.

Despite your dentist’s excellent credentials, he may not truly be committed to excellence in appearance-related dentistry. His credentials may really indicate that he excels at making things work well, rather than worrying about how they will look. Many highly educated dentists seem to consider the cosmetic aspects of dental repairs to be beneath their notice. Your dentist’s insistence on porcelain fused to metal crowns on your front teeth indicate strongly that he is more concerned about function than he is about the artistic quality of his work.

I strongly advice that you make no effort to push your dentist or his partner to do something they do not want to do. This is almost always a mistake.  You do not have to sacrifice form for function–a skilled cosmetic dentist can certainly come up with a functional solution for you that will be beautiful as well. Rather than pushing your dentist to place something he is not comfortable with, you should consider finding a dentist whose abilities and aesthetic sense are more in harmony with your preferences.

One more thing: I ask you to reconsider the use of a night guard. As you get older, your teeth can break off at the gumline from continued grinding. If you bend on using the night guard, you may find that your current dentist will be willing to reopen the discussion about the types of crowns he will place for you.