Question:
I went to a dentist who determined I should get a crown on one of my molars.
His office manager then came in to tell me the various options and their
prices. She seemed to really want to steer me away from a
Porcelain-Fused-to-Metal crown (PFM) and instead toward
Porcelain-Fused-to-Gold (PFG). I suspect it was because they can only
charge me $400 for the PFM, but they can charge $600 for the PFG, due to a
discount dental plan I have. She tried to give the impression that PFM
crowns don't last as long and can cause an erosion or discoloration of the
gums, as compared with PFG. She was kind of vague about it, citing only
annecdotal reports of these sorts of problems. But is there any validity to
what she's saying? Is there any online source where I can read an objective
comparison of PFM crowns with PFG?
Answer:
No dental gold (and certainly no casting dental gold) is
100% gold.
Many dentists will tell you they prefer high noble casting alloys for
their workability and long-term success. I have differed with some
others who have contributed to this newsgroup in the past regarding
non-precious alloys. I have seldom encountered problems with
non-precious alloys, which are generally variations on stainless steel.
There is no question that high noble crowns are easier to machine, but
this generally is not an issue IMO with a good lab that can make an
accurate casting.
Before 1980, the actual cost of gold in a crown wasn't really
significant, so there was little experience with non-precious alloys.
The early non-precious alloys contained nickel, which a significant
number of people are sensitive to. It also sometimes left a nice green
tarnish line at the gumline. However, after the Hunt brothers
manipulated the precious metal markets in 1980, it became necessary to
find reasonably good substitutes.
My lab prefers working with precious metals when implants are
concerned, because there is more metal-to-metal contact and they feel
the compatibility of the different prosthetic components are enhanced by
using all-precious. Otherwise, I use either with excellent success.
The $200 fee differential will be mostly eaten up by the cost of
the alloy, so I think your dentist's motives are not money, but their
own preference (to which I feel they are entitled, based on their own
experience).
