Question:
I need to make a decision regarding a dental crown. What are the pros and
cons of porcelain or gold as a material? Are their choices within each of
the categories?
Answer:
If it's in the back and nobody's going to see it except you and your
dentist, or if you have no aesthetic problems with gold showing, then I
would suggest gold.
The main reason is conservation of tooth structure. Full coverage with
porcelain requires (but is not always done) at least 1.5-2.0mm of
reduction of the tooth in order for the laboratory to fabricate a
porcelain/metal crown. Any less reduction results in an overcontoured,
opaque looking crown.
Gold requires about .5-1.0mm of reduction, is highly biocompatible, and
highly polishable.
As a compromise, your dentist can place a gold crown with porcelain on
the cheek side (buccal surface). This gives you the benefits of gold
at the gumline, gold on the biting surface (which is much kinder to the
opposing teeth), and a tooth colored surface where things are most
visible. This is a very common restoration, but many dentists make
these out of what is known as non-precious metal. There is much debate
amongst the profession as to what is best, and it's not that a
porcelain/non-precious crown will not work, however, in my opinion, if
you want the best, go with full gold, or a combination porcelain/gold
crown.
There are choices within all of your choices! First of all where is the
crown being placed-front or back? If in the back of the mouth, how far
back? Will it show when you smile? Do you mind if you show a bit of gold
when you smile (or a lot?)? Gold is a wonderful restoration, it lasts
probably the longest of all the metals as crowns, it is the kindest to the
opposing teeth, having nearly the same hardness as enamel, and therefore
does not abrade the tooth it bites on any faster than the rest of your
teeth do. There are different levels of gold crowns depending upon how
much gold they have. All are good.
Porcelain is of course aesthetic. Porcelain crowns can match any tooth in
your mouth. They, too, come in different types. You can have a full
porcelain crown i.e. Empress, dicor, or a porcelain fused to metal crown.
I use full porcelain crowns for front teeth since you do not get the metal
show through and "greying" of the gums. The aestetics are the best since
there is no metal substructure. For posterior teeth I use porcelain to
metal and of these there are three types of metal-base metal which has no
gold, platinum or palladium; noble metals-which have palladium but no gold
or platinum; or high noble-which has all three metals. Obviously the best
and most expensive is high noble, but you get the best looks, and least
irritation of the tissue.
