A Crown(or “Cap”) is used to reinforce/strengthen a weakened, tooth either because it is heavily filled, worn or fractured. To fit a tooth with a crown, a minimum thickness of tooth structure and or filling is reduced then an impression is made and sent to the dental laboratory in which the crown is fabricated as per the dentist’s instruction. While the lab is making the crown, the tooth is given a temporary, typically made of plastic, cemented in place with a weak cement; this is done in order for the temporary crown to be removed relatively easy when the permanent crown is ready to be cemented in. Crowns can be made of gold, all metal (no gold), porcelain, or porcelain fused to metal. The dentist talks to the patient about options and their individual needs for their tooth.
What is best for my tooth?
Gold: as much as the material strikes a chord of being unaesthetic, material gold is what dentists worldwide referred to as “the gold standard.” As cliché as this sounds, there is a reason for this saying. Gold, by far, lasts the longest in crown or in filling form. In most cases they will last for decades!(Here is an insight: the dentist, Dr. Tessier, and some staff have gold restorations. In one case, a patient has had them since the late 70s, and are still doing well). The material is very biocompatible, and very tooth friendly. Gold fits very well over the tooth and doesn’t excessively wear the teeth that it bites against. Incidentally any new filling or crown material that is introduced to the dental market worldwide is compared to the properties and wear characteristics of gold.
All metal: Like gold, all metal refers to different alloys of metal used exactly the same as gold. The all metal crown is generally cheaper than gold(especially in the last few years). They still deliver durability(wear), and strength. Poor aesthetics is the disadvantage. The all metal crown is a very strong crown indeed, and can be made thin but still retain its strength. In non-aesthetic regions, typically at the back and lower teeth, if the tooth is particularly short, a minimum thickness crown is a good option, so as to keep the reduction of the crown to a minimum, and take advantage of the most surface area for cementing. If a person is a clincher/grinder, a crown made of all metal or at least keeping the biting surface to metal is often recommended. Grinding is a very common occurrence in the general public(read more about this in the blog section).
Porcelain fused to metal: the design of this type of crown is a base thickness of metal(like the all metal or gold crown) but an added thickness of aesthetic porcelain, the shade chosen from the neighboring teeth so as to match. This type of crown has the obvious advantage of aesthetics. The porcelain is placed by hand layering powder and water then baking it in a high-temperature furnace. Generally this is the most common form of crown. Over the years these type of crowns, have improved tremendously, lasting for many years. For front teeth that demand high aesthetic attention, Dr. Tessier has found porcelain fused to high gold metal to have superior aesthetic, with good translucency(light coming through the crown).
All porcelain crowns: the concept of all porcelain crowns is exactly that; no metal substructure. The advantage of these type of crowns is aesthetics, especially the translucency effect. The disadvantage is that for strength, and integrity of the material there has to be a lot more tooth reduction required for a minimum thickness to the porcelain. This is inherently against the practice philosophy of Dr. Tessier and that he tries to keep to conservative tooth reduction. The other disadvantage is that even when the minimum thickness requirement is followed, it is still porcelain and can still can break.