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Medical Forum / General / Dentistry / April 2006

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Metal Fused to Porcelain Molar Crowns

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DIMMs - 05 Apr 2006 12:45 GMT
Is it possible for such crowns to have the aesthetics of a full porcelain
crown?

I read about Captek crowns. Are these as good, aesthetics-wise, as say
In-Ceram Alumina or Cercon?
Joel344 - 05 Apr 2006 13:12 GMT
DIMMs Wrote:
> Is it possible for such crowns to have the aesthetics of a ful
> porcelain
> crown?
>
> I read about Captek crowns. Are these as good, aesthetics-wise, as say
> In-Ceram Alumina or Cercon?

Captek is fired over a gold alloy that has a
warmer hue than the steely gray cast of a
regular PFM (porcelain-fused-to-metal).

Now with darker shades, say B1 that is never
a problem but with lighter shades say A1, the
technician must mask the steely gray metal first.

This compromises esthetics.

If its in the front, use Captek.

The difference is cost is minimal.

Joel

PS~ This advice is for dentists not patients .....
after all, its the dentist's decision and if it turns
out bad its the DENTIST's problem not the patient's .....

--
Joel34
Steven Bornfeld - 05 Apr 2006 13:55 GMT
> Is it possible for such crowns to have the aesthetics of a full porcelain
> crown?
>
> I read about Captek crowns. Are these as good, aesthetics-wise, as say
> In-Ceram Alumina or Cercon?

    To a certain extent it has to do not only with the crown but the
condition of the other teeth--shade, whether the other teeth have
crowns, etc.  You really want light transmitting properties to be
similar between different teeth, or one or another will stick out, esp.
in certain lighting conditions.
    For most shades and conditions, you'll get the best cosmetic result
with an all-ceramic crown.  This is because the porcelain is
translucent.  With a metal coping underneath there must be masking to
hide the gray or gold color, and this interferes with light
transmission.  Captek is nicer looking, not only because the gold coping
 has a warmer color, but because the coping is very thin; this means
the porcelain can be correspondingly thicker, increasing translucency.
But obviously not having a metal coping at all will be most
cosmetic--but you give up some strength in the bargain.
    If the tooth is sufficiently prepared, you can get enough thickness of
porcelain in a traditional porcelain/metal crown to get a very good
cosmetic result in most cases.  Additionally, since the cosmetic
problems with porcelain/metal crowns are usually most pronounced near
the gumline, if this is a critical area the tooth can be prepared and
the crown constructed with a full-porcelain margin on the facial
surface.  So you have a few good options for maximizing esthetics here.

Steve
DIMMs - 05 Apr 2006 14:48 GMT
> To a certain extent it has to do not only with the crown but the condition
> of the other teeth--shade, whether the other teeth have crowns, etc.  You
[quoted text clipped - 19 lines]
>
> Steve

Thanks to all who replied.
I was told  if I wanted to get a fully ceramic crown for a molar, the only
suitable material is Cercon, as Empress 2 and In-Ceram Alumina are not
strong enough. However it seems Cercon itself is rather opaque to the
detriment of aesthetics. Another dentist I spoke to thinks In-Ceram is fine
to use.

Any thoughts?
Mark & Steven Bornfeld - 05 Apr 2006 15:13 GMT
>>To a certain extent it has to do not only with the crown but the condition
>>of the other teeth--shade, whether the other teeth have crowns, etc.  You
[quoted text clipped - 28 lines]
>
> Any thoughts?

    Empress was designed as a very cosmetic material, but it was a little
low on strength.  Still, I know many dentists have used it for front
teeth with good success.  I believe (not sure) that Empress 2 is
supposed to be stronger--it may be similar to Procera, which certainly
is stronger than Empress.  One of its selling points is that it can be
cemented with traditional cements, rather than bonding in place
(required for original Empress).  I've done Procera restorations and
they are plenty cosmetic.  They supposedly aren't as beautiful as
Empress, but I really can't see much difference.
    None of these materials are indestructible--not even porcelain fused to
metal.  I have a patient who fractured the porcelain off a bridge
abutment of a porcelain/metal bridge two weeks ago.  The bridge is maybe
2 1/2 years old.  I tried repairing it in the mouth, but my luck with
these intraoral repairs isn't good, and the bridge will likely have to
be replaced.  It may have failed because the patient bit on something
the wrong way, or there may have been a flaw in the porcelain firing at
the lab.  You can't always tell why porcelain fails, but all of them
fail occasionally.
    What I don't want to do is ask too much of these materials.  Most of
them will work with single crowns; though In-Ceram has been used for
multiple units (bridges) I am far from ready to use any of these
materials for bridges--I've heard too many sad, sad stories.  But unless
you have habits such as chewing on ice, chicken bones or blasting caps,
all of these materials have a high likelihood of holding up for single
crowns.

HTH,
Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

 
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