Dental Crowns: Ceramic and Porcelain-Fused-to-Metal

A tooth consists of three main parts: the root or roots, the neck, and the crown. During a person’s lifetime, the natural crown (the visible part of the tooth) can deteriorate — technically fabricated artificial dental crowns are used to restore a damaged tooth.

If a doctor recommends placing a crown, it means extraoral restoration is needed. That is, the porcelain-fused-to-metal or ceramic crown will not be fabricated during the dental appointment but in a dental laboratory.

A large number of clinics in Kyiv now offer to perform extraoral restoration in one day. However, crowns should be fabricated not by the doctor but by a dental technician. This is a rather complex process during which all parameters are taken into account: from the shape to the selection of the exact color.

At our clinic, we follow the rule: a crown should not differ from the patient’s own teeth. To achieve this, we turn to the best dental laboratories in the country. Only in this way can we guarantee quality: both porcelain-fused-to-metal and ceramic crowns, priced no higher than the market average, will perfectly fit the patient’s own teeth and match in shade.

Replacing teeth with ceramics makes sense only when there are direct medical indications, such as:

1. Destruction of the tooth’s own crown by more than 30%.
2. Depulpation of a tooth (nerve removal). Quite often a depulpated tooth is restored with a photopolymer filling. However, the elasticity index of the filling differs from the elasticity index of tooth tissues. Under chewing load, the filling can destroy the root and lead to the need for extraction. Therefore, we recommend covering depulpated teeth with crowns.
3. Solving aesthetic problems. In case of tooth discoloration, trauma, or chipping, we also recommend using artificial crowns.
4. Pathological wear. Demineralization processes or improper bite can cause pathological tooth wear (enamel thinning). In such cases, to correct the bite and preserve the teeth, ceramic or porcelain-fused-to-metal crowns, which are not subject to wear, should also be used.

• Diagnostics and development of a bite restoration plan
• Fabrication of diagnostic tooth models
• Tooth preparation for prosthetics (tooth preparation, post and core build-ups)
• Fabrication of dental crowns, veneers, bridge structures, full or partial removable dentures
• Placement of prosthetic structures in the oral cavity.

• When one, several (or all) teeth are missing in the oral cavity
• With aesthetic defects of teeth or the dental arch
• With impaired chewing function after orthodontic treatment
• With pathological wear of hard dental tissues
• With temporomandibular joint dysfunction (pain and clicking near the ear).

Placement of a porcelain-fused-to-metal crown on a tooth is also possible when there is another medical indication — the impossibility of implantation. In the case where a tooth has been extracted and an implant cannot be placed in its position, it is necessary to place crowns on two (or more) adjacent teeth. A porcelain-fused-to-metal dental bridge is a structure where two (or more) crowns serve as support points, and between them is a pontic (an imitation of the missing tooth). Ceramic crowns cannot be used for dental bridges, as they are thinner and not suitable for this type of prosthetics.

Often in Ukrainian dental clinics, including those in Kyiv, doctors decide to connect several of the patient’s own teeth in a single structure. Of course, much depends on the clinical picture, but we recommend, if possible, making individual crowns and not connecting teeth that stand separately with a single bridge. In this case, one tooth that is part of the bridge structure and may deteriorate in the future can be replaced without affecting the dental crowns on other teeth.

A porcelain-fused-to-metal crown is a metal cap covered with ceramics.

Artificial crowns can be made of plastic, ceramic, metal, porcelain-fused-to-metal, or zirconium dioxide. It is important to understand that zirconium dioxide, zirconium oxide, and zirconia dioxide are the same material with the formula ZrO₂. One can often find information that zirconium dioxide is a metal-free crown, but this is not true.

Zirconium dioxide has a number of important advantages. Unlike other metal crowns that were previously manufactured by stamping or casting, zirconium dioxide is milled. Thus, the porcelain-fused-to-metal crown fits more precisely to the tooth. In addition, the material is inert to the body, and such porcelain-fused-to-metal crowns do not cause any reactions in the mouth.

A porcelain-fused-to-metal crown not made from zirconium dioxide may subsequently provoke the appearance of a bluish border on the gums. This is due to the fact that the metal of the crown reacts with acids and alkalis. Therefore, we recommend our patients choose ceramic dental prosthetics.

Placement of porcelain-fused-to-metal crowns at our clinic proceeds as follows. We perform diagnostics and treatment of the tooth. In some cases, depulpation of the tooth, i.e., nerve removal, is necessary. A porcelain-fused-to-metal crown cannot be placed on an untreated or partially treated tooth.

The stages of porcelain-fused-to-metal crown placement generally look like this. After the treatment is completed, we send measurements to the laboratory where the porcelain-fused-to-metal crowns are fabricated. During the patient’s next visit, we directly place the crown.

Quality control is also a mandatory stage of our work. We inform all patients that pain sensations after porcelain-fused-to-metal crown placement are possible for 1–2 days. If many crowns were placed in one appointment, then for 1–2 weeks there may be cheek biting due to the formation of a new correct bite.

An important factor for the client is often the price; placing a porcelain-fused-to-metal crown is a process in which the doctor is directly involved and the dental technician is indirectly involved, so the service price reflects both the cost of the crown itself and the cost of labor.

Such a product as a porcelain-fused-to-metal crown can vary significantly in cost depending on the material. At our clinic, we strive to use materials that allow us to achieve not only medical but also aesthetic results. Healthy, beautiful teeth that are indistinguishable from natural ones are not a wish but a basic requirement we adhere to. Therefore, only a metal crown whose price and quality are worthy of our clients suits our work.

In some clinics in Kyiv, the cost of placing a porcelain-fused-to-metal crown differs from the cost of a ceramic crown, but not at ours. Our clients can choose a crown that suits them not based on the price factor but depending on preferences and medical indications.

In some cases, porcelain-fused-to-metal crowns are needed for front teeth; the price of such products will not differ from the cost of other crowns of the same type.

A ceramic crown differs from a porcelain-fused-to-metal one in that both the cap and the coating are made of pressed ceramics. At our clinic, the cost of a ceramic crown is the same as that of a porcelain-fused-to-metal product made from zirconium dioxide. At the same time, from both an aesthetic and medical standpoint, ceramic crowns have a number of advantages — we recommend placing them on your own tooth.

A ceramic crown is thinner, more translucent, and does not fall short in durability. It should be noted that ceramic crowns on front teeth are an excellent solution, as pressed ceramics allows not only perfectly matching the shade but also creating a transparent edge. Such teeth will be indistinguishable from the patient’s own teeth.

Placing a ceramic crown on a tooth does not differ in any way from the process of placing a porcelain-fused-to-metal crown. Therefore, the same stages apply here.

During the first appointment, the doctor examines the X-ray and inspects the oral cavity. If the teeth do not require preliminary treatment, the doctor prepares them and takes an impression. Ceramic crowns are fabricated in the laboratory within 5–10 working days.

During the second appointment, the ceramic crown is directly placed; the price of such a service will be lower compared to placing a crown on a tooth that requires preliminary treatment.

Ceramic dental prosthetics cannot be placed on untreated or partially treated teeth. Depending on the clinical picture, treatment may take from 1 to 3 appointments.

It is important to know that whether it is ceramics or porcelain-fused-to-metal, before placement the doctor must study the orthopantomogram. OPG is an X-ray of the teeth, temporomandibular joints, jawbone tissue, and maxillary sinuses.

If the OPG raises concerns, a CT scan may be needed for more accurate diagnostics. Always ask the doctor what concerned them on the OPG and why they are requesting a CT scan.

Placing ceramic crowns on teeth without being confident that the teeth are treated is impossible. We also want to reassure patients who are afraid of radiation during CT scans. Modern devices emit minimal radiation: 12–25 mSv. However, this does not cancel the fact that in some cases an OPG is sufficient.

The cost of a ceramic crown at our clinic does not exceed the cost of a similar porcelain-fused-to-metal product. This is because even when working with porcelain-fused-to-metal crowns, we use only the best, and therefore not cheap, materials — zirconium dioxide. In virtually the entire world, prices for zirconium and ceramic crowns are the same.

The cost of a ceramic crown includes not only the price of the material but also compensation for the time spent. An experienced dental technician will need quite a lot of time and the assistance of assistants to fabricate a high-quality pressed ceramic crown. At the same time, so-called ceramic teeth, whose price is noticeable for the client, fully justify themselves. The long-term result that we can evaluate based on our practice is 20 or more years of successful use of ceramic crowns. Thus, the cost of a ceramic crown corresponds to the quality.

The basic condition for the longevity of any crowns is good daily oral hygiene and regular periodic cleaning at the clinic. These same conditions apply to maintaining the health of one’s own teeth.

Usually, after implant placement and before placing a crown on this implant, 3.5 months pass. If the goal is not to leave the patient without a tooth during the implant healing period, we use various temporary prosthetics methods.

We use temporary crowns or temporary bridge prostheses in virtually every clinical case. Temporary prosthetics can be declined if it involves prosthetics of back teeth, the absence of which does not affect aesthetics (they are not visible when a person speaks).

Porcelain-fused-to-metal and ceramic crowns can be placed on one’s own teeth or on an implant. The products do not differ in any way. The only difference is what the crown will be placed on. When working with an implant, we place the crown on a superstructure (abutment or multi-unit) rather than on the tooth’s own core.