Materials for metal crowns. What kinds of dental crowns there are, price review. Conclusion: which material to choose

Dental prosthetics is not the easiest process, but today it is accessible to almost everyone. Dental services in this area have always been expensive, and, nevertheless, today you can not only choose the type of crowns and material. Modern dental restorations have reached a high aesthetic level. You can literally give yourself a Hollywood smile with the help of prosthetics, and this is a reason to perk up for those who consider tooth loss to be completely irreversible.

Crowns are a type of fixed prosthesis. This means that the prosthesis is glued to the gum with special cement, and it is no longer possible to remove it. In appearance and in its functions, the crown resembles a natural tooth. Modern crowns are so similar to real teeth that only a specialist can distinguish one from the other.

In what cases are crowns installed?

Crowns are placed in several cases. The first is the degree of destruction of tooth enamel that threatens its safety. The second case is the protection of a damaged tooth with the pulp already removed. The third case includes a number of situations when a tooth requires cosmetic restoration; curvatures, cracks and other defects need to be corrected.

The crowns fit quite tightly to the tooth; they are fixed with powerful dental cement. Today's medicine offers several options for crowns, which differ in materials and manufacturing technologies.

As a rule, in order to resolve the issue of prosthetics, you need to come for a consultation with an orthopedist. It’s good if the patient comes to the appointment with a general panoramic photo of the teeth - this way the specialist can tell exactly which teeth can still be treated without prosthetics, which will have to be removed, and which are suitable for installing crowns. So, during the consultation, the tactics of treatment and prosthetics will be chosen, and this process, as a rule, includes several stages.

All-ceramic crowns

These crowns are considered the ideal option for anterior prosthetics. The aesthetics of the crowns are at the highest level, they are ideal for allergy sufferers, the biocompatibility of the crowns with the tissues of the gum surface is excellent. These safe structures are made from natural materials. Crowns are not afraid of the influence of pathogenic microorganisms, various dyes, and do not change color for a long time. The accuracy of the connection to the gum is very high. In addition, these structures are lightweight; they consist of glass-ceramic material with the inclusion of leucite crystals. The latter circumstance makes the structures wear-resistant and very durable.

Features of all-ceramic crowns:

• the ability to choose a tooth shade that is as natural as possible (a special Vita scale is used);
• are light in weight;
• hypoallergenic;
• environmentally friendly;
• fit perfectly to the gum;
• since ceramic crowns today are increasingly made by casting, they can also be placed on the lateral teeth;
• excellent color and light conductivity.

Many people believe that only porcelain can be better than ceramics. Firstly, porcelain is considered a type of ceramic, and secondly, such a crown can only be placed on a single tooth. True, porcelain made by injection molding is also suitable for bridges. In any case, the scope of application of dental porcelain is very narrow. It cannot be used if the patient's teeth are thin and too fragile, if the natural dental crown is low. A porcelain crown lasts no more than 7 years.

Are there any disadvantages to ceramic crowns?

The main disadvantage is the price of such crowns. This is an order of magnitude more expensive than metal-ceramics, and if we are not talking about single prostheses, the price is very high. Porcelain teeth are even more expensive. The next point is the relative fragility of the material. Metal-ceramics is considered a more reliable construction in this regard, but in terms of aesthetics and allergenicity it is inferior to a ceramic crown.

In addition, ceramics themselves are stronger than tooth enamel. This means that it is harder than it, and after some time of use it can damage the healthy tooth with which the crown meets in the bite. In short, the choice of ceramics for prosthetics is ideal from an aesthetic point of view; it is the most modern design. The nuances, price and possibility of installing ceramics in each specific case are discussed only with an orthopedic doctor.

Metal ceramics are the most acceptable prosthetic option for most patients. The price-quality ratio is more than satisfactory, which is why these are the crowns that are most often chosen today.

The ceramic crown is reinforced from the inside with a metal base. This serves as protection against cracking of the ceramics, which, admittedly, happens rarely, but there is still a risk.

The metal part of the crown can be made from:

• titanium,
• gold,
• chromium-nickel,
• cobalt chromium,
• zirconium,
• various combination options.

The ceramic mass is applied to the metal part in layers; the dental technician does this manually. Then all layers are fixed with cement, after which the crown is fired in a special oven at a very high temperature.

In general, metal ceramics are a practical, modern solution. The patient quickly, literally in a few days, gets used to the new prostheses. They do not need special care: regular cleaning, regular preventive examination every six months. The material is hygienic, therefore it is not afraid of various fungi and bacteria. The crown will not change its color over time, it is not afraid of coffee, nicotine, dyes, etc.

Metal crowns

This option is losing its popularity for obvious reasons. Today such crowns are placed only on the distant chewing teeth, since the criterion of aesthetics is not even discussed. The materials can be titanium, steel, chromium-nickel or cobalt-chromium alloy.

The main advantage of metal crowns is that they can be placed on a tooth without removing the nerve. You can also make metal crowns from expensive precious metals. This is gold, to a lesser extent silver, as well as alloys of gold and palladium, possibly gold and platinum.

Zirconium crowns deserve a special mention. They can be called simply ideal. If zirconium crowns are covered with porcelain, the result of such work will be more (compared to other options) replicating a living, healthy, beautiful tooth. It’s not for nothing that dentists call porcelain-zirconium construction the most convincing imitation.

Plastic crowns: a temporary measure

Plastic crowns are the cheapest, simplest option. But it certainly cannot be called reliable and highly aesthetic. Still, visually they differ from the same metal ceramics, although at first glance this may not be noticed. Plastic is a malleable material, so crowns are made quickly, in a few hours.

Today in dentistry, plastic structures are increasingly used as temporary structures. For example, a patient, after grinding his teeth, wants to hide such an unpleasant picture as his smile has become, which is why they give him temporary plastic crowns. When the permanent ones are ready in the laboratory, the temporary ones are removed.

The period of their use can be extended, but after six months or a year the crowns may break off. It’s rare that anyone can survive with plastic crowns for more than two years. In addition, plastic changes color when exposed to food coloring, coffee and nicotine. It cannot resist fungi and microorganisms, so the tooth can be destroyed. Even odors are absorbed by plastic.

True, there is a compromise option - metal-plastic crowns. It's still the same metal base and plastic lining. Such crowns can last even 5 years, which is incomparable to plastic crowns.

Modern prosthetics offer options – a matter of price, capabilities, and the doctor’s decision. For some individual reasons, a certain type of crown may be prohibited for a particular patient (allergy to metal, for example). Therefore, the decision is made only after consulting a doctor. Usually, after treatment, preparation for prosthetics, and taking impressions, the patient is given an order amount for crowns. The average duration for making crowns is 1-2.5 weeks.

Good choice!

Video - Types of dentures

From this article you will learn:

• types of dental crowns,
• crowns on teeth – which ones are better, reviews,
• how much does it cost to put a crown on a tooth - for 2020.

An artificial crown (Fig. 1) is a tooth prosthesis that restores its anatomical shape, aesthetics and chewing function. Single crowns are used to strengthen severely damaged teeth, and according to the rules, if the crown part of a tooth is destroyed by 1/2 or more, its restoration should no longer be done with a filling, but with a crown.

The second purpose of crowns is to restore missing teeth. In this case, several crowns connected to each other are made in the form (Fig. 2-3), which is fixed on the adjacent teeth ground for crowns. However, for prosthetic bridges there is a limitation - the patient must be missing no more than 2 teeth in a row (i.e., one after another).

Crown on a tooth: before and after photos

Before dental prosthetics with crowns, teeth require special preparation. For example, the crown part of a tooth destroyed by caries must first be restored with filling material. Root canal filling may also be necessary. After all this, impressions are taken under the crowns, according to which crowns will be made on the teeth.

Indications for prosthetic crowns –

• if the crown of the tooth is destroyed by 1/2 or more,
• absence of 1-2 teeth in a row,
• severe tooth wear,
• the need to change the color and shape of the tooth,
• the need to change the position of one or more teeth - as an alternative to correcting the bite with braces.

Important : in dentistry there is a rule (which, by the way, does not prevent many dentists from violating it) - that a tooth should be taken under an artificial crown if its destruction reaches 1/2 or more of the volume of the coronal part of the tooth. However, often such severely damaged teeth are restored with pins and fillings, which unfortunately leads not only to the rapid loss of such fillings.

Very often, teeth with such huge fillings simply cannot withstand the chewing pressure, and as a result, fractures of the remaining tooth walls occur. And if there is a pin in the root canal, a fracture of the tooth root can often occur, which will lead to its inevitable removal. Such problems arise especially often in pulpless teeth (due to their greater fragility).

Contraindications for crowns –

• tooth mobility,
• when the clinical height of the tooth crown is low (in this case, the artificial crown made for the tooth will constantly fall off),
• extended defects in the dentition (more than 2 teeth in a row),
• untreated focus of chronic inflammation at the apex of the tooth root,
• poorly filled root canals.

Dental crowns: what are they?

Dental crowns are divided into types based on the material used. The most commonly used are alloys of base metals (cobalt-chromium or nickel-chromium), and less commonly - alloys containing gold and platinum. The second main material is ceramics, which includes zirconium dioxide, porcelain, and lithium disilicate. Read about each type of crown below...

Speaking of how much a crown costs per tooth, the price will depend on the type of artificial crown, as well as the pricing policy of the dental clinic. The cost of a crown per tooth for 2020 in economy class and mid-price clinics will be (per 1 unit) –

• metal ceramics - from 10,000 to 20,000 rubles.
• ceramics – from 20,000 to 30,000 rubles.
• all-metal – from 5000 rub.

Important: as you will see below, such a range in prices is dictated, as a rule, not by the greed of dental clinics, but by the fact that in the manufacture of each type of crowns materials of different quality can be used (metal alloys, ceramic masses), as well as less or more labor-intensive methods of making crowns . And all this ultimately affects both the aesthetics and service life of the crowns, as well as the price.

For example, the aesthetics of standard metal-ceramic crowns priced from 5,000 to 7,000 rubles (made from inexpensive materials) is very different from the aesthetics of metal-ceramic crowns with the so-called “shoulder mass”, prices for which can start from 13,000 rubles. Read more about the subtle points in choosing different crown options below.

1. Metal-ceramic crowns –

Such crowns have a cast metal frame inside with a thickness of 0.3-0.5 mm (most often made of a cobalt-chromium alloy), lined on the outside with ceramic mass. Alloys of precious metals can also be used to make the frame, but the cost of such crowns is already equal to the prices of metal-free ceramics, although they are much inferior to them in aesthetics (Fig. 4).

The metal frame of standard metal-ceramic crowns contacts the gum in the neck of the tooth (just below the gum level), giving it a bluish color. To eliminate this complication, metal ceramics with the so-called “shoulder mass” were developed, in which the lower edge of the metal frame will also be lined with ceramic mass.

The cost of a metal-ceramic crown is

One crown, made from good budget Duceram ceramics (Germany) and high-quality cobalt-chromium alloy, will cost at least 10,000 rubles. At the same time, if a really high-quality ceramic mass is used, which allows you to achieve a higher level of aesthetics, the price for 1 crown will already be from 15,000 to 18,000 rubles. High-quality ceramic masses include Vita (Germany), Noritake (Japan), “Ivoclar” (Liechtenstein).

2. Crowns made of metal-free ceramics –

Unlike metal-ceramic crowns, these crowns are made entirely from ceramic mass and do not have a metal frame inside. The absence of metal can significantly improve the aesthetics of artificial crowns. The fact is that only an opaque ceramic mass can be used to mask the metal, which does not allow the metal-ceramic crown to be given the translucency of the enamel of a real tooth.

For the manufacture of ceramic crowns in dental clinics, 2 types of ceramics are most often used - zirconium dioxide and glass ceramics "E.max". These materials have certain transparency coefficients, i.e. similar in optical properties to tooth enamel (this property makes it possible to make crowns from these materials as similar as possible to real teeth).

• Metal-free zirconia ceramics –
  in the manufacture of zirconium crowns, modern CAD/CAM technology is used, which involves the manufacture of crowns/bridges from pressed blocks of zirconium dioxide by milling them on a computer-controlled machine (i.e., with virtually no human intervention). This material has a very high strength of more than 900 MPa, which is not inferior to the strength of metals. The price for 2020 for 1 crown starts from 30,000 rubles.

  Prosthetics with zirconium dioxide : before and after photos
  
  
  
  There are 2 types of zirconium crowns. Most often, crowns made of zirconium dioxide consist of 2 layers: the zirconium frame of the future crown is milled on a computer-controlled machine, which is then lined with layers of porcelain. Such crowns have better aesthetics, but they sometimes cause chips of the porcelain mass (according to statistics, chips occur in 5% of patients within 3 years).

  The second manufacturing option is from monolithic zirconium dioxide (such crowns will not have a surface layer of porcelain). The advantage of these crowns is that there is no risk of ceramic chips, but their aesthetics will be somewhat worse than the first option. But in any case, both types of zirconium crowns will be inferior in aesthetics to E.max glass-ceramic crowns - therefore, zirconium crowns/bridges are best done not on the front teeth, but on the chewing ones.

• Crowns made of metal-free glass ceramics E-max –
  E.max glass ceramic is the best metal-free ceramic for making crowns and bridges if you want really good aesthetics and want the artificial crowns to blend in with the surrounding teeth. E.max is esthetically superior to zirconia and is therefore more suitable for anterior teeth. The price for 1 crown for 2020 will be from 21,000 rubles.

  Glass ceramic crowns E.max – before and after photos
  
  
  
  

  However, E.max cannot be done in all clinical situations in the oral cavity. Only single crowns can be made from this material, as well as bridges no more than 3 units long with fixation primarily on the front teeth (the far support of the bridge should be inclusive of 5 teeth, but no further). But with single E.max crowns you can restore both front and chewing teeth. Such limitations are associated with the strength characteristics of the material.

  Crowns/bridges made of E.max (as well as crowns/bridges made of zirconium dioxide) can be either monolithic or made in the form of a pressed frame, onto which layers of ceramic mass will subsequently be applied. There are 2 main E.max materials - “E.max PRESS” and “E.max CAD”. Crowns from the first material are made by pressing under conditions of high pressure and temperature, and from the second - using CAD/CAM technology (read more about E.max in the link below).

3. Metal crowns –

Modern metal crowns in dentistry are made using the one-piece casting method and are called “solid-cast”. There are also stamped and gold crowns, which at this stage of development of dentistry can only be interesting from a historical point of view.

• Solid crowns (Fig. 11-12) –
  Such crowns are most often made from a cobalt-chromium alloy, and therefore their surface looks like highly polished metal. However, it is also possible to apply gold plating. Advantages: high strength and wear resistance, long service life, low price. The disadvantage is the lack of aesthetics. The price of 1 such crown for 2020 will be from 5,000 rubles.

  Such metal crowns behave well on chewing teeth (outside the smile line), and in addition, their production requires less grinding of hard dental tissues - compared to metal-ceramics. The latter allows you to extend the service life of the crowns. Also, crowns of this type can be lined with plastic facets on the front side, which will somewhat improve their aesthetics. Read about all the pros and cons of such structures at the link below.

• Stamped crowns –
  stamping is an outdated method of manufacturing metal crowns, which, however, can still be found in remote corners of Russia and the CIS. Such crowns are stamped from special blanks (steel sleeves of different sizes). It is possible to spray the crown “like gold”. The only advantages of such crowns were minimal tooth processing and low cost.

  Disadvantages of stamped crowns –
  → complete lack of aesthetics,
  → thin wall of crowns often leads to “eating” of the crown,
  → low precision of work - the crown does not fit well around the neck of the tooth, which causes saliva, microorganisms, and food debris to leak under the crown. This leads to decay of the tooth under the crown.

4. Combined crowns/bridges –

Such crowns are called metal-plastic (Fig. 14-15). They, like cast crowns, are made using a solid casting method from a cobalt-chrome alloy, but the front surface is additionally lined with white plastic. Their advantages include acceptable aesthetics. The price for metal-plastic crowns will be from 7,000 rubles per unit.

Disadvantages of metal-plastic crowns –

• Plastic in the oral cavity quickly loses its aesthetic properties, and over time, the white color of the plastic changes to gray. In addition, plastic tends to absorb liquid and swell slightly. This leads to the fact that over time the plastic begins to emit the smell of unbrushed teeth.

• Metal-plastic crowns are also not very reliable: if the teeth are clenched tightly or while chewing, the plastic lining may simply fall out.

• Plastic is not very good for health (especially for allergy sufferers), because... There is always some amount of chemically active monomer remaining in plastic, which is released for a very long time.

Combined bridges –

Because The metal frame of metal-ceramics, as well as solid-cast bridges, are made on the same cast metal frame - different types of crowns can be combined in one bridge. For example, you need to make a bridge of 3 units supporting teeth 5-7. In this case, the nearest 1-2 crowns falling into the smile line can be made with metal-ceramic, and the distant crowns can be made of solid casting (Fig. 16).

Dentists and dental technicians are not very fond of such designs, because... this reduces their cost. And if they tell you that this cannot be done, then this will only indicate the doctor’s reluctance.

5. Implant-supported crowns –

The cost of implant crowns depends on the choice of crown and abutment options. As a rule, the choice here is quite simple - it is metal ceramics with a metal abutment made of titanium, or a zirconium crown with an abutment also made of zirconium dioxide. Moreover, their cost will differ significantly from similar types of crowns that are fixed to ground teeth (this is due to their more complex production).

Features of pricing in dentistry –

How much it costs to install a crown (even of one type) can vary significantly in different clinics, and depends on:

• Pricing policy –
  Each dental clinic can be targeted at a specific segment of consumers (taking into account their income). That is why the cost of crowns of the same type, for example, zirconium, in different clinics can range from 30,000 to 40,000 rubles per unit.

• From personnel qualifications –
  → an orthopedic doctor whose task is to grind the teeth for crowns, take impressions, select the color of future crowns, and fix the finished crowns on the teeth. On average, the salary of an orthopedic doctor will be about 20% of the cost of the crown (maximum 25%, if a very highly qualified doctor).

  → a dental technician whose task is to make crowns based on dental impressions. On average, the cost of making a crown in a dental laboratory is about 25% of the final cost of the crown. Those. the clinic retains about 50%, from which it is necessary to deduct administrative expenses, rent of premises, depreciation of equipment, the cost of some consumables, utility bills, salaries of nurses, orderlies, chief physician... taxes.

• From the cost of materials used –
  for example, you can use high-quality German ceramic mass in the manufacture of metal ceramics, or you can use our Russian or Belarusian one. The price of the latter is an order of magnitude lower, which allows you to slightly reduce the final cost of the work. The same applies to metal alloys necessary for the manufacture of both solid-cast crowns and a metal frame for metal-ceramic ones.

• From having your own dental laboratory –
  The technical stage of making crowns takes place in a dental laboratory. Dental technicians sit there and make crowns. Not all dental clinics have their own laboratories. If there is no laboratory of its own, then the clinic must have an agreement with one of the third-party dental laboratories.

  Accordingly, the cost that will be included in the services of a third-party dental laboratory will include not only the cost, but also the profit margin like any commercial enterprise. Having its own laboratory allows the clinic to be more flexible in setting the final price for the consumer.

How clinics save on patients:

• Low qualification of personnel –
  this means lower salary costs, because good doctors, when hired, require a higher percentage of remuneration, which affects the cost of services. Therefore, clinics often hire bad and inexperienced doctors who are willing to work for a small percentage of revenue (this is somewhere around 12-15%). Therefore, when you are offered 1 unit of metal ceramics for 6,000 or 8,000 rubles, you need to think carefully.

• Use of cheaper materials –
  the use of low-quality materials of Russian and Belarusian production has its consequences. For example, the use of cheap ceramic mass can lead to inaccurate fit of the crowns to the teeth, because such a mass can give uncontrolled shrinkage during firing. Cheap ceramics can have transparency indicators that differ significantly from natural tooth enamel, which will lead to poor aesthetics of the finished crown.

  Also, cheap ceramic mass may have poor adhesion to metals (which is important in the manufacture of metal ceramics), which will lead to a high risk of ceramic chips. The use of cheap metal alloys can lead to cracks in the metal frame of the crowns and the need to replace them. We hope that our article on the topic: Types of crowns for teeth and which ones are better was useful to you!

Sources:

1. Personal experience as a dentist,
2. “Orthopedic dentistry. Textbook" (Trezubov V.N.),
3. National Library of Medicine (USA),
4. “Zirconium crowns” (Gevorgyan Kh.M., Zhidkikh E.D.),
5. “Metal-ceramic prostheses” (Zhulev E.N.).

Choosing a crown is not so easy, given their variety in manufacturing methods, materials and location of the teeth that need to be restored.

The main criterion that should be followed when choosing is the material.

For front teeth, metal-free ceramics (zirconium dioxide and porcelain), which are famous for their impeccable aesthetics, are better suited. And on the side teeth you can put crowns with a metal frame.

Of course, any option has its pros and cons. Read about it below.

Types of dental crowns by purpose

First of all, crowns are classified according to their purpose. They can be supportive and restorative.

Abutment crowns are used as an auxiliary element in prosthetics. If there are healthy “neighbors” on the sides of the lost tooth, crowns are fixed on them. This option is suitable for those who are afraid to install an implant or are allergic to the alloys from which they are made.

Restoring crowns, unlike abutment crowns, act as a full-fledged prosthesis that is attached to a single tooth. Their installation is indicated when the tooth is damaged by more than two-thirds.

By type of design

Another classification option is by type of construction:

1. Full. Completely cover the supragingival part of the tooth.
2. Stumps. They allow you to install a crown on a tooth from which only the roots remain.
3. Equatorial. Cover the upper coronal part of the tooth only to the middle. Installed for splinting, increased abrasion.
4. Telescopic. Needed for fixing clasp and plate dentures in the absence of several teeth.
5. Half-crowns. Cover only part of the chewing surface of the tooth. Used to support a prosthesis.
6. Jackets. Installed on the front teeth in case of severe destruction, when filling is impossible.
7. On the pin and pin tab. Used when the tooth is damaged by more than 50%. Installation takes 1-2 appointments.

Types of dental crowns and materials

There are many types of dental crowns. In their “pure” form, for example, metal or ceramic structures are now practically not installed.

Materials used to make crowns:

• metals and their alloys;
• plastic;
• ceramics;
• silicone;
• nylon;
• polyurethane.

Coated dentures and crowns made of a medical “composite” - an alloy of gold with copper, silver or platinum, an alloy of titanium with cobalt chromium or stainless steel - are being replaced by various combinations of metal: with ceramics, plastic or porcelain.

Crowns made of polymers

Composites – special polymers created by mixing various additives – are also suitable for making dental crowns.

Clinical observations have shown that polymer crowns on pins made of silver-containing alloys are the safest for dental prosthetics for pregnant women.

Advantages of polymer crowns:

• Due to the instability of the marginal gingiva during this period, the installation of less expensive and non-allergenic structures is recommended.
• They are inferior to ceramic ones in terms of aesthetics, but in general they imitate real teeth quite well.
• Low cost of the prosthesis.
• Fast production speed – from 4 minutes. Can be installed on the day the impression is taken.

Which crown to choose for one tooth or even several? To answer this question you need to decide on your priorities.

What is more important to you, beauty or durability? It is also worth considering the anatomical features and functions performed by the front and lateral teeth, which will be discussed below.

Which crown to put on chewing teeth

When choosing a combination of materials, the role that the tooth “plays” is not the least important.

As the name implies, chewing teeth are used primarily for chewing food, so when choosing a crown for such a tooth, you need to focus on its wear resistance.

At the moment, in the arsenal of orthopedists, unfortunately, there are no crowns that would equally combine high aesthetics and strength.

However, you shouldn't give up. The side teeth rarely come into the field of view of your interlocutor, since they are not included in the smile zone.

Stamped and cast metal.

The former are made from prepared sleeves, the latter are made from an individual cast, which allows for a greater fit of the crown. They are thick, and unlike stamped ones, they have no solders.

They have a long history of use due to their increased strength and lack of allergic reactions. In simple words, if certain alloys are contraindicated for you, and you have sufficient funds, invest in a gold crown.

Metal ceramics.

The disadvantage of using them for prosthetics of lateral teeth is the insufficient strength of the ceramics, so chips and cracks appear on them more often than on others. Given their aesthetics, they are more indicated for restoring the anterior group of teeth.

The service life of such prostheses, even the most durable ones, is approximately 10 years, and it can be shortened by improper hygiene, rough food, and accidental mechanical damage, which sharply accelerate the wear of the base material.

In order to extend the life of the crown on a chewing tooth, try to eat too hard foods (nuts, candies, cozinaki, etc.) less often. This also applies to caring for real teeth.

Benefits of zirconium crowns

Recently, orthopedists have found a more reliable method of prosthetics.

The variety of orthopedic prostheses has been replenished with designs made of zirconium, a material that has a number of advantages:

• hypoallergenic, antibacterial structure;
• low weight compared to metal ceramics;
• color identical to the natural shade of teeth;
• dental ergonomics – fits well to the gums;
• durability - 15-20 years, manufacturer's warranty - 5 years.

These are the best dental crowns available today.

Prosthetic options for anterior teeth

As a “budget” option for prosthetics of the front teeth, plastic structures can be used. They are unable to perform chewing functions even in combination with metal. Plastic quickly wears out under constant load, so this material is most often used for temporary prosthetics.

Soft dental crowns made of nylon or polyurethane are installed for people with weakened gums who are allergic to metal structures.

These are universal structures, so they are installed not only on the front teeth, but also used for complete prosthetics. Their service life is not long - 5-7 years.

Variations of metal with ceramic and porcelain as anterior dentures are most common. They successfully combine aesthetics and strength, sufficient to protect the internal dental tissues from the effects of food.

Photos “before” and “after” installation of crowns

Prices for dental prostheses

The price list for dental prostheses is formed quite freely, so their cost can only be approximately indicated:

• full/partial nylon prosthesis – 48,000/44,000 rubles;
• metal-ceramic - from 16,000 rubles per unit;
• zirconium - from 26,000 rubles per unit.

Plastic and metal-plastic structures are usually not even offered in private clinics, due to their fragility.

The choice of options for prosthetics is wide enough to find one that suits you in all respects. To prevent trips to the dentist from becoming regular, you need to contact experienced specialists who have at their disposal not only a comfortable office, but also modern professional equipment.

A dental crown is a prosthesis that completely replicates the anatomical shape of a tooth. The main task of such a product is to strengthen the damaged tooth and prevent further damage.

Indications and contraindications

To install a crown on a tooth, you must have the following indications:

• Tooth decay from 50%. This also applies to the presence of circular caries. In this case, it is important to install an orthopedic crown, otherwise in a few years the tooth will completely collapse.
• Chewing teeth without nerves are covered with special orthopedic crowns. This helps to avoid possible chips and fractures. It is also necessary to remember that in the absence of a nerve, the tooth becomes too fragile.
• Various aesthetic defects, especially changes in enamel shade due to tetracycline treatment, hypoplasia, fluorosis.
• Traumatic injuries.
• The need for jaw replacement. This may be the need to replace several missing teeth, or to correct dentofacial deformities.

Contraindications:

• loose teeth;
• malocclusion;
• allergy to the crown;
• various periodontal diseases;
• thinning of the walls of the teeth;
• insufficient height of the damaged part of the tooth;
• age under 16 years.

Advantages and disadvantages

The advantages of crowns include:

• aesthetic appearance;
• affordable price;
• no need to grind teeth when using cast crowns;
• the possibility of prosthetics for the front teeth when installing white crowns;
• biocompatibility with oral tissues.

Flaws:

• injury to healthy teeth that are supporting teeth;
• depulpation, which sometimes leads to the development of inflammation;
• insufficient strength of ceramic crowns;
• unaesthetic appearance of budget crowns.

Main varieties

What determines the cost of a crown?

Pricing in various dental centers depends on many factors. These include:

When going to a dental center to install a dental crown, many patients pay attention only to the price, because for some it is the only deciding factor when choosing a clinic. However, it is necessary to remember that institutions offering reasonable prices themselves save on something. Most often this is the hiring of low-skilled or inexperienced personnel.

Some clinics use the cheapest domestically produced material. Naturally, due to such savings, the finished dental crown may not fit well. In addition, cheap ceramics are not transparent enough. The likelihood of chipping also increases. When using low-quality alloys, cracks may appear in the metal, which is why the dental crown will have to be replaced.

Manufacturing and installation

Specialist at the clinic makes an impression of the jaw, thanks to which it is possible to produce a prosthesis taking into account all anatomical features. A plaster model is then cast in the laboratory to accurately replicate the client's teeth. Using wax, a sample of the crown is modeled and a metal frame is created. After trying on and choosing the shade of the teeth, the product is coated with ceramics.

During the process of making a denture, the patient is fitted with a temporary crown. It is carefully fixed with special cement.

Installation of a permanent prosthesis performed in stages:

1. First, the doctor carefully examines the oral cavity, as well as an x-ray. If any problems are found, the canals are filled and the necessary treatment is carried out.
2. Next comes the turn of preparing the tooth, that is, grinding it down. In this case, small ledges are made in the lower part.
3. In some cases, depulpation is indicated.
4. If there is no upper part of the tooth, a special metal lining is installed, which will ensure reliable fixation of the crown. Also, if necessary, a pin is installed.
5. After trying on the design and choosing a shade, the dental crown is secured using special cement.

Service life and care

Durability of the prosthesis depends on various factors. This includes the quality of the material used, the correctness of the metal frame, the condition of the oral cavity and compliance with care recommendations.

It must be remembered that dentures are most often removed due to various dental problems. Thus, 1-1.5 years after prosthetics, inflammation of the tooth root is often observed, which causes swelling of the gums and an unpleasant odor.

To ensure that the product lasts as long as possible, you need to take proper care of it. So, if only single crowns were installed, regular dental floss and a brush with toothpaste will do for cleaning. If you have a bridge, it is recommended to use an irrigator to remove food debris and plaque. In addition, you should visit the dentist once every six months.

What does the patient need to know?

Choosing a dental crown, you can't just think about cost or aesthetics. Thus, expensive ceramic products are best suited for front teeth, and cheaper metal-ceramic dentures are best for chewing teeth.

Several options for dental crowns

What types of crowns are there?.. What materials are modern crowns made of?.. Which crowns to choose?.. This is a far from complete list of questions that torment patients. I will try to answer them in the second part of the article, dedicated to dental crowns.

So, let's start with the simple...

1. Metal dental crowns

Here it must be said that metal dental crowns can be made using two completely different methods.

A) Stamped dental crowns

They are made from standard materials (stainless steel, in rarer cases gold). In our country they are still used, unfortunately, and are also very fashionable to this day in the countries of Asia closest to us.

If you do not plan to settle in an African-American ghetto or in the Asian countries of the former USSR, then such a smile is unlikely to evoke admiring glances from others...

Throughout the civilized world, our person can easily be identified using such “fixes”. In fact, the place of this technology has long been in the museums of medical universities and students should study it not in the cycle of orthopedic dentistry (as is still the case), but exclusively within the framework of such a useful subject as the “history of medicine.” Therefore, I will not Let's look at these dental crowns in detail. The technology is the simplest (a technician cuts a metal cylinder to the required length and, tapping it with a hammer, brings it closer in shape to the semblance of a tooth), the cost is a pittance. For a semblance of money, you get a semblance of treatment.

Complete absence of any aesthetics (although some residents of the above-mentioned countries could argue with me in this place);

The edge of the crown hangs between the tooth and the gum, being an excellent help for accumulating food reserves for a rainy day, causing chronic inflammation of the gums, circular caries, giving the breath a corresponding aroma;

The inability to make a normal anatomical shape; most often, such crowns have a completely flat chewing surface, worsening the chewing process and causing problems in the temporomandibular joints;

The thin walls of such crowns often wear out and rub through, leading to the destruction of the tooth underneath by caries...

I think this is quite enough.

This photo shows stamped dental crowns with gold-plated titanium nitride. Spraying itself is a carcinogen and is prohibited for use in civilized countries. Here you can clearly see the condition of the crowns themselves and the surrounding tissues after several years of wear. Oddly enough, a crown that has not fallen out for many years does not mean quality treatment. Here you can see what is happening around the crown...

An example of a single stamped dental crown without spraying...

And the whole bridge. Such flat chewing surfaces without a pronounced anatomical relief lead to numerous problems that are not always easy to treat. This is especially true for diseases of the temporomandibular joint.

It would be unfair not to mention at least some advantages. If you show the miracles of tolerance, then I can hardly squeeze out two - low cost, minimal processing of tooth tissue. That's it, let's forget about them.

B) Cast metal dental crowns

This is a more modern option, which is widely used in modern dentistry and has a right to life. The technology for making a cast dental crown involves the entire standard sequence (this is discussed in the first part of how dental crowns are installed): processing a tooth with a ledge, taking an impression, casting a model, modeling the crown from wax and melting the wax blank into metal. If all stages are properly completed by the dentist and technician, the result is a crown that fits exactly to the tooth and well reproduces its anatomical shape. It can be made from a conventional alloy (most often KHS - cobalt-chromium alloy) or from a precious alloy, which is certainly better.

Cast metal crowns function at the proper level, are durable and reliable. Therefore, if you are not embarrassed by the prospect of sending sunbeams into the eyes of your interlocutor with your teeth when smiling in clear weather, then you can completely opt for them...

Extremely poor aesthetics, although the lateral teeth, which are not so noticeable when smiling and communicating (especially the upper ones), can well be restored with just such crowns

Possible allergic reactions to metal (especially common alloy)

High wear resistance

Relatively low price

2. Plastic dental crowns

Sometimes in our country, where there are no standards of treatment, they are used as permanent crowns. Although all over the world, according to all standards, they can only be used as temporary (the wearing period, depending on the manufacturing technology, is from several days to several months). Why? Plastic is a fairly soft material and wears out quickly. The surface is unstable to mechanical and chemical influences - it quickly loses its appearance, is stained with food dyes, becomes unsmooth, promoting increased accumulation of soft plaque, causing bad breath. Both bridges and single crowns can easily break due to the fragility of the plastic. The marginal fit of such crowns to the tooth is quickly disrupted - accordingly, caries easily develops already under the crown. In general, wherever you spit, there are continuous disadvantages. The advantages are simplicity and low cost of production, acceptable appearance (although mostly only at the very beginning of wearing them). These advantages determine their widespread use as temporary restorations.

Plastic dental crowns - white, fast, cheap... but not for long

3. Metal-plastic dental crowns

Another type of technology unclaimed by modern dentistry. As you might guess, it combines a metal frame and a plastic cladding (full or only on the outside). The metal frame can also be stamped or cast. This technology combines all the advantages and disadvantages of those already mentioned. The only special drawback is that the metal and plastic do not have any chemical bond, and therefore the adhesion strength is very low. From here, the plastic cladding often flies off, leaving bare metal underneath. It can only be properly used for making temporary crowns for long-term wear (several months).

Metal-plastic stamped dental crowns...

Metal-plastic cast crowns... The lack of a chemical bond between plastic and metal leads to frequent chipping of the veneer

4. Metal-ceramic dental crowns

In fact, if we talk about modern options for prosthetics, then we could not mention all the previous points at all (well, maybe except for metal cast crowns), but start with metal-ceramics (MC). Because exactly metal-ceramic dental crowns are currently at the “lower stage” of the evolution of materials for the manufacture of dental crowns.

Acceptable aesthetics (especially when it comes to lateral teeth). With ceramics, which the technician covers the metal frame of the dental crown, many shades and nuances can be recreated. Its color is stable over time. However, the opaque metal frame inside the crown most often does not allow the appearance of a metal-ceramic crown to be 100% similar to the appearance of a natural tooth.

Here, all the upper front teeth were restored with MK crowns. In contrast with the lower ones, everything looks good, but still the lack of “color depth”, opacity (especially noticeable in bright lighting), unnatural fluorescence (in the ultraviolet of a nightclub, the crown will differ from its natural neighbor, and on the front teeth this will be very noticeable) allow us to consider them the optimal solution for the restoration of the anterior group of teeth...

High strength - it is very difficult to chip a ceramic veneer if a dental crown is made according to all the rules, unlike a plastic one

Relatively low cost. Nowadays this is the most popular technology, which has become a standard in cases that do not require high aesthetic solutions.

Insufficient aesthetic options for prosthetic replacement of anterior teeth. Particularly problematic is the cervical area, which will almost always look more “dead” and opaque compared to a natural tooth. Additionally, the metal edge of a dental crown can create a dark rim around the tooth. To disguise it, the doctor often makes a ledge on the outer (front) side of the tooth just below the level of the gum. But over time, the gums may change their position in relation to the edge of the crown and it may become noticeable.

After several years of wear, the metal frame of the crown may appear as a dark stripe in the cervical area. For front teeth - not the most pleasant prospect...

Another option to combat this undesirable property of metal-ceramic dental crowns is the use of the so-called. shoulder mass. To do this, the technician removes the metal edge on the front side of the crown by 0.5-1 mm and “extends” it with special ceramics. That. The edge of the crown on the front side is purely ceramic, which improves its aesthetics.

In the left photo the arrow indicates the so-called. "ceramic shoulder". Masking the metal edge helps improve the esthetics of metal-ceramic dental crowns. Thus, in the hands of a good dental technician there is a tool to make the appearance of metal-ceramic crowns as close as possible to the appearance of a natural tooth. And over time, such a crown will not reveal itself as a dark stripe near the gums.

Allergy to the metal from which the frame of the dental crown is made (most often CHS). The solution is to use titanium or a gold-platinum alloy (ZPS) for casting the frame.

Metal-ceramic dental crowns on a gold-platinum alloy frame. In addition to the greater bioinertness of the frame, such crowns, due to the base being golden yellow and not gray like the KHS color, are more aesthetically advantageous...

5. Metal-free ceramic dental crowns

For simplicity, I combined into this group several different materials and technologies at the top of the hierarchy. Since they all have the main advantage over others - the absence of metal and high aesthetic properties. Here we can distinguish 2 large groups.

A) Dental crowns that do not have a frame (i.e. crowns made only from pure ceramics).

The advantage of such crowns is their impeccable aesthetic capabilities. The downside is quite high fragility. Therefore, their use is very limited - basically this technology can only be used on the front teeth and only in the form of single crowns.

A darkened, pulpless incisor (upper 2) with a crack in the enamel is the best indication for an all-ceramic frameless crown. The load on the tooth is small, high aesthetics are required...The result of the work of a highly qualified dental technician will not allow even a professional to identify a crown among natural teeth at first glance...

B) Crowns based on non-metallic translucent Zirconium dioxide dental crown frame, lithium disilicate (E.max technology) or aluminum oxide.

These types of dental crowns have both significant mechanical strength (i.e., these frames can be used to make not only single crowns on the front teeth, but also on lateral and even small bridges) and high aesthetics. In fact, they are devoid of disadvantages, which can only include a high price. Besides everything else dental crown frames based on zirconium dioxide and aluminum oxide are manufactured on modern precision milling machines controlled by computers.

First, the frame of the future structure made of zirconium dioxide is modeled on a computer using a special program...... then a computer-controlled milling machine grinds the frame of future crowns from the workpiece. Since the computer does not get tired, does not come to work with shaking hands after a stormy weekend, the result of its work is predictably more accurate... the importance of the human factor in such an important part as the manufacture of a precision crown frame is significantly reduced.

As a result, this technology provides a predictably more accurate fit of the edge of the crown to the ledge on the tooth, compared to a metal-ceramic dental crown, where the frame is made by casting. And this means, on average, a longer service life of such crowns. Another undeniable advantage of metal-free crowns is their absolute biocompatibility. I have never heard of cases of allergic reactions to zirconium dioxide. While allergies to metals, incl. and on precious alloys it is not so rare in practice.

The zirconium dioxide frame is ready for ceramic veneering......ready-made crowns on a zirconium dioxide frame have all the necessary advantages - reliability, strength, biocompatibility, excellent aesthetics... the fly in the ointment is the high price. The average cost of 1 unit of ceramics on a zirconium frame in St. Petersburg is approximately equal to 1 average salary in our city (20-30 thousand rubles)...

... but provided the quality is executed, the result is worth it...

Now you have very complete information about dental crowns, which will help you and your doctor make the right choice. This topic is too broad to fit the answers to all the most frequently asked questions into 2 parts, so I will definitely return to it in the future, and will try to cover specific types of materials and technologies in more detail and clearly. The most common metal-ceramic and metal-free ceramic dental crowns in modern practice deserve a separate discussion.