Porcelain crowns: features, pros and cons

Porcelain crowns are the best option for tooth replacement in terms of aesthetics

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1. Porcelain: material features
2. Indications and contraindications
3. Types of porcelain crowns
4. Advantages and disadvantages of the material
5. Porcelain crowns: the process of creation and installation
6. How to fix the product
7. Care rules for long-term use of dentures
8. Life time
9. Comparison of porcelain with other materials
10. Price issue

Question for a specialist
Teeth are one of the strongest parts of our body, but, nevertheless, they are not immune from the negative effects of the food we eat, the lifestyle we lead, and the environment. They grow twice, in the milk and permanent dentition, and if we fail to maintain their original shape, color, functionality, then we have to find ways to correct the situation. Fortunately, today prosthetic technology is experiencing its heyday, and restoring damaged or destroyed teeth is not a problem. Today, attractive porcelain crowns, for example, are in increasing demand. Let's look at the features of this material and the stages of manufacturing structures based on it in detail.

Installation conditions

All orthopedic products have certain indications for use. Taking the latter into account, the dentist selects the most suitable designs for a particular patient. Installation of porcelain crowns is indicated in the following cases:

1. Allergic reactions to products made of metals or alloys. In such a situation, porcelain crowns are the optimal prosthetic option. This is due to its hypoallergenicity.
2. For restoration of molars. Today, such use of crowns has become possible. This is due to changes in the technological process of manufacturing porcelain mass. Due to this, the material has an increased strength coefficient.
3. For covering front teeth. The manufactured structures are characterized by being close to the natural color of the enamel. Even at close range, it is difficult to see the difference between real teeth and artificial teeth.
4. High sensitivity to polymers. Due to the bioinertness of the material, it interacts well with the tissues of the oral cavity, which makes it suitable for those who have similar problems.
5. In case of complete destruction of crowns or complex restoration of several adjacent teeth.

On the front teeth

In addition, installation of products is recommended for some diagnoses. Among them:

• non-carious enamel disorders.
• enamel hypoplasia;
• destruction of the cutting edge;
• wedge-shaped defects;
• light and shaped anomalies of teeth.

Porcelain: material features

Today, porcelain, first used in prosthetics just over two centuries ago, is considered the most popular material. Crowns made from it are essentially a ceramic product without metal impurities in the composition. The product is produced by processing ceramic mass at high temperatures. The complexity of the manufacturing process of porcelain structures determines their high qualities - wear resistance, precision fit, high aesthetics. They are easy to install, hypoallergenic, and serve their owner for many years, maintaining their original color and shape.

This is interesting! It is believed that the first dentures with a porcelain component appeared about three centuries ago. Orthodontist Pierre Fauchard sharpened crowns from durable ivory, additionally strengthening them with a layer of gold. To make the structure look aesthetically pleasing, he made the top covering from a thin layer of ceramic to match the adjacent units. It was only towards the end of the 19th century that the technology of firing a porcelain crown on platinum foil appeared.

It is important to understand that porcelain and ceramics are actually the same thing. Porcelain is a type of ceramic, one of its highest quality types, since it has a snow-white color even from the inside, i.e. in cross-section, as well as high strength characteristics. But in dentistry there is no division as such into “porcelain” and “ceramics”, so crowns are generally called ceramic, even though there are varieties (pressed ceramics, regular or even with the addition of a composite).

What is better to choose for veneers – porcelain or ceramics, how they differ and how much they cost

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1. How are veneers different from crowns?
2. Indications
3. Ceramic or porcelain?
4. Ceramic - made from powder or liquid
5. Glass ceramics
6. How do they compare favorably
7. Overlays
8. Zirconium oxide and aluminum veneers
9. Composite veneers
10. Material
11. Veneer color
12. Size and shape
13. What do dentists recommend?

Question for a specialist
Veneers are one of the methods of microdental prosthetics, which involves restoring the aesthetics of a smile. Veneers are thin, permanent plates that are fixed to the front surface of the teeth, allowing them to be aligned and changed color. There is a lot of controversy around such microprostheses today - some doctors recommend them as the most acceptable option for restoring aesthetics, others oppose their astronomical cost. What is it, and which veneers are better - porcelain or ceramic? What are they made of, and are these dentures really a panacea for patients who want to have a “Hollywood smile”? We'll talk about all this further.

Indications and contraindications

Porcelain structures are an excellent choice in many problematic situations. Here is a list of indications for their installation:

• allergies to plastic or metal: porcelain crowns are absolutely compatible with oral tissues, they are hypoallergenic,
• ideal restoration of the smile area: porcelain has excellent light transmission and perfectly matches the natural shade of the enamel, which allows you to make the prosthesis very aesthetic and hide its presence from others (it will not stand out against the background of neighboring teeth),
• the need to restore teeth severely damaged by caries or other dental diseases,
• the need to restore teeth that have fluorosis, hypoplasia, a wedge-shaped defect: in this case, prosthetics with crowns are resorted to if it is not possible to correct the defect by other methods (for example, whitening),
• the need to adjust the shape and position of the tooth: crowns can be used only if there is slight curvature or deviation from the norm, otherwise the patient may be recommended to wear braces.

Contraindications to the installation of these orthopedic products should also be taken into account. Limitations include serious malocclusion, bruxism, and various inflammatory processes in the oral cavity in the acute stage. First, you need to eliminate the existing problems in the doctor’s chair, and only then can you begin prosthetics.

Advantages and disadvantages

The main positive aspects of using porcelain crowns in dental prosthetics include their complete identity with natural human teeth. Due to their hardness and excellent appearance, they are quite popular among visitors to dental offices. At the same time, analyzing the positive and negative aspects of these crowns, one cannot fail to mention a number of disadvantages:

• the inherent fragility of ceramics;
• insufficiently tight fit to the gum and tooth;
• high degree of abrasiveness, which affects the contacting teeth;
• the relative high cost of such artificial teeth compared to polymer and metal ones.

The lack of an ideal fit at the attachment points forces dentists to operate on a larger area in the patient’s oral cavity; in addition, deterioration in the strength of the attachment can correspondingly affect articulatory properties.

Types of porcelain crowns

The types of porcelain dentures are determined by their location in the oral cavity - in the front (frontal smile zone) or on the side. In addition, such prostheses can be made from various types of materials.

Made from classic ceramics

Such crowns are made of classic ceramics or porcelain. They are distinguished by high aesthetics and fairly good strength. They are placed mainly on the front teeth, since this is where the appearance is most important, while the chewing load is reduced to a minimum - that is, the risk of product breakage is reduced.

Made from pressed ceramic

In fact, it is lithium silicate, which today is commonly called glass ceramics. There are no pores in it, so the aesthetics of the finished product remains at the same high level, but at the same time the strength characteristics increase significantly. This category includes IPS brand materials (e.max and Empress), which are most popular in the dental market today.

On a note! Very often, ceramic crowns include products made from zirconium dioxide (or oxide). Unlike zirconium, it is not a metal, but simply an element or material that is completely incorrect to call ceramics. In general, ceramic or porcelain or zirconium dioxide crowns constitute a group of metal-free products – this is already the correct name.

Advantages

Porcelain onlays for teeth are popular among patients of dental clinics because they have many advantages.

• Porcelain veneers look very aesthetically pleasing and completely imitate natural tooth covering.
  Attention! Thanks to their translucent color, it is impossible to distinguish them from your own teeth, but at the same time, they well mask enamel imperfections (stains, scratches, etc.).
• The covers are very practical due to their resistance to staining with food dyes (tea, coffee, red wines, etc.). For a long time, the surface of the veneers does not change its color. In addition, the plates do not require special care.
• The material from which the pads are made is very durable. When used correctly, the records do not break or become damaged.
• The material does not cause allergic reactions and does not emit harmful substances.

Advantages and disadvantages of the material

It is no coincidence that Europeans call special dental porcelain an enamel substitute. Prostheses made from it not only perfectly replicate the anatomical features and shade of the original units, but they are also smooth, translucent, and have a mirror-like shine. Exactly like enamel. Porcelain teeth, if they are truly made with high quality, cannot be distinguished from natural ones. Therefore, the material is often chosen for prosthetics of the front teeth - those that are located and clearly visible in the “smile zone”.

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In addition, they are quite durable and resistant to chips, and perfectly retain their original shade even when exposed to coloring pigments from food. With proper installation and high-quality oral care (regular hygiene, professional cleanings, avoiding combining hot and cold foods), porcelain products will delight you with their shine, stable shade and shape for about 10-15 years.

And if you have long dreamed of a flawless smile, then porcelain crowns are a great way to achieve it. Installation is quick, the designs are well suited for allergy sufferers who may react to polymers or metal. Products made from pressed ceramics are very light, and you get used to them quickly.

However, this modern aesthetic material has its drawbacks. Due to its fragility, the material does not allow the manufacture of bridge structures. Only single restorations are made from it. And the production of porcelain dentures itself is expensive, which affects the final cost of the product. Especially if the choice fell on modern pressed ceramics.

Interesting! The very first known dentures, as archaeologists testify, were allegedly made from the teeth of wolves and other wild animals. The artifacts were found in Mexico and date back to 2500 BC. Later, dentures were made from the shells of sea creatures and were fixed in the mouth with gold rings. Until the middle of the 18th century, dentures were made from ivory and the teeth of various animals.

Porcelain crowns: the process of creation and installation

The process of creating porcelain dentures is quite labor-intensive. It consists of two stages.

Preparatory stage

At this stage, the doctor determines the condition of the tooth that will need to be restored. The specialist also sanitizes the oral cavity and performs therapeutic procedures. Next, the doctor begins to work with the tooth on which a ceramic prosthesis will be installed. It is advisable to remove the nerve from it to protect it from further inflammation under the crown.

If there is nothing left from the top of the tooth, it will not be possible to fix the crown - you must first build up the tooth. For this, pins or stump inlays are used (the first option is universal, the second is individual, laboratory). If the crown remains, then it is given the shape of a cone. Pure ceramics are quite thin, so little living tissue is ground away - a layer of hard tissue will need to be removed from the prepared unit to form a ledge 0.8 to 1.5 mm wide. It is this thickness of the walls of the future porcelain crown that ensures the strength of the product. The prepared apex becomes like a cylinder or a truncated cone.

Next, the orthopedist makes several impressions or impressions of the prosthetic area and the entire jaw. And selects the shade of the future artificial unit. The data obtained will be sent to the dental laboratory, where the prosthetic structure will be manufactured. Take this period up to a couple of weeks. During this period of time, the doctor will install a protective temporary plastic structure on the prepared tooth.

Laboratory stage

The technician, having received all the data from the orthopedist, begins making the crown. First, a model of the patient's jaw is cast based on the impressions. A cap made of platinum foil is placed on a specific tooth, which is filled with porcelain mass. Next, the product is double fired - inside and outside. The final stage is adjusting the size, giving the shape, the desired shade and glazing the resulting artificial tooth, final firing at a very high temperature - just under 1000°C.

On a note! Some ceramic materials (mostly pressed) are processed using CAD/CAM milling technology. That is, first a scan of the oral cavity or a finished model of the jaw is performed, the crown is created in a special program, and then turned on a robotic machine. Of course, this is more expensive for the patient, but it is more accurate, and the result is more predictable.

How to fix the product

The finished product must be tried on. The doctor evaluates how the prosthesis fits into the color range, checks the quality of the design, determines whether it interferes with the bite, whether it puts pressure on the adjacent tooth, or injures the mucous membrane. If the prosthesis needs adjustment, it is carried out. If everything is in perfect order, you can proceed to installing an artificial tooth - and here there are two options:

1. fixation with temporary cement: the patient walks with a new artificial tooth for 2-3 weeks. During this period of time, it is important to determine the degree of comfort of the product, note all the sensations that arise and possible discomfort. If you fix the crown directly with permanent glue, you will no longer be able to correct the product,
2. fastening with permanent cement: if the patient does not express any complaints, you can begin treating the crown with an antiseptic and fixing it to the stump. After this procedure, the structure is considered permanent; it cannot simply be pulled out of the mouth and adjusted.

How to decide on the color of veneers

When understanding the question of what color of veneer to choose, you will need to know how the desired shade combines with the color of neighboring teeth, the shape and color of the lips, skin tone and facial features. Too white, as well as very dark, does not look natural. Previously, when choosing the color of veneers, dentists were guided only by the Vita scale, which includes 16 shades. To do this, a colored palette was brought to the teeth, and the optimal shade was determined. But now, when choosing the color of restorations, this method is supplemented - and most often completely replaced - by computer smile modeling Digital Smile Design (DSD).

Digital Smile Design is a specialized program that processes photos of the patient’s smile and face in accordance with the principles of the golden ratio and the “beauty mask.” Next, a virtual appearance of a new smile is offered - individual for each person. But if desired, the patient can make his own adjustments to the color of the restorations. Typically, the DSD concept is used before the production of zirconia glass ceramic onlays.

Care rules for long-term use of dentures

In order for porcelain structures to serve you for a long time, it is important to treat them with care. By taking the following precautions, you will extend their life:

• Clean your mouth thoroughly after each meal - use an irrigator, rinse,
• do not use dental floss or brushes in the area of ​​the installed crown - it can be damaged,
• Once every six months, carry out hygienic cleaning in the dentist’s chair: caries does not threaten the artificial tooth. However, the resulting plaque can penetrate under the gingival margin and destroy the root system of a living tooth,
• give preference to foods that are not very hard or particularly tough: also avoid eating too hot or too cold food and drinks at the same time (such temperature changes can negatively affect not only the enamel of living teeth, but also any artificial material),
• Give up bad habits: don’t snack on floss with restored (as well as natural) teeth, don’t open lids, don’t bite your nails.

What are composite veneers and how are they different?

For the manufacture of such structures, the same materials are used as for creating fillings (liquid composites or photopolymers). Here, veneers, as a rule, are installed directly on the teeth directly in the oral cavity, in one visit, without taking impressions and subsequent production of microprostheses in a dental laboratory.

But there are composite materials in the form of milling blocks (for example, Tetric CAD from Ivoclar Vivadent), which are processed only in the dental laboratory using the indirect method. These are already classic linings (and not just very large fillings), similar to ceramic ones, but with slightly lower strength.

Dentists note that these are the most inexpensive restorations of all those presented. But they are not recommended for patients, and there are several reasons for this. They do not adhere well to the surface of the enamel - voids may remain between the restoration and the enamel, which increase over time, and then bacteria enter them, destroying the tooth. Composite materials are more porous, so they become colored when exposed to food and drinks containing pigments. In addition, plaque penetrates into a large number of micropores, which again leads to a change in the color of the structure.

Comparison of porcelain with other materials

To understand whether dental porcelain is right for you for dentures or not, look at its comparison with other materials.

Differences from plastic

Prostheses made of polymers are easier to process, and their installation is easier. However, plastic crowns lack such advantages of porcelain products as high aesthetics, hardness and preservation of the original shape, shade and transparency. In addition, they are porous, so they do not retain color for a long time - they can only be considered as a temporary option for restoring dental defects.

Differences from metal ceramics

Products containing metal impurities can cause allergies and oxidize over time under the influence of saliva. The slightly more expensive and much more aesthetic dental porcelain does not have this drawback. The combination of metal-ceramic materials is suitable for prosthetics of chewing units, but in the smile area under certain lighting it will not look very aesthetically pleasing. Porcelain teeth require more care and adherence to rules than metal-ceramic teeth, but they also last longer.

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Differences from zirconia

This material is ideal from all points of view: beautiful, hypoallergenic, strong, wear-resistant, which allows it to be used on chewing and frontal units. But it has a drawback - a high price. However, zirconium dioxide often costs the same as pressed ceramics.

Indications for installation of veneers

• chips and cracks in enamel,
• thinning of the enamel layer, which, in addition to visible defects, is manifested by increased sensitivity to hot and cold,
• change in enamel color, incl. tetracycline staining, fluorosis,
• change in color of fillings,
• diastemas and tremas – spaces between teeth,
• minor changes in the position of the teeth,
• desire to improve the aesthetics of a smile, incl. lighten it or lengthen the incisors (the latter factor rejuvenates the face).

As already noted, veneers are placed only on teeth in the “smile zone” - on incisors, canines, and sometimes on first premolars. They cover only the front side, affecting the lateral and cutting edges. A prerequisite is that the tooth should not have massive fillings (more than 50% of the surface area), especially on the back surface. It is also preferable that it be “live”, i.e. with a healthy preserved nerve. Otherwise, the ceramic1 or porcelain overlay will not last very long, as it will quickly lose its fixation.

Price issue

When choosing between different materials, it is important to consider their cost. The question of how much a porcelain crown costs concerns many. The price of prostheses made from this material starts from 10 thousand rubles and reaches 20-30 thousand per unit including installation. Also take into account the costs associated with preparing for prosthetics - treatment of the abutment tooth, as a rule, always has to be paid separately.

Author: Chernov A. R. (Thank you for your help in writing the article and the information provided)

Preparation before production

To ensure a harmonious combination of the crown with other organs of the dentition, the doctor takes a combined impression.

After preparing the stump, a copper ring is placed on it, which is pre-filled with a special mass. While it is in the oral cavity, an impression of the entire dentition is taken. A plaster model is cast on it.

It is necessary that the cast of the stump be inserted and removed well into it. Thanks to this, it is possible to produce a high-quality porcelain crown.