"All-Porcelain" Crowns

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breaux

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I am a patient looking to have a front incisor replaced with an "all-porcelain" crown. I have spoken to several dentists and a lab and have been reading online and there seems to be a lot of use of the terms "all-porcelain" and "all-ceramic" and I am very confused what the terms mean. To me the term all-porcelain would mean a monolithic porcelain crown but from the dentists and lab I have called they dont seem to know what I am talking about. They talk about e-max, zirconia, and pfms. They also mention crowns with either an emax or zirconia coping and porcelain on top. The lab I spoke to said that the most aesthetic option would be an emax coping with porcelain on top. Is there such a thing as a monolithic porcelain crown? The image below seems to indicate there is. I am trying to find the most aesthetic option for my front incisor and would appreciate clarity on this subject. Thanks in advance.

Types of dental crowns
 
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I am a patient looking to have a front incisor replaced with an "all-porcelain" crown. I have spoken to several dentists and a lab and have been reading online and there seems to be a lot of use of the terms "all-porcelain" and "all-ceramic" and I am very confused what the terms mean. To me the term all-porcelain would mean a monolithic porcelain crown but from the dentists and lab I have called they dont seem to know what I am talking about. They talk about e-max, zirconia, and pfms. They also mention crowns with either an emax or zirconia coping and porcelain on top. The lab I spoke to said that the most aesthetic option would be an emax coping with porcelain on top. Is there such a thing as a monolithic porcelain crown? The image below seems to indicate there is. I am trying to find the most aesthetic option for my front incisor and would appreciate clarity on this subject. Thanks in advance.

Types of dental crowns
if you are talking with dentists and labs that do NOT know what an all ceramic or all porcelain crown is.....run, dont walk.
there are all ceramic monolithic options. emax being a brand that falls within that generalized term.

i highly suggest finding proper educated care for your dental needs.
 
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breaux

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if you are talking with dentists and labs that do NOT know what an all ceramic or all porcelain crown is.....run, dont walk.
there are all ceramic monolithic options. emax being a brand that falls within that generalized term.

i highly suggest finding proper educated care for your dental needs.
Thank you for your reply. I think it is more of a definition issue that I am not understanding than incompetence on behalf of the lab and dentists. All porcelain to me as a layman is not emax or zirconia which I may be wrong about. What is an example of an "all-porcelain" crown?
 
CoolHandLuke

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Thank you for your reply. I think it is more of a definition issue that I am not understanding than incompetence on behalf of the lab and dentists. All porcelain to me as a layman is not emax or zirconia which I may be wrong about. What is an example of an "all-porcelain" crown?
porcelain needs to be fused to a framework material, it will not have any strength without a base material to which the porcelain sticks.

so a zirconia framework or an emax framework can be made that gives the porcelain an even thickness and room to generate shade.

an all porcelain crown cannot mean a porcelain crown minus its framework.

in ye olden days porcelain jacekted crowns that wanted to avoid the use of metals used the precursor material to zirconia - "alumina"

this is no longer done except by a handful of providers.

all-porcelain must mean porcelain on all aspects of the visible areas. this is a departure really, back to roughly 2008-2009 when porcelain bonded to zirconia became a big deal.

nowadays people more use zirconia in all aspects except for a "window" area cut into the front of the crown, the part you can see. this saves porcelain and has a higher strength because the majority of the crown is now zirconia instead of porcelain.
 
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breaux

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Thank you very much for that explanation. That was very helpful. My understanding is for front teeth that emax layered with porcelain is the best aesthetic option as it is more translucent in comparison to zirconia layered with porcelain? Does this seem accurate?
 
rkm rdt

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Thank you very much for that explanation. That was very helpful. My understanding is for front teeth that emax layered with porcelain is the best aesthetic option as it is more translucent in comparison to zirconia layered with porcelain? Does this seem accurate?
More translucency isn’t always better especially if your underlying tooth is dark.
Let a skilled ceramist decide the best material choice for your situation. . All porcelain just means “ no metal substructure “. Each individual has a different way of chewing and biting so material choice is about more than what looks pretty.
 
Car 54

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Helpful for the lab in knowing what to use is also the prep shade color (taken chairside by the Dr or assistant),as rkm mentioned, which can alter the shade, lowering the value. In which case we would need to use a more opaque frame to help block out any darker prep color.
 
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Thank you very much for that explanation. That was very helpful. My understanding is for front teeth that emax layered with porcelain is the best aesthetic option as it is more translucent in comparison to zirconia layered with porcelain? Does this seem accurate?
Yes and no at the same time. If you are going to a good dentist that knows something about all ceramics , he needs to determine that after the preparation and checking you stump shade( color of the core of your tooth) . Too much translucency could be bad because it show what is underneath that Crown and might alter the final shade. You dove in a big see of all ceramic conversation that you might end up more confused than when you started.
 
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breaux

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Thank you all for the replies. So if my stump is a light color emax layered with porcelain would be the most aesthetic choice? as the dark of the stump will not show through the tooth. If I have a dark stump, a zirconia layered with porcelain may be more aesthetic as it will block some of the dark shade of the stump shining through the tooth? Is this a fair simplification?
 
Brett Hansen CDT

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Best option is for you to have a custom shade match at your dentist's lab. Then let the lab choose which material will work the best in consultation with your doctor. You are obviously interested in how this will be restored, which is good. I like knowledgeable patients. Now let the people who make these decisions everyday do their job.
 
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Thank you all for the replies. So if my stump is a light color emax layered with porcelain would be the most aesthetic choice? as the dark of the stump will not show through the tooth. If I have a dark stump, a zirconia layered with porcelain may be more aesthetic as it will block some of the dark shade of the stump shining through the tooth? Is this a fair simplification?

I would say that is a fair simplification. I think it’s good that you’re interested and trying to do some homework for a cosmetic procedure. The best looking material will be decided on by who’s delivering your care within their skills. Which may be either material. You won’t be able to consider how it looks until your doctor try’s in the tooth and see for yourself. If your receiving only a single incisor you should be able to have an opinion at that time and voice it if you would like a better outcome. A single incisor is more difficult and sometimes requires more work as well.
 
rkm rdt

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Thank you all for the replies. So if my stump is a light color emax layered with porcelain would be the most aesthetic choice? as the dark of the stump will not show through the tooth. If I have a dark stump, a zirconia layered with porcelain may be more aesthetic as it will block some of the dark shade of the stump shining through the tooth? Is this a fair simplification?
Emax with layered porcelain will also be the weakest option and more likely to fracture than a monolithic restoration. The latest generation of zirconia crowns can be multi layered and multi translucent and still be monolithic.
 
JKraver

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Thank you all for the replies. So if my stump is a light color emax layered with porcelain would be the most aesthetic choice? as the dark of the stump will not show through the tooth. If I have a dark stump, a zirconia layered with porcelain may be more aesthetic as it will block some of the dark shade of the stump shining through the tooth? Is this a fair simplification?
.... This seems like a heck of a length to go to just to get a crown. This shouldn't be your problem. Unless you have very unique teeth, Monolithic emax should be fine.
 
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breaux

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Thank you all for the replies. I will see what my dentist says. I really appreciate the help and advice.
 
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I would say that is a fair simplification. I think it’s good that you’re interested and trying to do some homework for a cosmetic procedure. The best looking material will be decided on by who’s delivering your care within their skills. Which may be either material. You won’t be able to consider how it looks until your doctor try’s in the tooth and see for yourself. If your receiving only a single incisor you should be able to have an opinion at that time and voice it if you would like a better outcome. A single incisor is more difficult and sometimes requires more work as well.
i agree a single front tooth is a bugger to get just right. sometimes if the adjacent teeth are in rough shape its worth doing them at the same time to get a better result.
personally I tell the patient to expect a try appt. were we check. to make sure the color and anatomy are good.
if they dentist is taking photos then you know u are off to a good start
as far as materials you can almost go with anything depending on the doc and the lab. Ive had beautiful work done with just " monolithic" zirconia, "stacked" porcelain on emax ( lithium dislicate),and "stacked" porcelain on zirconia as well as just emax. Avoid pfm in the front as it harder to make pretty ( although they tend to fit the tooth beautifully= longer lasting)
source- dentist
 
CatamountRob

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Doing a single central in Vermont can be pretty easy. Nailed this one.
82351BBD-8030-45E3-9722-E749ECFC2D1A.jpeg
 
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