Hi, Dr. Burhenne here of AsktheDentist.com So, you’ve just been told by your dentist that you need a crown. But what material is the best material for your new crown? So in general, essentially, there are two categories when it comes to materials. One is more aesthetic. It would be mostly used for the front teeth and it recreates what a tooth looks like. But then there’s another material which is literally the gold standard still in dentistry, and that is a material that is very durable and lasts longer. I’m going to explain. So, let me start with that. So, the gold standard, literally, is gold. A gold crown. It wins in every category except for aesthetics, if that’s important. And of course, on a front tooth, it is but on a back tooth you may want to consider it. There’s less tooth reduction, less drilling of the tooth. The material, the gold crown is further away from the pulp, the nerve and the blood vessels inside the tooth. It wears. Gold wears, dental gold does, at the exact same rate that enamel does. Why is that a good thing? Well, if the crown doesn’t wear and the rest of the teeth are naturally, then that crown becomes this island. I mean you start fulcruming off of that and it can cause a root canal. It can cause the tooth to start hurting and become a problem. So, it wears at the same rate that natural teeth do. It’s stronger. They never break. With gold, the marginal integrity, that’s how the margin fits to the surface of the tooth, is very tight, more precise and allows fewer bacteria to get in there over time. And hence, the crown would fail due to leakage. Leakage is bacteria getting in there and causing a cavity underneath the crown. So again, gold is a wonderful material and if you can hide it, I have a gold crown, my wife has a gold inlay, if you can hide the material, that would be your first choice. So, for those of you who can’t or don’t want gold in your mouth, even a hint of it, if it was visible then the next choice would be a porcelain tooth-like material that looks and reflects light like teeth do. And so, that category is the porcelain crown. It’s a little bit more complicated with porcelain though. So, there are different types of porcelains and then there’s a non-porcelain material called “zirconia”, I’m going to talk about that. But porcelain has some disadvantages. The advantage, of course, and the reason people choose it is that it looks wonderful. The older style porcelain crown has a coping or like a gold framework, it’s white gold, they have to add some alloys to that to keep the melting temperature higher because when they stack the very hot porcelain on there, if it was real gold, pure gold, it would melt. So, you’ve got alloys in there. You’ve got some nickel and some other metals that you have to worry about but it looks better. A porcelain crown does require more tooth reduction because the thickness of porcelain has to be quite a bit thicker than gold otherwise it will break. The zirconia crowns, which is kind of the latest, new thing in dentistry, it’s about 10 years old, those are all porcelain. There is no metal or no semi-precious gold frameworks underneath the crowns. But those require even more reduction but they look fabulous. They can be made to look fabulous. And there are different categories within that all porcelain category. They are strong but they require a lot of tooth reduction. And if your tooth is already reduced a lot or it’s been broken for a long time, and you’ve had many crowns, successive crowns, then maybe that’s a good option for you. And they look great on the front teeth, of course. But they can weaken the tooth because you’ve reduced more of it and is more likely to snap off. So, those are your choices for porcelain. There’s nothing wrong with the older porcelain crowns. They look good. They don’t allow the same amount of light to shine through so they lack some of that translucency. So, on a back tooth, it’s fine. On the front tooth, you’d want to go all porcelain. But remember, the dentist has to reduce a lot more tooth to get it done. So, when you’re choosing these materials, one of the concerns, of course, is toxicity. Is it healthy? Does it get into my system? And it’s a really good question. Being a dentist and being around these materials, especially when we adjust them, a lot of that stuff can be inhaled. So, it’s more of a concern for the dentist but I am going to talk about it because I do think it’s enough of a concern that you should know about it. So gold, again, even as you grind it, we really don’t know of any, and it’s been around forever, it’s been around for 200+ years in dentistry, and right now it still has a great safety record. It still is the gold standard. It wins in this category. If you’re worried about toxicity, pick gold. But if you have a front tooth, obviously, that’s not going to work. So, what are the other two materials like in terms of safety? It’s a tough choice but I would go with the older conventional porcelain crown because that is actually porcelain. It is glass. And once it’s been ground down and smoothed and fit to you, then it’s glass. I mean it’s not a problem. The zirconia crowns actually are not porcelain. We call them the all porcelain crowns. They look great. They’re amazingly translucent. They look like real teeth. Sometimes they look too good depending on what the surrounding teeth look like. But when you grind them, and this is a concern for dentists, especially, because we do this all day long, when you adjust them, some of that is airborne. That material is airborne. And when breathe in can cause respiratory problems. So, if you’re around that a lot, it’s definitely a concern. If you’re around it, for a few crowns in your lifetime, maybe not a concern. But I would be careful and be aware of that. And the question is, and these are particles of zirconia bonded with all sorts of long chemical names that if you look up has some health concerns, the questions is, does that get into your system? So, you can have a beautiful crown but you may have to worry about the materials. And they’ve only been around for 10-15 years so we’re still gathering information on that. So, those are your options as far as health concerns. So, when picking the material of your crown, one of the considerations, obviously, and I saved it for last is, how long do these materials last? So again, gold wins in that category. I’ve been in practice for 30+ years and crowns, gold crowns that I put in, gold bridges, which are multiple crowns joined together, they are still in service. And they look brand new, literally. Porcelain, on the other hand, an insurance company would pay for a porcelain crown after 5 years has elapsed. I think that’s too short for a porcelain crown, of course. But typically the old style porcelain crowns were 12-15, 17, 18 years, they would last that long. And that’s pretty good. That’s a good track record. But they could be wearing down the opposing teeth while they’re there because they are so hard. And then the zirconia crowns potentially can last longer. Some of the more aesthetic versions of that all porcelain crowns have broken in half. Spectacular fractures where they just break in half. The tooth is fine. But that’s inconvenient, especially if it’s a front tooth. And then some of the harder versions of these all porcelain crowns are incredibly durable. But, eventually, because those porcelain to tooth margins aren’t quite as tight as gold is, they will fail due to bacteria getting up underneath the crown and causing a cavity. So, those are the things you need to worry about in terms of material. Choices when it comes to longevity. Again, gold wins the category handily. So, I’m hoping by viewing this video you have a better idea of which material you would choose for your crown. And if you’ve already chosen, I would love to hear in the comments if you would have chosen differently now having viewed this video. That would be very interesting to me to hear. But in any case, don’t let your dentist choose for you. Be part of the process. Ask them questions based on what you’ve heard in this video. And I think in the end you’ll be very satisfied with what you choose. To your good health, I’m Dr. Mark Burhenne.