Non Metallic Crown options for Implants

[mike]

I am in the process of having two implants with crowns, plus one crown fitted to an adjacent tooth. All three placements are to my upper front teeth.
This procedure is the result of an accident many years ago. I have asked my dentist to fit non-metallic crowns to all three. I.e. All porcelain. An Empress porcelain crown is suitable for the existing prepared tooth with a live nerve. I am advised however that regarding the two implants my choice for all porcelain crowns is limited to either a metal bonded porcelain crown or a Zirconium sub frame crown.
If I understand this correctly, the reason I cannot have an all porcelain crown placed onto implants is due to the fact that the implant abutment is quite bulky, and therefore leaves less room to build up the required layers of porcelain.
Whatever the professional reason is for an apparent inappropriate all porcelain crown placed on an Implant, I am not that concerned.
I would however be happy for a learned cosmetic dentist to advise me if this advice regarding my limited choice of non-metallic crown materials is either correct or incorrect. In other words, are there any other choices out there. Thank you.

[Dr Sepehrara]

Dear Mike

I would agree that your options for crowns in relation to implants are:

1. porcelain bonded to metal crown
2. zirconia crown

I would not personally consider empress as an option for an implant crown.

At our practice, we mostly use porcelain bonded to gold for implant crowns, as these tend to be very strong, considering the bite forces which are going to be placed on these implants. It also depends on the technician who is making these crowns and what is best in his/her hands.

Implants have no nerves around them , unlike our teeth. Therefore there is no feedback when we bite on these, unlike our teeth. Therefore we can put tremendous forces on implant retained crowns. The stronger the material the better. As already mentioned above, those two types of crowns are strong.

Hope this helps


Kind Regards

Raha

[mike]

Dear Mike

I would agree that your options for crowns in relation to implants are:

1. porcelain bonded to metal crown
2. zirconia crown

I would not personally consider empress as an option for an implant crown.

At our practice, we mostly use porcelain bonded to gold for implant crowns, as these tend to be very strong, considering the bite forces which are going to be placed on these implants. It also depends on the technician who is making these crowns and what is best in his/her hands.

Implants have no nerves around them , unlike our teeth. Therefore there is no feedback when we bite on these, unlike our teeth. Therefore we can put tremendous forces on implant retained crowns. The stronger the material the better. As already mentioned above, those two types of crowns are strong.

Hope this helps


Kind Regards

Raha

Dear Raha,

What a great forum this is.

Thank you very much for your prompt and informative reply, It not only confirms the advice that I was given, but also the reasons why and the options that I have for implant crowns. Thankyou.

Kind regards

Mike.

[Dr Sepehrara]

I'm glad I could help.

Best Wishes,

Raha

[Dr Pav Khaira]

Mike, may I ask why you do not want porcelain bonded to a metal substructure?

I know Raha will agree with me here, the main reason these crowns look false is not due to the material but rather how they are made. I could put one of my all ceramic crowns and one of my "metal bonded" crowns next to each other and you wouldn't be able to tell them apart!

Aesthetic result lies in dentist and techinican capability

Kindest regards

[mike]

Hi Pav,

Thanks for replying,

The reason that I would prefer to choose all porcelain over metal bonded is purely my perception of aesthetics.

I had an accident many years ago in which I broke three front upper teeth. I had three metal bonded crowns placed on the remains. Over time with a receding gum line I have suffered the appearance of a dark line at the margins between the gum and crown. Now it is time to replace these old crowns and I wish to avoid the same appearance.

I understand that technology and materials have advanced since my old crowns were placed, however I am concerned that a metal bonded crown could still expose/display the dark line between gum and crown on my new titanium implants over time, especially if my gums ever start to recede in future. Added to that, as I understand it, the translucent effect of a metal bonded crown is more difficult to replicate on metal bonded than all porcelain.

Perhaps I am being too cautious and looking at a future worst-case scenario, but this is why this forum is so helpful, as I can learn from a professional dentist what exactly are my options, choices and the reasons why. There may be other advantages to metal bonded crowns over porcelain (apart from cost) that I am not aware of, so every bit of information will help me make an informed decision when I need to choose.

Kind regards

Mike.

[Dr Pav Khaira]

Mike, if I may make a comment. I think you are over amalysing the situation! I of course mean no offense by this and totally understand you concerns. If your gums recede, what about the metal implant showing?!

However the viable alternatives for your concerns include zircionia based materials and alumina based materials. Do rest assured that if done well, there is no reason that metal bonded crowns cannot look completely natural, even if recession were to occur.

Zirconia and alumina based materials are no stronger than metal and the cores underneath are very opaque or "dense white" in colour and look just as unnatural. They key for yourself would be management of the gums to make sure they do not recede

Hope this helps